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].

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].

Treatment for bladder cancer depends on the stage and grade of the tumor. Options include surgery, chemotherapy, radiation therapy, and immunotherapy. Surgery may involve removing the tumor or, in more severe cases, the entire bladder. Chemotherapy uses drugs to kill cancer cells, while radiation therapy uses high-energy rays. Immunotherapy helps the immune system fight cancer. Treatment plans are tailored to the individual, considering factors like overall health and cancer stage.

The prognosis for bladder cancer varies based on the cancer's stage and grade at diagnosis. Early-stage bladder cancer has a high survival rate, especially if it is non-invasive. However, bladder cancer has a tendency to recur, so regular follow-up is crucial. Advanced bladder cancer that has spread beyond the bladder is more challenging to treat and has a lower survival rate.

The exact cause of bladder cancer is not fully understood, but several risk factors have been identified. Smoking is the most significant risk factor, as it exposes the bladder to harmful chemicals. Other risk factors include exposure to certain industrial chemicals, chronic bladder inflammation, and a family history of bladder cancer. Age and gender also play a role, with older adults and men being more commonly affected.

Bladder cancer is the tenth most common cancer worldwide. It is more prevalent in developed countries and is more common in men than women. The risk of developing bladder cancer increases with age, with most cases diagnosed in individuals over 55. Lifestyle factors, such as smoking and occupational exposure to chemicals, contribute to its prevalence.

Bladder cancer begins when cells in the bladder lining undergo genetic mutations that cause them to grow uncontrollably. These mutations can be triggered by carcinogens, such as those found in tobacco smoke. Over time, these abnormal cells can form tumors and potentially invade deeper layers of the bladder or spread to other parts of the body.

Preventing bladder cancer involves reducing risk factors. Quitting smoking is the most effective way to lower risk. Limiting exposure to industrial chemicals and maintaining a healthy lifestyle with a balanced diet and regular exercise can also help. Regular medical check-ups and monitoring for those at high risk can aid in early detection and treatment.

Neoplasm of the urinary bladder, or bladder cancer, is a common cancer that primarily affects older adults. It presents with symptoms like blood in the urine and requires a thorough diagnostic workup for confirmation. Treatment varies based on the cancer's stage and may include surgery, chemotherapy, radiation, or immunotherapy. While early-stage bladder cancer has a good prognosis, regular follow-up is essential due to the risk of recurrence. Prevention focuses on reducing risk factors, particularly smoking cessation.

If you or someone you know is experiencing symptoms such as blood in the urine, frequent urination, or pain during urination, it is important to seek medical evaluation. Bladder cancer is treatable, especially when detected early. Understanding the risk factors, such as smoking and chemical exposure, can help in taking preventive measures. Regular check-ups and being aware of changes in urinary habits can aid in early detection and improve outcomes.

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.