Treatment Guideline Chart

Bladder cancer is a heterogenous neoplasm that ranges from non-life-threatening, low-grade, superficial papillary lesions to high-grade invasive tumors that often metastasizes at the presentation.

It is the most common cancer involving the urinary system and it is the 11th most commonly diagnosed in the world.

Microscopic or gross painless hematuria is the most common presenting complaint.

Bladder%20cancer Signs and Symptoms


  • Bladder cancer is an uncontrollable growth of cancer cells in the hollow organs of the pelvis which is the bladder
  • Most common cancer involving the urinary system and it is the 10th most commonly diagnosed in the world
    • It is the 6th common cancer in US, 11th in UK and 14th in Asia
    • It is the 9th most common cancer in men in Malaysia, and 10th most common cancer in men in Singapore
  • The predominant histologic type of bladder cancer is the urothelial (transitional cell) carcinoma
    • Less common histologic types include squamous cell carcinoma and adenocarcinoma
  • It is 3-4 times prevalent in men than in women
    • Bladder cancer is the 7th most common cancer in men and the 17th most common cancer in women
    • But women present with more advanced disease and have worse survival

Signs and Symptoms

  • Microscopic or gross, painless hematuria is the most common presenting complaint
    • Gross hematuria is associated with higher disease stage than microscopic hematuria
  • Urinary frequency from irritation or a reduced bladder capacity can also develop
    • Carcinoma in situ (CIS) may be suspected in patients with lower urinary tract symptoms (eg irritative voiding)
  • Dysuria and urgency are other complaints
  • Less commonly, a urinary tract infection (UTI) is the presenting symptom
  • Upper tract obstruction or pain may occur in more advanced tumors

Risk Factors

  • Active and passive tobacco smoking is the most important risk factor for bladder cancer
    • Tobacco smoke contains aromatic amines and polycyclic aromatic hydrocarbons that are renally excreted
  • Occupational exposure to aromatic amines, polycyclic aromatic hydrocarbons and chlorinated hydrocarbons is the second most important risk factor for bladder cancer
    • Occurs mainly in industrial plants processing paint, dye, metal and petroleum products
  • Increasing age
    • Mean age of diagnosis is 73 years old
  • Exposure to ionizing radiation is connected with increased risk
    • There is an increased risk of developing bladder cancer in patients undergoing external-beam radiotherapy, brachytherapy or a combination
  • Bladder schistosomiasis (Schistosoma haematobium)
    • Well-established relationship relationship with squamous cell carcinoma of the bladder
  • Genetic predisposition
    • Has shown to influence the incidence of bladder cancer through its impact on the susceptibility to other risk factors
    • Increased risk for 1st- and 2nd-degree relatives
    • Inherited mutations in carcinogen-detoxification genes such as N-acetyltransferase 2 (NAT2) and glutathione S-transferase mu 1 (GSTM1) are associated with susceptibility to bladder cancer
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