Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about or that we otherwise haven’t been able to report on very often.

Eyes front and ears open. Class is now in session.

The rare disease that we will be learning about today is:

Bladder Cancer

What is Bladder Cancer?

• Bladder cancer is a form of cancer that appears from the tissue of the urinary bladder
  • Several different types of cancer can occur in this tissue, with transitional cell carcinoma being most common
  • Other forms include adenocarcinoma and squamous cell carcinoma
• Cystoscopy is typically used to diagnose this cancer
• The highest diagnostic rates occur in southern and western Europe and in North America; however, highest rates of death were in North Africa and western Asia
• Onset of this cancer typically occurs in relatively old age

How Do You Get It?

• A number of risk factors for bladder cancer have been identified, which include:
  • Family history
  • Tobacco smoking
  • Exposure to certain chemicals
  • Frequent bladder infections
  • History of radiation therapy
  • Being male (risk of bladder cancer is four times higher in men)
• Age of onset is usually between 65 and 84 years

What Are the Symptoms?

• Signs and symptoms include:
  • Blood in the urine
  • Frequent urination
  • Pain during urination
  • Urge to urinate without being able to
  • Flank pain (advanced disease)
  • Pelvic or bone pain (advanced disease)

How Is It Treated?

• Treatment of bladder cancer is based on the extent of tissue penetration by the tumor, which is determined by cancer staging, whether the tumor is considered muscle invasive or not, or other signs of metastasis
• Non-muscle invasive:
  • Transurethral resection – A procedure in which the tumor is ‘shaved’ off with electrocautery
  • Chemotherapy
  • Immunotherapy
• Muscle invasive:
  • Multimodal therapy – Surgical removal of part or all of the bladder, sometimes with chemotherapy after
  • Trimodal therapy- Combination of endoscopic surgery to remove the tumor in combination with radiation and chemotherapy
• Metastatic:
  • Cisplatin-based chemotherapy is the standard treatment for metastatic bladder cancer. Second-line immunotherapy or chemotherapy may be used if the cancer returns or progresses
• Quality of life and outcomes vary considerably in bladder cancer. Five-year survival rate is around 77% in the US.

Where Can I Learn More???

• Learn more about this disease from the Bladder Cancer Advocacy Network.