Introduction

Bladder cancer occurs in developed and less-developed countries, with 60% of the world cases occurring in more developed countries. The estimated world incidence was 360 000 and mortality 132 000 for the year 2000. Bladder cancer accounts for 2% of cancer deaths worldwide. The incidence of this disease has been increasing over the last several years while the mortality rate has been decreasing. Bladder cancer is the fourth most common cancer in men and the eighth most common cancer in women in the US, with a 3:1 ratio in men versus women worldwide.,

Transitional cell carcinoma accounts for 90% of bladder cancers diagnosed in developed countries. Known risk factors for the development of transitional cell carcinoma of the bladder include cigarette smoking and occupational exposure to various agents, including aromatic amines used in textile, rubber, and cable industries. Squamous cell carcinoma accounts for 3% of bladder cancers diagnosed in the US compared with 75% in the Middle East and parts of Africa where schistosomiasis is endemic. Other risk factors for squamous cell carcinoma of the bladder may include chronic bladder infections and calculi. Much less common bladder cancer histologies include adenocarcinoma, small cell carcinoma, lymphoma, and melanoma.

Patterns of presentation and progression

In the US, the median age at diagnosis is 65 years. It is rarely diagnosed before the age of 40, and 80–90% of patients present with hematuria, which is often intermittent. Patients over 40 presenting with hematuria should be investigated.