Bladder cancer is the ninth most common cancer worldwide, with more than 380,000 new cases each year and more than 150,000 deaths per year.1 It is more common in elderly and affects approximately four times the number of men than women.2 The US National Cancer Institute estimates that there will be 72,570 new cases of bladder cancer in the US in 2013 and 15,210 deaths.3 If detected at an early stage, non-muscle invasive bladder cancer can be successfully treated and has a relatively good prognosis. Nonetheless, up to 46 % of bladder cancer patients will experience cancer recurrence already at their first follow-up. Blue-light cystoscopy responds to the need for an improved diagnosis and treatment in order to reduce the recurrence of bladder cancer.
Bladder cancer occurs when cells in the bladder start to grow out of control, typically on the inner layers of the bladder. Some may spread into the deeper layers of the bladder, eventually penetrating the muscular layers, making it much harder to treat. The type of tissue that constitutes the lining of the bladder, where tumors initiate, is equivalent to the inner layers of the kidneys, ureters and urethra. Therefore, similar cancers may occur in these areas, though much less frequently.
Diagnosing and treating bladder cancerThe most common initial sign of bladder cancer is macroscopic hematuria (blood in the urine). During the initial assessment, use of voided urine cytology or urinary biomarkers is advocated to predict high-grade tumor before referring to a transurethral resection of the bladder (TURB, TUR, and TURBT). Cystoscopy is recommended in all patients with symptoms suggestive of bladder cancer and cannot be replaced by cytology or any other non-invasive tests. If confirmed, two distinct forms of bladder cancer can be identified; non-muscle invasive and muscle invasive bladder cancer.
Non-muscle invasive bladder cancer accounts for about 75% of all newly diagnosed bladder cancer cases. Most of these cases show a high probability of recurrence and 10-20 % will progress to muscle invasive bladder cancer. The treatment will consist of a transurethral resection of affected bladder areas followed by adjuvant treatment options such as early instillation of chemotherapy or instillation of BCG (recommended when the risk of recurrence and progression is high).
Muscle invasive bladder cancer is the second form of bladder cancer. This form of bladder cancer has a much higher mortality rate (approximately 50 %), which is why early detection is crucial. In these cases radical cystectomy (bladder removal), lymphadenectomy and/or chemotherapy are the recommended treatments.4, 5, 6
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- www.globocan.iarc.fr (05-11-2013)
- Babjuk M et al., European Association of Urology. Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS). 2013.
- NCI: Bladder Cancer. Available at: http://www.cancer.gov/cancertopics/types/bladder (accessed June 2013).
- Cancer Facts & Figures 2011, American Cancer Society: Cancer Facts & Figures 2011, Atlanta: American Cancer Society, 2011.