Epidemiology

Risk Factors

• Benzidine Exposure: aniline dye intermediate
• Genetic Mutations
  • HRAS
  • KRAS2
  • RB1
  • FGFR3
• Low Daily Oral Water Intake: risk of bladder cancer might be related to carcinogens which are excreted in urine being in concentrated contact with the bladder
• Occupational Risk
  • Bus Drivers: may be related to long urine dwell times in bladder
  • Rubber Workers: due to aniline exposure (in rubber) (see Aniline, [[Aniline]])
  • Mechanics
  • Leather Workers: due to aniline dye exposure
  • Blacksmiths
  • Machine Setters
  • Hairdressers: due to exposure to hair dyes
  • Printing Workers: due to aniline exposure
  • Textile Workers: due to aniline dye exposure (most commonly indigo, which is used in blue jeans)
• Tobacco Abuse (see Tobacco, [[Tobacco]])
  • 2-Naphthylamine is found in tobacco smoke and may play a role
  • Linear relationship between tobacco use and risk of bladder cancer
  • Tobacco use is associated with >50% of bladder cancer cases in men and 33% of cases in women
  • Cessation of tobacco use decreases the risk of bladder cancer
  • Second-hand smoke exposure is not a risk factor

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Pathology of Bladder Cancer

• Urothelial Cell Carcinoma (Transitional Cell Carcinoma) (see Urothelial Cell Carcinoma, [[Urothelial Cell Carcinoma]]): 90% of bladder cancer cases are due to urothelial cell carcinoma
• Squamous Cell Carcinoma
• Adenocarcinoma
• Sarcoma
• Small Cell Carcinoma

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Diagnosis

• Cystoscopy
  • Hexvix/Cysview Guided Fluorescence: may increase detection rates
• Pelvic CT: may be used for staging

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Clinical Manifestations

Renal Manifestations

• Microscopic or Gross (Macroscopic) Hematuria (see Hematuria, [[Hematuria]]): present in 80-90% of cases
• Dysuria (see Dysuria, [[Dysuria]])
• Frequent Urination
• Inability to Urinate
• Palpable Bladder Mass: uncommon

Other Manifestations

Metastases to Lungs

• Epidemiology
  • Lung is the only site of metastasis in only 9% of cases
  • There are case reports of metastases to lungs even with superficial Tumors, with no prior evidence of muscle invasion [MEDLINE]
• Clinical
  • Single or Multiple Lung Nodules (see Lung Nodule or Mass, [[Lung Nodule or Mass]]): may cavitate
  • Interstitial Micronodules
  • Endobronchial Metastases (see Lung Metastases-Endobronchial, [[Lung Metastases-Endobronchial]] and Obstructive Lung Disease, [[Obstructive Lung Disease]])

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Treatment

Surgery

• Transurethral Resection: for early stage tumors
• Cystectomy: for more advanced disease

Chemotherapy

• Bacillus Calmette-Guerin (see Bacillus Calmette-Guerin, [[Bacillus Calmette-Guerin]]): intravesical
• Docetaxel (Taxotere) (see Docetaxel, [[Docetaxel]]): indicated for transitional cell pathology
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Treatment of Lung Metastases

• Surgical Resection: may considered for isolated lung metastases

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References

• Cavitary Pulmonary Metastases in Transitional Cell Carcinoma of Urinary Bladder. AJR 154:493-494, March 1990
• Occupational bladder cancer in textile dyeing and printing workers: six cases and their significance for screening programs. J Occup Med. 1990 Sep;32(9):887-90 [MEDLINE]
• Cystic Pulmonary Metastasis of Bladder Cancer: Report of Two Cases. Turkish Respiratory Journal, December 2002, Vol.3, No.3
• Superficial Bladder Cancer Metastatic to the Lungs: Two Case Reports and Review of the Literature. Urology 2009; 73: 210 [MEDLINE]
• Surgery for Isolated Lung Metastasis in Two Patients with Bladder Cancer. Urology 2005; 66: 881
• Urothelial bladder cancer with cavitary lung metastases. Can Respir J Vol 18 No 3 May/June 2011
• Metastasis from transitional cell carcinoma of urinary bladder as cystic pulmonary lesion. J Thorac Dis 2011;3:71-73