Bladder cancer



. Bladder cancer is the seventh most common cancer diagnosis in worldwide, with 500 000 new cases and 200 000 deaths in 2018 (Globocan 2018).
 
. More than 2.7 million people have a history of bladder cancer worldwide.
 
. At the initial diagnosis of bladder cancer, more than 80% of cases are diagnosed as non-muscle-invasive bladder cancer (NMIBC). 

. Due to the very high recurrence rate (>80%), NMIBC patients require lifelong surveillance with periodic follow-up cystoscopy (an unpleasant invasive exam) and urine cytology (utility limited because cytology has a low sensitivity in detecting low-grade tumors). 

. The bladder cancer is the most expensive cancer.



Bladder cancer incidence and mortality statistics worldwide in 2020




Risk factors


  Tobacco smoking

  . Cigarette smoking most important factor related to bladder cancer

  . More than 50% due to cigarette smoking

  . Confers a twofold increased of bladder cancer than nonsmokers; dose-related



 

Occupational and environmental exposure

. Carcinogenic chemical substances (e.g., aromatic amines, paints and solvents) represent up to 25% of bladder cancer

. Workers in chemical, petrochemical, plastic, paint and rubber industry

 





Diagnostic: How is bladder cancer diagnosed?

 

  Symptoms

  . Gross heamturia: Visible blood in the urine

  . Miscroscopic hematuria: Presence of microscopic red cells in the urine

  . Urinary discomfort

  . Frequent urination

  . Bladder spasms


 


  Urine cytology

  . Laboratory test in wich a sample urine is checked under microscope for abnormal cells

  . Cytologist dependent

  . Medium sensitivity for high-risk bladder cancer (40-50%)

  . Low sensitivity for low-risk bladder cancer (20-40%)

  . Low sensitivity for detection of recurrences (38-65%)



  Bladder cystoscopy

  . Cystoscopy is the gold standard procedure for diagnosis and surveillance of bladder cancer

  . Invasive exam, uncomfortable and costly

  . Urologist dependent

  . High accurate with sensitivity and NPV >95%  

  . Risks and side effects: swelling of the urethra, blood in urine, pain to urinate, microbial infection

 

  Histology analysis

  . Histological analysis performed by the pathologist

  . Examination of tissue samples and surgical specimens under a microscope

  . Determination whether the tumor is benign or malignant, as well as the malignancy potential

  . Bladder cancer classification based on the type, grade and stage