NON RARE IN EUROPE: Bladder cancer

Bladder cancer, also known as urinary bladder neoplasm or carcinoma of the bladder, is a malignant tumor arising from the tissues of the urinary bladder. It is classified as non-rare in Europe due to its relatively high incidence. The most common type is urothelial carcinoma (formerly called transitional cell carcinoma), which accounts for approximately 90% of cases. Other histological types include squamous cell carcinoma and adenocarcinoma. Bladder cancer primarily affects the urinary system, originating in the urothelial lining of the bladder, and can range from superficial, non-muscle-invasive tumors to aggressive muscle-invasive and metastatic disease. The hallmark symptom of bladder cancer is painless hematuria (blood in the urine), which may be visible to the naked eye or detected only on microscopic examination. Other symptoms include increased urinary frequency, urgency, dysuria (painful urination), and in advanced cases, pelvic pain, flank pain due to ureteral obstruction, weight loss, and bone pain from metastatic spread. Risk factors include tobacco smoking (the most significant modifiable risk factor), occupational exposure to aromatic amines and other industrial chemicals, chronic bladder infections, and prior pelvic radiation therapy. The disease is more common in males than females and incidence increases with age, typically presenting after the age of 55. Treatment depends on the stage and grade of the tumor. Non-muscle-invasive bladder cancer is typically managed with transurethral resection of the bladder tumor (TURBT) followed by intravesical therapy, most commonly Bacillus Calmette-Guérin (BCG) immunotherapy or intravesical chemotherapy. Muscle-invasive bladder cancer often requires radical cystectomy (surgical removal of the bladder) with urinary diversion, frequently preceded by neoadjuvant cisplatin-based chemotherapy. Advanced or metastatic disease is treated with systemic chemotherapy, immune checkpoint inhibitors (such as pembrolizumab and atezolizumab), antibody-drug conjugates (such as enfortumab vedotin), and targeted therapies (such as erdafitinib for FGFR-altered tumors). Regular surveillance with cystoscopy and urine cytology is essential due to the high recurrence rate of this cancer.

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