Bladder cancer is the growth of abnormal or cancerous cells on the inner lining of the bladder wall. Most bladder cancers are detected at early stages when the tumor has not spread outside the bladder and treatments are successful.
Blood in Urine (Hematuria)
One sign of bladder cancer is blood in the urine, also known as hematuria. Blood in the urine does not always mean bladder cancer. Hematuria is most often caused by other conditions like trauma, infection, blood disorders, kidney problems, exercise, or certain medications. Blood in the urine may be seen by the naked eye (gross hematuria) or only detected on urine testing (microscopic hematuria). The urine may be discolored and appear brownish or darker than usual or, rarely, bright red in color.
Bladder ChangesBladder cancer sometimes causes changes in bladder habits like having to urinate more often or feeling an urgent need to urinate without producing urine. Another symptom of bladder cancer is pain or burning during urination without evidence of a urinary tract infection. These symptoms of bladder problems, like bleeding, are usually caused by conditions other than cancer. Bladder cancer tends to cause no symptoms until it reaches an advanced stage that is difficult to cure.
Possible Causes of Bladder Cancer:
· SmokingSmoking is the greatest known risk factor for bladder cancer; smokers are four times more likely to get bladder cancer than nonsmokers. Harmful chemicals from cigarette smoke enter the bloodstream in the lungs and are ultimately filtered by the kidneys into the urine. This leads to a concentration of harmful chemicals inside the bladder. Experts believe that smoking causes about half of all bladder cancers in men and women.
· Chemical ExposureExposure to certain chemicals on the job can increase risk of bladder cancer. Occupations that may involve exposure to cancer-causing chemicals include metal workers, hairdressers, and mechanics. Organic chemicals called aromatic amines are especially associated with bladder cancer and are used in the dye industry. Those working with dyes, metal workers, or in the manufacturing of leather, textiles, rubber, or paint should be sure to follow recommended safety protocols. Smoking increases the risk even more for these workers.
Who is at Risk for Bladder Cancer?Bladder cancer can affect anyone, but certain groups are at greater risk. Men are three times more likely than women to get bladder cancer. Around 90% of cases occur in people over age 55, and whites are twice as likely as African Americans to develop the condition.
Other factors that increase the risk of getting bladder cancer include a family history of the condition and previous cancer treatment. Birth defects involving the bladder increase the risk of bladder cancer. When people are born with a visible or invisible defect that connects their bladder with another organ in the abdomen, this leaves the bladder prone to frequent infection. This increases the bladder’s susceptibility to cellular abnormalities that can lead to cancer. Chronic bladder inflammation (frequent bladder infections, bladder stones, and other urinary tract problems that irritate the bladder) increase the risk of developing bladder cancer.
>> TestingThere is no single lab test that can specifically screen for and diagnose bladder cancer, even though urine tests may suggest that cancer is present. If a cancer is present, several tests may be abnormal, including urine cytology and tests for tumor marker proteins.
Urinalysis and Urine Cytology
CT Scans and MRI
Types of Bladder CancerBladder cancers are named for the specific type of cell that becomes cancerous. Most bladder cancers are transitional cell carcinomas, named for the cells that line the bladder. Other less common types of bladder cancer are squamous cell carcinoma and adenocarcinoma.
Transitional Cell Carcinoma
There are two types of transitional cell carcinoma, low-grade and high-grade. Low-grade transitional cell carcinoma tends to come back after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body. High-grade transitional cell carcinoma also tends to come back after treatment and will often spread into the muscle layer of the bladder, other parts of the body, and the lymph nodes. High-grade diseases cause most bladder cancer deaths.
Squamous Cell Carcinoma
Stages of Bladder Cancer
Cancer staging is typically determined by the extent to which a cancer has grown or spread. A staging system is a way for professionals to specifically describe how much a cancer has progressed. Typically, the TNM system is used for bladder cancer and represents the following:
- T describes how far the main tumor has grown
- N reveals any cancer spread to lymph nodes near the bladder
- M reveals whether the cancer has spread (metastasized) to other locations away from the bladder.
Bladder Cancer StagesStage 0a (Ta, N0, M0): The cancer is non-invasive papillary carcinoma and has not invaded the connective tissue or bladder wall muscle.
Stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only.
Stage I (T1, N0, M0): Tumor has spread onto the bladder wall.
Stage II (T2, N0, M0): Tumor has penetrated the inner wall and is present in muscle of the bladder wall.
Stage III (T3, N0, M0): Tumor has spread through the bladder to fat around the bladder.
Stage IV applies to one of the following: (T4, N0, M0): Tumor has grown through the bladder wall and into the pelvic or abdominal wall.
Any T, N1, M0: The tumor has spread to the nearby lymph nodes. Any T, any N, M1: The tumor has spread to distant lymph nodes or to sites such as bones, liver, or lungs.
