Authors
S Vasudevan, Department of Urology, Medical College, Trivandrum*
Abstract
Introduction: Bladder cancer is a prevalent cause of painless hematuria, primarily urothelial carcinoma (90%), and the second leading cause of death among genitourinary tumors. Gross hematuria prompts comprehensive evaluation including cystoscopy and imaging.
Risk Factors: Several factors contribute to bladder cancer development. These include general demographic aspects such as male gender, older age (average diagnosis at 73), and Caucasian race. Genetic predispositions like family history and specific inherited syndromes (e.g., Rb1, Cowden disease, Lynch syndrome) also increase risk. Lifestyle factors are critical, notably cigarette smoking, workplace exposure to industrial chemicals (e.g., dyes, rubber, leather), arsenic in drinking water, and insufficient fluid consumption. Other contributing conditions include chronic bladder infections, schistosomiasis, a personal history of urothelial cancer, and certain congenital bladder defects. Previous treatments such as long-term cyclophosphamide use and pelvic radiation therapy are also risk factors.
Management: Treatment is stage-dependent. Non-muscle invasive bladder cancer (NMIBC) is typically managed with transurethral resection (TURBT) and intravesical instillations (BCG, mitomycin C). Muscle invasive bladder cancer (MIBC) often requires radical cystectomy with lymphadenectomy and urinary diversion (ileal conduit, neobladder, continent reservoir). Bladder preservation protocols involving radiation and chemotherapy are also options. Chemotherapy, notably MVAC or gemcitabine/cisplatin regimens, is crucial for metastatic disease and as neoadjuvant therapy. Immunotherapy with BCG is standard for superficial disease. Ongoing research in gene therapy aims for personalized treatment approaches.