Bladder Cancer: Overview, Epidemiology, Initial Presentation and Diagnosis

Bladder cancer, also known as urothelial carcinoma, is the most common malignancy of the genitourinary system. It can occur anywhere along the urothelial lining, including the kidneys, ureters, bladder, and urethra. Bladder cancer is the ninth most common cancer worldwide and sixth most common cancer in the United States. Transitional cell carcinoma is the most common type of urothelial carcinoma. Histologic variants of bladder cancer are harder and aggressive to treat. Squamous cell carcinoma is the most common type of non-urothelial carcinoma. Smoking is one of the major risk factors for the development of bladder cancer, and smokers are three times more susceptible to developing bladder cancer compared to nonsmokers. The mortality rate for urothelial cancer has decreased by 5% mainly because of awareness, which helped with smoking cessation, changes in environmental carcinogens, healthier lifestyles, better access to treatments, and better choice of chemotherapy for metastatic urothelial cancer patients to name a few. In terms of diagnosing urothelial carcinoma, a complete urological evaluation with complete history and physical, laboratory tests including microscopic analysis, urine culture, and cytology is warranted. Complete workup involves computed tomography (CT) urogram and cystoscopy as the final steps of evaluation. Gross hematuria and asymptomatic hematuria are one of the key elements of clinical presentation, as well as other irritative urinary symptoms. Early detection of bladder cancer is the key to have a favorable prognosis and to prevent metastasis.