Bladder Cancer

There are 2 main types of bladder cancer: ^[Ref]

• Transitional cell carcinoma (urothelial carcinoma) – 95% cases
• Squamous cell carcinoma

Risk factors for bladder cancer: ^[Ref]

• Advanced age (esp. >55 y/o)
• Tobacco smoking – most important risk factor
• Occupational exposure to aromatic amines (primarily seen in industrial areas processing dye, paint, metal and petroleum products)
• Water pollution (exposure to arsenic in drinking water)
• Family history
• Pelvic radiation (e.g. external-beam radiotherapy for prostate cancer)
• Drugs (↑ risk of transitional cell carcinoma)
  • Cyclophosphamide
  • Pioglitazone

Hallmark clinical feature: painless visible haematuria

Other features:

• Recurrent UTIs
• Abdominal / pelvic pain
• Urinary obstruction in advanced cases

Refer with suspected bladder cancer pathway if:

• ≥45 y/o with unexplained visible haematuria in the absence of UTIUrinary tract infection / persisting or recurring after UTIUrinary tract infection treatment, OR
• ≥60 y/o with unexplained non-visible haematuria + dysuria / ↑ WCCWhite cell count

Consider non-urgent referral if: ≥60 y/o + recurrent / persistent unexplained UTIUrinary tract infection

Offer:

• Neoadjuvant chemotherapy (cisplatin-based combination), and
• Radical cystectomy

  Radical cystectomy is the surgical removal of the entire bladder and adjacent organs at risk for tumor extension (prostate and seminal vesicles in men; uterus, cervix, and part of the vaginal wall in women when indicated), along with a pelvic lymph node dissection.

   / radiotherapy

  Radical radiotherapy refers to high-dose external beam radiation therapy delivered to the bladder with curative intent, typically as part of a bladder-preserving protocol. The most effective approach is trimodality therapy: maximal transurethral resection of the bladder tumor (TURBT) followed by concurrent chemoradiation, using radiosensitizing agents such as cisplatin, gemcitabine, or mitomycin C plus fluorouracil.

   

Offer cisplatin-based chemotherapy

Other management:

• Palliative radiotherapy for bladder symptoms
• Percutaneous nephrostomy / retrograde stenting for ureteric obstruction