Bladder cancer

Bladder cancer is any of several types of malignancy arising from the epithelial lining (i.e., the urothelium) of the urinary bladder. Rarely the bladder is involved by non-epithelial cancers, such as lymphoma or sarcoma, but these are not ordinarily included in the colloquial term "bladder cancer." It is a disease in which abnormal cells multiply without control in the bladder.[1] The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer recapitulates the normal histology of the urothelium and is known as transitional cell carcinoma or more properly urothelial cell carcinoma. It is estimated that there are 383,000 cases of bladder cancer worldwide.[2]

Bladder cancer characteristically causes blood (redness) in the urine. This blood in the urine may be visible to the naked eye (gross/macroscopic hematuria) or detectable only by microscope (microscopic hematuria). Hematuria is the most common symptom in bladder cancer.

Other possible symptoms include pain during urination, frequent urination, or feeling the need to urinate without being able to do so. These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections, over-active bladder and cystitis. There are many other cause of haematuria, such as bladder or ureteric stones, infection, kidney disease, kidney cancers and vascular malformations.

Causes

Tobacco smoking is the main known contributor to urinary bladder cancer; in most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.[3] There is a linear relationship between smoking and risk, and quitting smoking reduces the risk.[4] Passive smoking has not been proven to be involved.[5]

In a 10-year study involving almost 48,000 men, researchers found that men who drank 1.5 liters of water per day had a significantly reduced incidence of bladder cancer when compared with men who drank less than 240mL (around 1 cup) per day. The authors proposed that bladder cancer might partly be caused by the bladder directly contacting carcinogens that are excreted in urine, although this has not yet been confirmed in other studies.[6]

Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine, which is found in cigarette smoke, has also been shown to increase bladder cancer risk. Occupations at risk are bus drivers, rubber workers, motor mechanics, leather (including shoe) workers, blacksmiths, machine setters, and mechanics.[7] Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes.

It has been suggested that mutations at HRAS, KRAS2, RB1, and FGFR3 may be associated in some cases.[8]

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