It is well documented that the etiology of
bladder cancer involves environmental factors. Most chemical
carcinogens probably affect the urothelial cells via their presence in the urine. As an important cofactor, cell proliferative activity may be increased by urinary bladder
infection, irritation by
bladder stones or through the action of a variety of endogenously produced direct acting chemicals or agents. Among the known causative factors, avoidable major ones are occupational exposure to certain chemicals such as
benzidine and
4-aminobiphenyl, cigarette smoking and bilharzial
infection, which could be eradicated by a combination of
praziquantel, antihelminth
therapy, education and improvements in social welfare. An anticarcinogenic
drug,
cyclophosphamide, used as an
immunosuppressive agent also seems to be associated with a high risk of idiopathic induction of
bladder cancer and physicians should therefore pay particular attention to its diverse effects when considering its prescription. In contrast to the above, the consumption of
coffee and
tea including
artificial sweeteners is now thought unlikely to be major risk. So far there is no good biochemical tool to predict individual exposure to bladder
carcinogens/or relative risk of
bladder cancer development. However, acetylation capacity can be applied to assess susceptibility to carcinogenic
amines in people exposed in their working environment. Progress in molecular
biological analysis will hopefully bring to light etiology-specific DNA damage in the
bladder tumors and prove useful for prediction of
tumor behavior in the near future.