Urology
Bladder Cancer
방광암
Urothelial carcinoma is the most common bladder malignancy
- How common
- 3x more common in men; smokers
- Typical age
- Most common in 60s–70s
What is it?
Carcinogens (smoking aromatic amines, aniline dyes) damage urothelial DNA → mutant or differentiated tumors.
Commonly affected: Bladder mucosa; advanced: muscle, lymph nodes, liver/lung
How it develops
- Carcinogen exposureSmoking, aniline dyes, cyclophosphamide
- DNA damageUrothelial cell mutations (FGFR3, TP53)
- Non-invasive tumorMucosal or carcinoma in situ
- Muscle invasion≥T2 → lymph node, liver, lung metastasis
Symptoms
- Painless hematuria~80%; cardinal symptom
- Pelvic painAdvanced disease
- Irritative LUTSFrequency/urgency (CIS)
- Obstructive symptomsLarge or trigone tumors
- Weight lossMetastatic disease
How it is examined
- Urine cytologySensitive for high-grade tumors
- CystoscopyGold standard for diagnosis
- TURBT (biopsy)Stages tumor (muscle invasion?)
Imaging
CT urography to evaluate upper tracts.
- Bladder filling defect
- Synchronous upper-tract tumor
MRI for muscle invasion; PET for metastases.
- Depth of muscle invasion
- Nodal metastasis
Non-surgical care
- TURBTFirst-line for non-muscle invasive (NMIBC) and diagnosis
- Intravesical BCGAdjuvant for high-risk NMIBC
- Intravesical mitomycin/gemcitabineSingle dose post-TURBT or adjuvant
- Cisplatin-based chemotherapyNeoadjuvant for MIBC or metastatic
- Immunotherapy (pembrolizumab)Cisplatin-ineligible or metastatic
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Muscle-invasive (≥T2), high-risk NMIBC failure
Procedures that may be discussed
- Radical cystectomy + ileal conduit
- Orthotopic neobladder
- Bladder-preserving chemoradiation
Outlook
NMIBC 5-yr survival >90%; MIBC 50%; metastatic 5%.