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bladder/urothelial cancers

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Seventy percent of urothelial tumours are superficial at presentation; two-thirds will subsequently recur locally or elsewhere in urinary tract, and in 10-15%, the recurrence will be invasive. This potential instability of the urothelium is often described in terms of a "field change".

  • majority are transitional cell carcinomas that arise from the specialised waterproof epithelium that lines the urinary tract. In men, this extends from the tips of the renal papillae to the navicular fossa; in women, to halfway along the urethra

Tumours can arise at any site in this epithelium and are often multifocal. The bladder is the most common site.

  • bladder cancer is the seventh most common cancer in the UK. It is 3-4 times more common in men than in women. In the UK in 2011, it was the fourth most common cancer in men fand the thirteenth most common in women
  • bladder cancer is usually identified on the basis of visible blood in the urine or blood found on urine testing, but emergency admission is a common way for bladder cancer to present, and is often associated with a poor prognosis
  • most bladder cancers (75-80%) do not involve the muscle wall of the bladder and are usually treated by telescopic removal of the cancer (transurethral resection of bladder tumour [TURBT])
    • often followed by instillation of chemotherapy or vaccine-based therapy into the bladder, with prolonged telescopic checking of the bladder (cystoscopy) as follow-up
    • some people in this group who are at higher risk are treated with major surgery to remove the bladder (cystectomy). People with cancer in or through the bladder muscle wall may be treated with intent to cure using chemotherapy, cystectomy or radiotherapy, and those who have cancer too advanced to cure may have radiotherapy and chemotherapy

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