With more than 380,000 new cases and 150,000 deaths occurring every year in the world, bladder neoplasm is ranked among the most common malignancies in medical practice [1]. It was considered as the fourth most common cause of cancer in males [1]. But in 2016, data from the United States indicates that its incidence has risen to third place amongst malignant diseases in males (after prostate and lung cancer), with more than 75,000 new cases, of which almost 60,000 are in males [2]. Apart from male gender, cigarette smoking, known as the single most important risk factor for bladder neoplasm, as well as occupational exposure to aromatic amines (frequently in rubber and cable manufacturing) are well-established risk factors [3]. The main clinical presentation is gross painless hematuria, seen in almost 85% of patients when the diagnosis is made [4] [5]. The second important feature of bladder neoplasm is the appearance of asymptomatic microscopic hematuria [4]. In addition, lower urinary tract symptoms (LUTS), such as dysuria, frequent urination, nocturia, etc., have been strongly associated with the development of bladder neoplasms [3], and their unexplained occurrence must be evaluated thoroughly [4]. Unfortunately, their poor follow-up and misdiagnosis as infections or kidney stones are the main factors for a delayed diagnosis [5], and pelvic pain or a palpable pelvic mass, are signs of metastatic dissemination. A very important feature of bladder neoplasms is their recurrence after excision, often at sites rather than at the primary site of the lesion, making long-term monitoring of operated patients mandatory [6].

• Hematuria

  The main clinical presentation is gross painless hematuria, seen in almost 85% of patients when the diagnosis is made. The second important feature of bladder neoplasm is the appearance of asymptomatic microscopic hematuria. [symptoma.com]

  Herein, we reported a 59-year-old female patient consulted to our outpatient clinic with the incidents of hematuria. [ncbi.nlm.nih.gov]

  Clinical features  Often vague  Gross or microscopic hematuria. [slideshare.net]

  This blood in the urine may be visible to the naked eye (gross/macroscopic hematuria) or detectable only by microscope (microscopic hematuria). Hematuria is the most common symptom in bladder cancer. [checkorphan.org]

• Nocturia

  In addition, lower urinary tract symptoms (LUTS), such as dysuria, frequent urination, nocturia, etc., have been strongly associated with the development of bladder neoplasms, and their unexplained occurrence must be evaluated thoroughly. [symptoma.com]

  Other symptoms may include suprapubic pain after voiding, bladder irritability, dribbling, and nocturia. Physical examination The physical examination is usually normal. [medical-dictionary.thefreedictionary.com]

  Less commonly, patients may complain of urinary frequency, nocturia, and dysuria, symptoms that are more common in patients with carcinoma in situ. [cancer.gov]

Signs and symptoms of bladder neoplasm may be insidious and are often absent in its early stages, making the diagnosis difficult. In the setting of macroscopic hematuria, however, bladder cancer must be excluded as the underlying cause. A detailed patient history regarding the onset of symptoms and their progression is the first step, followed by a thorough physical examination of the abdomen and a prostate exam, as prostate cancer must be excluded as well. Urinalysis is also a valuable diagnostic procedure that can reveal microscopic hematuria, which is particularly valuable in the absence of other symptoms [5]. Urine cytology is also an important diagnostic method used to detect the presence of malignant cells that have been shed from the tumor into urine [5]. However, cystoscopy is considered to be the gold standard, although it is invasive and highly unpleasant [1] [5]. Cystoscopy provides a viable sample for biopsy and enables adequate classification according to TNM staging [7]:

• Tumor (T) - Depending on the depth of tissue infiltration, tumors are divided into the following stages: Noninvasive papillary lesions (Ta), carcinoma in situ (Tis), lesions that invade the subepithelial connective tissue (T1), muscle (either superficial or deep, demarcated as T2a and T2b, respectively), perivesicular tissue, either microscopic or macroscopic (T3a and T3b), and tumors that invade adjacent organs (infiltration of the prostate, uterus, or vagina are designated as T4a, whereas T4b denotes invasion of the pelvic or abdominal wall).
• Nodal involvement (N) - Infiltration of adjacent lymph nodes by the tumor is not seen in the initial stages of the disease (N0), but further development results in infiltration of only one node in the pelvis (N1), 2 or more in the same area (N2) or 1 or more iliac nodes (N3).
• Metastasis (M) - Presence of metastases (M1) confirms the advanced stage of the disease and carries a very poor prognosis.

In order to define the tumor stage, histopathological findings must be supported by imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI). However, the diagnosis primarily relies on the extent of the primary tumor and its spread such as nodal and metastatic involvement indicating advanced (IV) disease [7]. Recent studies have evaluated several markers that may be of use in the diagnostic workup such as apolipoprotein E (APOE), fibrinogen β chain precursor (FGB) and polymerase (RNA) I polypeptide E (POLR1E) which have shown promising results [1].

