Primary bladder cancer is a malignancy that originates from the cells lining the inside of the urinary tract. This malignancy is most common in the area of the bladder, but can also affect the ureters (tubes draining urine from the kidney to the bladder) and the kidneys.
It is the seventh most commonly diagnosed malignancy in male patients worldwide.
The incidence varies between countries. In Australia, it is estimated at about 3000 patients per year with men being more affected than women.
There are different types of primary bladder cancer, the most common is urothelial, then squamous, adenocarcinoma and other rarer variants – small cell, pheochromocytoma etc.
Smoking is the most important risk factor for the development of bladder cancer. It increases the risk 2-4 times and accounts for half of the cases.
Other risk factors are certain chemicals used in the textile, rubber, dye, petroleum, dry cleaning industries leading to increased occupational exposure.
Chronic infection, the presence of stones, foreign bodies also contribute for the development of bladder cancer.
Radiation exposure of the bladder and certain chemotherapy agents also increase the risk.
Parasites (not in Australia, but can be exposed during travel overseas) can cause changes to the lining of the bladder which can subsequently change in to bladder cancer.
The most common presentation of patients with bladder cancer is painless haematuria (blood in the urine). This can be visible or non-visible, only detected on a urine dipstick test.
Not all haematuria is a result of bladder cancer, but all haematuria needs to be investigated by an urologist. Approximately 20% of patients with visible and 5% of patients with non-visible haematuria will be diagnosed with a bladder malignancy.
The assessment of haematuria involves history, examination, blood and urine tests as well imaging of the urinary tract. A cystoscopic examination of the bladder is also required.
Depending on this initial work up, other tests or procedures may be required.
If a bladder cancer is detected this can be usually removed by using specially designed instruments that fit into the urethra (water pipe) and the entire procedure is carried out through this approach (transurethral resection of bladder tumour, TURBT).
The procedure provides important information to the urologist to determine the type, volume, extent/depth and aggressiveness of disease. These parameters are extremely important to be able to determine the best management plan for a particular patient.
Not all bladder cancers are the same and based on their characteristics the treatment, follow up schedules and outcomes differ considerably.
A quick and accurate assessment of all patients with suspected haematuria is a paramount to avoid delays in the diagnosis and management of bladder malignancy.