Comparative Outcomes of Bladder Cancer in Patients Under 40 Years of Age

Main Article Content

Rebecca Tregunna
Mark Feneley
Alex Freeman
Dan Wood


Background and Objectives
Bladder tumours are rare in young patients. Consequently, the literature is sparse and studies provide con-flicting reports on clinicopathological data and patient outcomes. This study examines, to our knowledge, the largest UK series of patients aged less than 40 years diagnosed with bladder cancer, and examines their risks and outcomes.
Material and Methods
A prospectively recorded database (2008-2018) was used to identify patients aged under 40 years diagnosed with bladder cancer. Data were retrospectively analyzed. Patients were then sub-divided into 2 groups based on age: group 1 was aged below 20 years and group 2 was aged 20–39 years.
A total of 27 patients were identified with a median age of 34 years (range 14–39). Male to female ratio was 2.86:1. Median follow-up was 41.5 months (range 3–108). 61.9% presented with visible hematuria and 54.2% had one or more risk factors such as cigarette smoking. A total of 96.3% of patients had urothelial carcinoma and 92.3% of these were non-muscle invasive tumours. 7.7% presented with muscle invasive disease with 3.8% having positive nodes at diagnosis. Patients with non-muscle invasive urothelial tumours were risk-stratified according to the EAU-Guidelines Panel risk grouping with 39.1% low-risk, 4.3% intermediate-risk and 56.5% high-risk of recurrence and/or progression. During follow-up 30.4% recurred and 4.3% progressed to invasive disease. 23.1% underwent cystectomy and overall 11.5% died during follow-up, all due to metastatic disease. Patients in group one showed a statistically significant incidence of lower-grade disease at diagnosis with lower risk-group stratification but there was no significant difference in other parameters.
The majority of young patients in our series presented with non-muscle invasive urothelial bladder tumours but a significant proportion of these had high-risk disease. Some patients presented with aggressive, muscle invasive bladder cancer and consequently bladder cancer remains an important differential diagnosis in symptomatic patients regardless of age.


Download data is not yet available.

Article Details

How to Cite
Tregunna, R., Feneley, M., Freeman, A., & Wood, D. (2019). Comparative Outcomes of Bladder Cancer in Patients Under 40 Years of Age. Journal of Endoluminal Endourology, 2(4), e10-e19.
Original Article
Author Biographies

Mark Feneley, University College Hospital London

Consultant urological surgeon, department of urology.

Alex Freeman, University College Hospital London

Consultant histopathologist, department of histopathology.

Dan Wood, University College Hospital London

Consultant urological surgeon, department of urology.