Bladder Cancer Treatment:
Partial and Radical Cystectomy
>> Urinary Diversion After SurgeryWhen the entire bladder is removed the surgeon will create an alternate way for urine to be stored and passed. This procedure is called urinary diversion. Depending on preference, a bag can either be placed inside or outside of the body to collect urine. Non-continent urinary diversion is when a urostomy bag is placed outside the body, worn under the clothes. Continent urinary diversion consists of a pouch, made from intestinal tissue, inside the body to hold urine. In a newly introduced surgical procedure, the insertion of an artificial bladder has also been successful for some patients.
>> ChemotherapyChemotherapy is given in some cases before surgery to shrink bladder cancer tumors. It can also be used after surgery to destroy any remaining tumor cells. Chemotherapy may be given intravenously or administered directly into the bladder (intravesical chemotherapy). Intravesical chemotherapy is effective in decreasing the recurrence rate of superficial bladder cancers on a short-term basis, but not effective against bladder cancer that has already invaded the muscular walls. Systemic or intravenous chemotherapy is required when the cancer has deeply penetrated the bladder, lymph nodes, or other organs.
Chemotherapy Side EffectsSide effects vary from patient to patient. Common side effects of systemic chemotherapy include the following:
- Nausea andvomiting
- Loss of appetite
- Hair loss
- Sores on the inside of the mouth or in the digestive tract
- Feeling tired or lacking energy
- Increased susceptibility to infection
- Easy bruising or bleeding
- Numbness or tingling in the hands orfeet
>> ImmunotherapyImmunotherapy involves the administration of helpful bacteria through a catheter into the bladder to trigger the immune system to attack both the bacteria and the cancer cells. Immunotherapy is only given in stages Ta, T1, and CIS (carcinoma in situ) bladder cancers. Bacillus Calmette-Guerin (BCG) is a type of bacteria used in this therapy. Intravesical BCG treatment is given once a week and can be used after surgery to lower the chance of tumor recurrence. Immunotherapy side effects can include irritation of the bladder, minor bleeding in the bladder, and flu-like symptoms.
What is Radiation?Radiation therapy is the use of painless, invisible, high-energy radiation that can kill both healthy and cancerous cells. Radiation can be used as an alternative approach or in addition to chemotherapy or surgery to destroy cancer cells.
Radiation Side EffectsRadiation therapy also has side effects, which can include fatigue, nausea, skin irritation, pain with urination, and diarrhea.
Alternative Treatments for Bladder CancerThere are no alternative or complementary therapies that have been shown to prevent or cure bladder cancer. Ongoing research studies are examining the role of green tea or broccoli sprouts as potential complementary treatments.
Bladder Cancer Survival Rates and Prognosis
Bladder Cancer Survival RatesAs with most cancers, survival rates are dependent upon the stage or extent of spread of the cancer when it is found. About 50% of bladder cancers are detected when the tumor is limited to the inner lining of the bladder, and 5-year survival rates for this early stage of cancer are nearly 100%. Cancers that have spread further typically have lower survival rates. Today the relative survival rates for all stages of bladder cancer are 77% at 5 years, 70% at 10 years, and 65% at 15 years.
Bladder Cancer PrognosisThe outlook for bladder cancer patients depends on the stage of cancer at the time of diagnosis. Patients with metastatic bladder cancer that has spread to other organs have an average life expectancy of 12 to 18 months. Recurrent cancer suggests a more aggressive type and a negative outlook for long-term survival for patients with advanced stage bladder cancer.
Sex After Bladder Cancer TreatmentThe surgery for bladder cancer can damage nerves in the pelvis, making sex difficult.
Changes for MenSome men may have trouble getting an erection, but in younger men, this may improve over time. Semen cannot be produced if the surgery involved removal of the prostate gland and seminal vesicles.
Changes for WomenIn women, the uterus, ovaries, and part of the vagina are removed during radical cystectomy. This permanently stopsmenstruation and prohibits all future pregnancies. Women who undergo surgery for bladder cancer may also find that sex is less comfortable, and achieving orgasms may be difficult.
Bladder Cancer PreventionThere is no known way to prevent bladder cancer, but it is always advisable to follow a healthy lifestyle. Stop smoking and limit alcohol consumption to 1 to 2 drinks a day. A healthy diet contains lots of fruits, vegetables, whole grains, and correct portion sizes of lean meats. Regular exercise and having checkups can also help you support your health and provide peace of mind. Avoid unsafe chemical exposures and keep protected if working with chemicals.
New and Experimental Treatments for Bladder CancerNew treatments are being investigated for bladder cancer. These include photodynamic therapy, gene therapy, and targeted therapy. Clinical trials are available to test some of these or other new therapies.