Bladder Cancer

The bladder is a hollow organ in your lower abdomen that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age. It is the sixth most common type of cancer in the United States.

The most common type of bladder cancer is transitional cell carcinoma, which begins in urothelial cells that line the inside of the bladder. Urothelial cells are transitional cells, which are able to change shape and stretch when the bladder is full. This type of cancer is also called urothelial carcinoma. Other types of bladder cancer include squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Symptoms of bladder cancer include blood in your urine, a frequent urge to urinate, pain when you urinate, and low back pain.

Risk factors for developing bladder cancer include smoking and exposure to certain chemicals in the workplace. People with a family history of bladder cancer or who are older, white, or male also have a higher risk of developing bladder cancer.

Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and biologic therapy.

Most bladder cancers are diagnosed at an early stage when bladder cancer is easy to treat. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests for years after treatment to look for bladder cancer recurrence.

The most common sign of bladder cancer is blood in the urine. Bladder cancer can also cause changes in urination, such as:

• Having to urinate more often than usual
• Pain or burning during urination
• Feeling as if you need to urinate right away, even when the bladder is not full

These symptoms can also be caused by a benign condition such as infection, bladder stones, an overactive bladder, or an enlarged prostate (in men).

Bladder cancers that have grown large enough or have spread to other parts of the body can sometimes cause other symptoms, such as:

• Being unable to urinate
• Lower back pain on one side
• Loss of appetite and weight loss
• Swelling in the feet
• Bone pain

The cause of bladder cancer is not always clear. Bladder cancer has been linked to smoking, a parasitic infection, radiation and chemical exposure.

Bladder cancer develops when cells in the bladder begin to grow abnormally. Instead of growing and dividing in an orderly way, cells develop mutations that cause them to grow out of control and not die. These abnormal cells form a tumor.

Several risk factors make a person more likely to develop bladder cancer:

• Smoking. Smoking is the most important risk factor for bladder cancer. Smokers are at least 3 times as likely to get bladder cancer as non-smokers.
• Chemical exposures. Certain industrial chemicals have been linked with bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, which are sometimes used in the dye industry, can cause bladder cancer.
• Race and ethnicity. Caucasians are approximately twice as likely to develop bladder cancer as African Americans. Hispanics, Asian Americans, and American Indians have slightly lower rates of bladder cancer. The reasons for these differences are not well understood.
• Advanced age. The risk of bladder cancer increases with age, and most people with bladder cancer are older than 55.
• Gender. Bladder cancer is more common in men than in women.
• Chronic bladder irritation and infections. Urinary tract infections, kidney and bladder stones, bladder catheters left in place for a long time, and other causes of chronic bladder irritation have been linked with bladder cancer , but it is not clear if they actually cause bladder cancer.
• Personal history of bladder or other urothelial cancer. Urothelial carcinomas can form in many areas in the bladder as well as in the lining of the kidney, the ureters, and urethra. Having a cancer in the lining of any part of the urinary tract puts you at higher risk of having another tumor.
• Bladder birth defects. Rarely, defects in the bladder and abdominal wall can cause bladder cancer. Surgery soon after birth can repair defects, but these people will have a higher risk for urinary infections and bladder cancer.
• Genetics and family history. People who have family members with bladder cancer have an increased risk of getting it themselves. A small number of people inherit a gene syndrome that increases their risk for bladder cancer.
• Chemotherapy and radiation therapy. Long-term use of the chemotherapy drug cyclophosphamide(Cytoxan) can irritate the bladder and increase the risk of bladder cancer. People taking this drug are often told to drink plenty of fluids to help protect the bladder from irritation and decrease the risk of bladder cancer. People who are treated with radiation to the pelvis are more likely to develop bladder cancer.
• Certain medicines or herbal supplements. According to the US Food and Drug Administration (FDA), use of the diabetes medicine pioglitazone (Actos) for more than 1 year may be linked with an increased risk of bladder cancer. Dietary supplements containing aristolochic acid (mainly in herbs from the Aristolochia family) have been linked with an increased risk of urothelial cancers, including bladder cancer.
• Arsenic in drinking water. Arsenic in drinking water has been linked with an increased risk of bladder cancer in some parts of the world. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a public water system that meets the standards for arsenic content. For most Americans, drinking water is not a major source of arsenic.
• Low fluid consumption. Not drinking enough fluids may increase the risk of bladder cancer. People who drink a lot of fluids each day have a lower rate of bladder cancer. This is thought to be because they empty their bladders often. By doing this, they keep chemicals from lingering in their bodies.

Tests and procedures used to diagnose bladder cancer may include:

• Cystoscopy. A narrow tube (cystoscope) is inserted through your urethra. The cystoscope has a lens and fiber-optic lighting system, allowing your doctor to see and examine the inside of your urethra and bladder.
• Biopsy. During cystoscopy, your doctor may pass a special tool through the scope and into your bladder in order to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.
• Urine cytology. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
• Imaging tests. Imaging tests allow your doctor to examine the structures of your urinary tract. Tests to highlight the urinary tract sometimes use a dye, which is injected into a vein before the procedure. An intravenous pyelogram is a type of X-ray imaging test that uses a dye to highlight your kidneys, ureters and bladder. A computerized tomography (CT) scan is a type of X-ray test that allows your doctor to better see your urinary tract and the surrounding tissues.

There is no guaranteed way to prevent bladder cancer, but steps can be taken to help reduce your risk.

• Do not smoke. 
• Take caution around chemicals. 
• Drink plenty of water throughout the day. 
• Eat a variety of fruits and vegetables. 

If you have or have had bladder cancer, you can take steps to manage the stress that accompanies the diagnosis:

• Have a schedule of follow-up tests and go to each appointment. 
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Talk with other bladder cancer survivors or attend support groups. 

Treatment for bladder cancer depends on the type and stage of the cancer, your overall health, and your treatment preferences.

If your cancer is very small and has not invaded the wall of your bladder, your doctor may recommend surgery to remove the tumor, surgery to remove the tumor and a small portion of the bladder, or biological therapy (immunotherapy).

If your cancer has invaded the deeper layers of the bladder wall, your doctor may recommend surgery to remove the entire bladder and/or surgery to create a new way for urine to leave your body.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves 2 or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing a tube through your urethra (intravesical therapy).

Chemotherapy may be used to kill cancer cells that might remain after surgery. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy in very select cases when surgery isn't an option.

Chemotherapies used for bladder cancer include cisplatin (Platinol, Platinol-AQ), doxorubicin hydrochloride (Adriamycin, Doxil), and thiotepa.

Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy for bladder cancer usually is delivered from a machine that moves around your body, directing the energy beams to precise points. Radiation therapy can be used after surgery to kill any remaining cancer cells. In very select cases, radiation therapy is combined with chemotherapy when surgery is not an option, though this is generally considered an option of last resort.