BLADDER CANCER

EPIDEMIOLOGY
Is the most common malignant tumor of the urinary
tract.
Incidence rates are high in African countries, most
especially in Egypt, where schistosomiasis is endemic.
Marked male predominance.
The median age of diagnosis being 65 years.

ETIOLOGY AND RISK FACTORS

Exposure to aromatic amines. The specific compounds
that have been identified include 2-napthylamine, 4aminobiophenyl, benzidine, chlornaphazine, and 4chloro-o-toluidine.
Cigarette smoking-most significant risk factor
Occupation- aluminum workers, motor vehicle
operators, drycleaners, chemical workers, pesticide
applicators, miners, chimneysweeps, and cooks, truck
and bus drivers.

 Diet- high consumption of fried meats and fats has been

associated with increased risk
Drugs- phenacetin and cyclophosphamide
Parasitic infection- schistosoma haemotobium and
recurrent urinary tract infection
Pelvic radiation

PREVENTION

PRIMARY PREVENTION
Identification of persons at high risk because of
environmental and work exposure is a priority.
Smoking cessation
Communities be informed about the consequences of these
diseases for mortality and cost.
Health teaching related to the risks and consequences of
prolonged exposure to aromatic amines, chemicals, and
rubber also should be illustrated in detail. Dye industries
must be obliged to test workers periodically with at least
cytology and urine examination annually and to protect
workers with the use of masks during their daily work.

 A high fluid intake--irrespective of its kind--reduces the Bc risk by

approximately 50%.
folic acid-containing food may reduce the Bc risk for smokers.
Avoidance of tobacco smoke and occupational exposure to
carcinogens such as aromatic amines, nitrosamines, and acrolein,
avoidance of water polluted with chemicals such as arsenic, and when
possible, limitation of pelvic irradiation.
Prompt treatment and prevention of urinary tract infection, removal of
urinary stones, and avoidance of prolonged use of indwelling
catheters would reduce inflammation as a cause of bladder cancer,
and minimising bladder exposure to cyclophosphamide chemotherapy
and radiotherapy would help reduce iatrogenic bladder cancer.

 Metformin, which may potentiate the anti-tumour

efficacy of both chemotherapy and radiotherapy, is
reported to significantly reduce the incidence of bladder
cancer.
Education regarding the signs and symptoms of bladder
cancer is critical for patients who have undergone pelvic
irradiation or who have received cytotoxic therapy with
cyclophospahamide. Such patients should have
urinalyses performed with microscopic evaluation at
follow-up visits.

DETECTION
Rectal examination
Cystoscopy is used to verify the presence of a bladder
tumor and to characterize its gross appearance, and as
a means of obtaining a biopsy specimen.
Flow Cytometry, a technique that allows examination of
the DNA content of cells within the urine, is useful
providing information for staging and grading purposes.
Urinary cytology may be of screening value in industrial
settings and can be used to detect lesions at an early
stage.

SECONDARY PREVENTION
NONINVASIVE TUMORS
Goals of therapy: eradicate the existing disease, prevent
disease progression and invasion, avoid loss of the
bladder, and prevent the development of recurrent
disease.
Transurethral resection and fulguration using electrical
current or laser, with or without intravesical therapy
Intravesicular therapy

INVASIVE TUMORS
Surgical removal of the bladder by radical cystectomy
Men- cystoprostatectomy
Women-cystectomy and hysterectomy
Pretreatment chemotherapy using methotrexate, vinblastine,
doxorubicin, and cisplatin has been demonstrated to double
survival rates for patients with advances bladder cancer as
compared to surgery alone.
Urinary diversions are created in the form of ileal conduits or by
directing urine flow into an internal urinary reservoir with
drainage to the abdominal wall or the urethra.

TERTIARY PREVENTION
External beam RT and multimodality therapy combining
TUR, RT, and systemic chemotherapy,
Patients are instructed to empty the bladder frequently
and increase intake of fluids, such as water and
cranberry juice. Caffeine, alcohol, tobacco and spices
may irritate the bladder mucosa and should be avoided.
Pharmacological treatments provide relief and are used
to prevent infection. Antispasmodics or
parasympathetic blockers provide relief of symptoms
and promote analgesia.