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Published online by Cambridge University Press: 25 August 2009
Introduction
The etiology of bladder cancer is multifactorial, with chemical carcinogens, viruses, bacteria and other inducing agents causing aberrations in DNA. This can lead to the induction of oncogenes, the negation of suppressor genes and the failure of DNA repair mechanisms. This, coupled with inherited, acquired or anatomic factors, will determine whether individuals, when exposed to identical mutagens, will go on to develop bladder cancer or not. Once urothelial malignancy has developed, the entire urothelium can be affected, from the renal pelvis to the urethra; this field change coupled with the ability of transitional cell carcinoma to implant makes surveillance of the whole urinary tract essential.
Epidemiology
Bladder cancer has a male preponderance, with an incidence in males of 30 per 100 000 compared to 10 per 100 000 in females. There has been an increase in the incidence of bladder cancer in both sexes. In view of the negligible rates of detection of incidental bladder cancer during autopsy studies, this increase is unlikely to be because of better detection of indolent disease.
The mortality rate for bladder cancer is twice as high in men (11 per 100 000) as in women (5.7 per 100 000). The incidence of bladder cancer increases with age, with a peak between 80 and 84 years of age. Elderly patients with this disease have a higher mortality. This may be related to the advanced stage of the disease at presentation, coupled with possibly the biologic response of the elderly to this disease [1].
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