1. Compérat E, Larré S, Roupret M, et al. Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old. Virchows Arch 2015;466(5):589–94.
2. Beukers W, Hercegovac A, Zwarthoff EC. HRAS mutations in bladder cancer at an early age and the possible association with the Costello Syndrome. Eur J Hum Genet 2014;22(6):837–9.
3. Jayadpour N, Mostofi FK. Primary epithelial tumors of the bladder in the first two decades of life. J Urol 1969;101(5):706–10.
4. Huang H, Sun M, Li X, et al. Urothelial carcinoma of the bladder in patients aged 30 years or younger: clinicopathological analysis and expression of fibroblast growth factor receptor 3 (FGFR3) of 45 cases. Med Oncol 2015; 32(5):137.
5. Paner GP, Zehnder P, Amin AM, et al. Urothelial neoplasms of the urinary bladder occurring in young adult and pediatric patients: A comprehensive review of literature with implications for patient management. Advances in Anatomic Pathology 2011;18(1):79–89.
6. Wang ZH, Li YY, Hu ZQ, et al. Does urothelial cancer of bladder behave differently in young patients? Chin Med J (Engl) 2012;125(15):2643–8.
7. Owen HC, Giedl J, Wild PJ, et al. Low frequency of epigenetic events in urothelial tumors in young patients. J Urol 2010;184(2):459–63.
8. Babjuk M, Burger M, Compérat E, et al. Non-muscle-invasive Bladder Cancer (TaT1 and CIS) EAU Guidelines. 2019;1–50.
9. Shariat SF, Sfakianos JP, Droller MJ, et al. The effect of age and gender on bladder cancer: A critical review of the literature. BJU Int 2010;105(3):300–8.
10. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69(1):7–34.
11. Migaldi M, Rossi G, Maiorana A, et al. Superficial papillary urothelial carcinomas in young and elderly patients: A comparative study. BJU Int 2004;94(3):311–6.
12. Hartge P, Harvey EB, Linehan WM, et al. Unexplained excess risk of bladder cancer in men. J Natl Cancer Inst 1990;82(20):1636–40.
13. Gunlusoy B, Ceylan Y, Degirmenci T, et al. Urothelial bladder cancer in young adults: Diagnosis, treatment and clinical behaviour. J Can Urol Assoc 2015;9(9–10):E727–E730.
14. Stanton ML, Xiao L, Czerniak BA, et al. Urothelial tumors of the urinary bladder in young patients: A clinicopathologic study of 59 cases. Arch Pathol Lab Med 2013;137(10):1337–41.
15. Bujons A, Caffaratti J, Garat JM, et al. Long-term follow-up of transitional cell carcinoma of the bladder in childhood. J Pediatr Urol 2014;10(1):167–70.
16. Nomikos M, Pappas A, Kopaka M-E, et al. Urothelial carcinoma of the urinary bladder in young adults: presentation, clinical behavior and outcome. Adv Urol 2011;480738.
17. Freedman ND, Silverman DT, Hollenbeck AR, et al. Association between smoking and risk of bladder cancer among men and women. JAMA - J Am Med Assoc 2011;306(7):737–45.
18. Cancer Research UK. Tobacco Statistics. Available at:
19. Sen V, Bozkurt O, Demir O, et al. Clinical behavior of bladder urothelial carcinoma in young patients: a single center experience. Scientifica (Cairo) 2016;6792484.
20. Özbey I, Aksoy Y, Biçgi O, et al. Transitional cell carcinoma of the bladder in patients under 40 years of age. Int Urol Nephrol 1999;31(5):655–9.
21. Abbasov B, Munguia G, Mazal PR, et al. Epithelioid angiosarcoma of the bladder: report of a new case with immunohistochemical profile and review of the literature. Pathology 2011;43(3):290–3.
22. Nizam A, Paquette EL, Wang BG, et al. Epithelioid angiosarcoma of the bladder: a case report and review of the literature. Clin Genitourin Cancer 2018;16(6):e1091-95.
23. Mongiat-Artus P, Miquel C, Van Der Aa M, et al. Infrequent microsatellite instability in urothelial cell carcinoma of the bladder in young patients. Eur Urol 2006;49(4):685–90.
24. Erozenci A, Araus S, Pekyalcin A, et al. Transitional cell carcinoma of the bladder in patients under 40 years of age. Int Urol Nephrol 1994;26(2):179–82.
25. Wen YC, Kuo JY, Chen KK, et al. Urothelial carcinoma of the urinary bladder in young adults - Clinical experience at Taipei Veterans General Hospital. J Chinese Med Assoc 2005;68(6):272–75.
26. Yossepowitch O, Dalbagni G. Transitional cell carcinoma of the bladder in young adults: Presentation, natural history and outcome. J Urol 2002;168(1):61–6.
27. Lara J, Brunson A, Keegan THM, et al. Determinants of survival for adolescents and young adults with urothelial bladder cancer: results from the california cancer registry. J Urol 2016;196(5):1378–82.
28. Caione P, Patruno G, Pagliarulo V, et al. Nonmuscular invasive urothelial carcinoma of the bladder in pediatric and young adult patients: age-related outcomes. Urology 2017;99:215–20.
29. Shelekhova K V., Krykow KA, Mescherjakov IA, et al. Molecular pathologic subtyping of urothelial bladder carcinoma in young patients. Int J Surg Pathol 2019;27(5):483–91.
30. Wild PJ, Giedl J, Stoehr R, et al. Genomic aberrations are rare in urothelial neoplasms of patients 19 years or younger. J Pathol 2007;211(1):18–25.

DB Error: Unknown column 'Array' in 'where clause'