1. Epidemiology

• Incidence: Bladder cancer is the 10th most common cancer worldwide, with over 570,000 new cases annually. It is more prevalent in men than women, with a male-to-female ratio of approximately 3:1.
• Geography: Higher incidence rates are seen in developed countries, particularly in North America, Europe, and parts of Asia.
• Age: Most cases occur in individuals aged 65 and older.

2. Risk Factors

• Tobacco Smoking: The most significant risk factor, responsible for approximately 50% of cases. Smokers have a 3-4 times higher risk than non-smokers.
• Occupational Exposure: Contact with aromatic amines, polycyclic aromatic hydrocarbons, and chemicals used in dye, rubber, leather, and paint industries.
• Chronic Inflammation: Chronic bladder inflammation due to recurrent urinary tract infections, bladder stones, or long-term catheter use.
• Schistosomiasis: Associated with squamous cell carcinoma of the bladder, particularly in endemic areas (e.g., Africa and the Middle East).
• Radiation Therapy: Previous pelvic irradiation increases the risk.
• Chemotherapy: Prior exposure to cyclophosphamide is linked with an increased risk.
• Genetics: Family history and genetic predisposition play a role, though less significant than environmental factors.

3. Types of Bladder Cancer

• Transitional Cell Carcinoma (TCC):
  • Also known as Urothelial Carcinoma: Accounts for about 90% of cases.
  • Subtypes: Non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC).
• Squamous Cell Carcinoma: Makes up 5% of cases, often linked to chronic irritation or schistosomiasis.
• Adenocarcinoma: Rare, about 1-2% of cases, associated with bladder exstrophy or persistent urachal remnants.
• Small Cell Carcinoma: Very rare and aggressive, comprising less than 1% of cases.
• Other Rare Types: Include sarcomas and lymphomas.

4. Diagnostic Methods

• Clinical Presentation:
  • Hematuria: Most common presenting symptom, either gross or microscopic.
  • Irritative Symptoms: Frequency, urgency, and dysuria, particularly in advanced cases.
  • Advanced Disease: May present with pelvic pain, bone pain (due to metastasis), or lower extremity edema.