The most striking features of this case included the histopathologic findings and rapid disease progression, despite treatment with agents known for their efficacy against tumors of epithelial and mesenchymal origin. [ncbi.nlm.nih.gov]

Treatment - Bladder neoplasm The treatment of bladder neoplasm depends on how deep the tumor invades into the bladder wall. [checkorphan.org]

Treatment Treatment for bladder cancer depends on the stage of the tumor. The patient's medical history, overall health status, and personal preferences also are taken into account when deciding on an appropriate treatment plan. [medical-dictionary.thefreedictionary.com]

These factors have led to braoder programs of combined integrated multimodal treatment earlier in the course of the disease process. [books.google.com]

Bladder tumors rarely occur in the first two decades of life, and, in contrast to the cases in adults, 97% of transitional cell carcinomas of the bladder in childhood are low grade, superficial, and of good prognosis, with a progression rate of only 2% [ncbi.nlm.nih.gov]

Metastasis (M) - Presence of metastases (M1) confirms the advanced stage of the disease and carries a very poor prognosis. [symptoma.com]

Prognosis  Non–muscle invasive bladder cancer has a good prognosis, with 5-year survival rates of 82-100%. [slideshare.net]

Xanthogranulomatous cystitis is a rare, benign chronic inflammatory disorder with unclear etiology. Since its similar features to bladder neoplasm, it is extremely easy to be mistaken for malignant tumor. [ncbi.nlm.nih.gov]

Cancer of bladder 1) Incidence and prevalence. 2) Etiology/ Risk factors. 3) Pathology. 4) Clinical features. 5) Investigation and diagnosis. 6) Staging and Management. 7) Prognosis 18. [slideshare.net]

Even after 5 years, however, patients continue to fail not only locally and regionally but also with disseminated disease, thereby creating enigmas as to the continued influence of basic molecular changes, basic etiologic agents, and unsuspected more [books.google.com]

Neoplasms of the bladder account for a very small proportion of known etiologies. [e-ultrasonography.org]

The etiology in these cases is thought to be multifactorial, potentially involving exposure to numerous carcinogens. Arsenic exposure may be a factor in the development of bladder cancer. [emedicine.medscape.com]

[…] urothelial papilloma but with increased cellular proliferation exceeding the thickness of normal urothelium; appears to lack the capacity to invade or metastasize ICD-O: 8130 / 1 Terminology PUNLUMP: papillary urothelial neoplasm of low malignant potential Epidemiology [pathologyoutlines.com]

Bladder cancer: Epidemiology, staging and grading and diagnosis. Urology, 66: 4-34. Direct Link Kundra, V. and P.M. Silverman, 2003. Imaging in the diagnosis, staging, and Follow-up of cancer of the urinary bladder. Am. J. [scialert.net]

[…] transitional cell carcinoma of the urinary tract TCCs in other locations: transitional cell carcinoma of the renal pelvis transitional cell carcinoma of the ureter other histologies: squamous cell carcinoma of the bladder adenocarcinoma of the bladder Epidemiology [radiopaedia.org]

C 19, 20 Epidemiology Bladder cancer is the fourth most common cancer in men and the eighth most common in women. [aafp.org]

Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. 2009 Sep. 56(3):430-42. [Medline]. [emedicine.medscape.com]

Nonurothelial primary bladder tumors are extremely rare and may include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma (see Pathophysiology ). [emedicine.medscape.com]

Prevention Since the exact causes of bladder cancer are not known, there is no certain way to prevent it. Avoiding risk factors whenever possible is the best alternative. [medical-dictionary.thefreedictionary.com]

Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is also used to treat and prevent the recurrence of superficial tumors. [checkorphan.org]

It helps to prevent the tumor from coming back and helps prevent development of muscle invasive disease. About 6 weeks after completing the BCG, the doctor will do a cystoscopy again to make sure all of the cancer is gone. [urology.wustl.edu]

Preventing bladder cancer While it is not possible to prevent bladder cancer, it is possible to reduce your risks such as not smoking or quitting smoking, and avoiding exposure to chemicals listed above. [cancer.org.au]

What To Expect Following surgery, a catheter may be placed in the urethra to help stop bleeding and to prevent blockage of the urethra. When the bleeding has stopped, the catheter is removed. You may need to stay in the hospital 1 to 4 days. [northshore.org]

1. Lindén M, Segersten U, Runeson M, Wester K, Busch C, Pettersson U, et al. Tumour expression of bladder cancer-associated urinary proteins. BJU Int. 2013;112(3):407-415.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
3. Zhou J, Kelsey KT, Smith S, Giovannucci E, Michaud DS. Lower Urinary Tract Symptoms and Risk of Bladder Cancer in Men: Results from the Health Professionals Follow-Up Study. Urology. 2015;85(6):1312-1318.
4. Dobbs RW, Hugar LA, Revenig LM, Al-Qassab S, Petros JA, Ritenour CW, et al. Incidence and clinical characteristics of lower urinary tract symptoms as a presenting symptom for patients with newly diagnosed bladder cancer. Int Braz J Urol. 2014;40(2):198-203.
5. Garg T, Pinheiro LC, Atoria CL, et al. Gender Disparities in Hematuria Evaluation and Bladder Cancer Diagnosis: A Population-Based Analysis. J Urol. 2014;192(4):1072-1077.
6. Aster, JC, Abbas, AK, Robbins, SL, Kumar, V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.
7. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.