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In the United States, 60,000 new cases of bladder cancer are diagnosed each year. Bladder cancer is the 4th most common cancer in men and the eleventh most common in women, and the 8th and 10th leading cause of cancer deaths, respectively.. At diagnosis, 75% of tumors are non-invasive (involving only the superficial mucosal layer of the bladder). Most of these tumors are at low risk of progression and metastasis. However, up to 25% of bladder cancer cases present with disease invading the muscular layers of the bladder. The therapy that offers the best chance for survival for these patients is complete removal of the bladder and surrounding lymph nodes (radical cystectomy and extended lymph node dissection). When treated early and appropriately, muscle-invasive bladder cancer is a potentially curable disease even when it involves limited regional lymph nodes. Some patients with aggressive non-invasive bladder cancer will also ultimately die of their cancer, due in part to resistance to undergo radical cystectomy. With the alternative of an orthotopic neobladder available to most men and women, radical cystectomy should be considered a viable alternative to continued conservative measures for selected patients with aggressive non-invasive bladder tumors.
The leading risk factor for bladder cancer is smoking, including second hand smoke. Occupational exposures to chemicals containing hydrocarbons or arylamines also increase the risk of developing bladder cancer. Occupations with high exposure to these carcinogens include the dye, rubber, leather, painting and aluminum industry. Other risk factors include certain chemotherapeutic agents, in particular cyclophosphamide. Bladder cancer staging, treatment and prognosis depend on how deeply it has invaded the organ.
