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Bladder cancer refers
to any of several types of malignant growths of the urinary
bladder. It is a disease in which abnormal cells multiply
without control in the bladder. The bladder is a hollow,
muscular organ that stores urine; it is located in the lower
abdomen. The most common type of bladder cancer begins in
cells lining the inside of the bladder (epithelial cells)
and is called transitional cell carcinoma (TCC).
The greatest risk factor for bladder cancer is a genetic
predisposition; it is also associated with smoking and occupational
exposure to aniline-based dyes (such as in textile factories),
as well as with petrol and other chemicals.
Signs and symptoms
Bladder cancer may cause blood in the urine, pain during
urination, frequent urination, or feeling the need to urinate
without results. These signs and symptoms are not specific
to bladder cancer, and are also caused by noncancerous conditions,
including prostate infections and cystitis.
Treatment
The treatment of bladder cancer depends on how deep the
tumor invades into the bladder wall. Superficial tumors
(those not entering the muscle layer) can be "shaved
off" using an electrocautery device attached to a cystoscope.
Immunotherapy in the form of BCG instillation is also used
to treat and prevent the recurrance of superficial tumors.
BCG immunotherapy is effective in up to 2/3 of the cases
at this stage. Instillations of chemotherapy into the bladder
can also be used to treat superficial disease.
Untreated, superficial tumors may gradually begin to infiltrate
the muscular wall of the bladder. Tumors that infiltrate
the bladder require more radical surgery where part or all
of the bladder is removed (a cystectomy) and the urinary
stream is diverted. In some cases, skilled surgeons can
create a substitute bladder (a neobladder) from a segment
of intestinal tissue, but this largely depends upon patient
preference, renal function, and the site of the disease.
A combination of radiation and chemotherapy can also be
used to treat invasive disease, and, in many cases, it is
not yet known which is the better treatment - radiotherapy
or radical ablative surgery.
Epidemiology
In the United States, bladder cancer is the fourth most
common type of cancer in men and the ninth most common cancer
in women. More than 47,000 men and 16,000 women are diagnosed
with bladder cancer each year.
Genetics
The FGFR3, HRAS, RB1 and TP53 genes are associated with
bladder cancer. As with most cancers, the exact causes of
bladder cancer are not known; however, many risk factors
are associated with this disease. Chief among them are smoking
and exposure to industrial chemicals. Mutations in the FGFR3
gene that arise in the bladder are another important risk
factor for developing bladder cancer. Similar changes in
other genes, such as RB1, HRAS and TP53, may also increase
risk. Each of these genes plays a critical role in regulating
the cycle of cell division, preventing cells from dividing
too rapidly or in an uncontrolled way. Alterations in these
genes may help explain why some bladder cancers grow and
spread more rapidly than others.
Bladder cancer is generally not inherited; tumors usually
result from genetic mutations that occur in certain bladder
cells during a person's lifetime. These noninherited genetic
changes are called somatic mutations. A family history of
bladder cancer is, however, a risk factor for the disease.
Along these lines, some people appear to inherit a reduced
ability to break down certain chemicals, which makes them
more sensitive to the cancer-causing effects of tobacco
smoke and certain industrial chemicals.
http://en.wikipedia.org/wiki/
Bladder_cancer#Genetics
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