Bladder cancer

doi:10.1136/bmj.317.7169.1366

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Adrian P M van der Meijden, consultant urologist (urology.bmc@tip.nl)

Department of Urology, Bosch Medicentrum, PO Box 90153, 5200 ME s-Hertogenbosch, Netherlands

Bladder cancer is the fifth most common malignancy in Europe and the fourth most common malignancy in the United States.1 About 75% of patients with bladder cancer are men. The most established risk factors for bladder cancer are cigarette smoking and occupational exposure to certain carcinogens.2 About 80% of bladder tumours are confined to the bladder mucosa, the so called superficial tumours, and 20% invade the muscle layer. The management and prognosis of the two types of cancer are completely different: superficial tumours are fairly benign, and invasive tumours are highly malignant.

Summary points

Exposure to industrial chemicals and cigarette smoke are risk factors for bladder cancer
Haematuria is the key symptom
In superficial bladder cancer, intravesical chemotherapy can prevent recurrences but not progression to invasive bladder cancer
Fifty per cent of patients with muscle invasive tumours will die within 5 years
Quality of life has been improved but not survival
Systemic chemotherapy for invasive bladder cancer has not proved to be beneficial in large series of patients

Methods

This article is based on the results of several clinical trials carried out during the past 20 years by the European Organisation for Research and Treatment of Cancer Genito-Urinary (EORTC-GU) Cancer Cooperative Group and the British Medical Research Council's working party on superficial bladder cancer, and selected articles published in peer reviewed urological journals during the past two decades.

Aetiology

Bladder cancer is strongly linked to occupational and environmental exposure to chemicals. The development of the disease is associated with the excretion of carcinogenic metabolites in the urine.

In the early 1950s an investigation of bladder cancers in workers in British chemical industries showed that individuals exposed to benzidine and 2-naphtylamine had a 30 times greater risk of developing bladder cancer than the general population. The average latent period for the development of the disease was …