What Is Bladder Cancer?

Over 90 percent of bladder cancer cases develop in the tissue lining the inside of the organ.

Bladder cancer is cancer that forms in your urinary bladder, the muscular sac that stores urine.

This balloon-shaped organ is located in your pelvis. Urine made by the kidneys goes into your bladder for storage.

The bladder consists of several layers, including a muscular wall. The muscle relaxes to allow the bladder to fill with urine, and contracts to allow urination.

Cancer is a disease in which abnormal cells grow out of control. Cancer cells can form tumor masses and may invade other nearby tissues.

Types of Bladder Cancer

Most bladder cancer develops in the tissue that lines the inside of the bladder.

This tissue is called urothelium, or transitional epithelium, and cancer that develops here is called transitional cell carcinoma. More than 90 percent of all bladder cancers are this type of cancer.

When bladder cancer affects only the inner lining of the bladder, it is called superficial bladder cancer.

More advanced bladder cancer may spread into other layers of the bladder wall, or may pass into lymph nodes in the pelvis. This is called invasive bladder cancer.

Invasive bladder cancer is harder to treat and is more likely to spread to other tissues and organs in the body.

Who Gets Bladder Cancer?

In the United States, about 74,000 people are diagnosed with bladder cancer each year. About 16,000 people die from the disease each year, according to the American Cancer Society.

Bladder cancer ranks as the fourth most common cancer in men, and the eighth most common cause of cancer death in men.

The vast majority of people with bladder cancer is over the age of 55. The average age at diagnosis is 73, notes the American Cancer Society.

Men are more likely than women to develop bladder cancer, and whites are more likely to get it than African-Americans.

Your risk of developing bladder cancer increases if you:

• Smoke tobacco
• Work with chemicals or industrial materials such as dyes, rubber, leather, metals, petroleum, textiles, paints, or diesel fumes
• Were born with a bladder defect
• Have a history of chronic bladder infections, kidney stones, or other bladder disorders
• Have had to use a bladder catheter for a long time
• Have previously received certain types of chemotherapy drugs, or radiation to the pelvis
• Have a history of infection with a bladder parasite (rare in the United States)
• Have a family history of bladder cancer
• Drink water that contains chlorine or arsenic
• Use the Chinese herb Aristolochia fangchi

Bladder Cancer Outlook

As with most types of cancer, a smaller and more-contained tumor is associated with a better prognosis (outlook).

Bladder cancer that is limited to the bladder’s innermost lining has the best prognosis. Luckily, most bladder cancers fall into this category.
The situation is more concerning if there are cancer cells:

• That have spread through and beyond the muscular wall of the bladder
• In the fat surrounding the bladder.
• Within a man’s prostate or a woman’s uterus or vagina
• In the abdominal or pelvic wall
• In the pelvic lymph nodes
• In distant lymph nodes or other organs (such as the bones, lungs, or liver)
• Other factors that can affect the outcome include the specific type of cancer cells involved, whether the cancer has recurred after previous treatments, and the person’s age and health.

 

Bladder Cancer Symptoms and Diagnosis

This cancer is usually diagnosed after blood shows up in the urine.

At first, bladder cancer may not cause any symptoms, or the symptoms may be very subtle.

Eventually, symptoms can include:

• Blood in the urine — either enough to be visible (with larger amounts, the urine may appear cola-colored), or smaller amounts that can only be seen under a microscope
• Frequent or urgent need to urinate
• Pain or burning with urination
• Pain in the back or pelvis

More advanced cases of bladder cancer can cause:

• Inability to urinate
• Back pain, usually confined to one side
• Pelvic or rectal pain
• Anemia
• Decreased appetite
• Unintended weight loss
• Swelling in the feet and lower legs
• Bone pain or fractures

Diagnosing Bladder Cancer

Bladder cancer may first be suspected when you start passing blood in your urine.

Once there is reason for suspicion, your doctor will do a careful check of your medical history to determine whether you have any risk factors for bladder cancer.

You will also need a complete physical exam, including a pelvic exam for women and a rectal exam for men.

This exam may reveal the presence of a pelvic mass, which can be a sign of bladder cancer.

Tests used to diagnose bladder cancer include:

Urinalysis: Testing a urine sample in a laboratory can reveal blood, infection, or other abnormalities.

Urine culture: A sample of urine is put in a special dish in a laboratory to see if any bacteria or fungi grow.

Urine cytology and/or tumor markers: A urine sample is examined to see if cancer cells are present, or if substances produced by tumors can be identified.

Cystoscopy: A lighted fiber-optic scope is passed through the urinary opening (urethra) into the bladder.

The inside of the bladder can then be examined, and tiny instruments can take a small sample of bladder tissue (biopsy) for testing.
Fluid may be introduced and then tested for the presence of cancer cells.

Imaging tests: X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, or other imaging tests may be ordered to visualize the bladder.

You may be asked to drink a contrast dye, which makes the bladder easier to see in certain tests. Imaging may also be used to guide a very thin needle into a tumor for biopsy.

Stages of Bladder Cancer

If you are diagnosed with bladder cancer, your doctor will perform further tests to determine the stage of the cancer.

Staging bladder cancer involves assessing the growth of the tumor and checking whether the cancer has spread to other areas of the body.

Knowing the cancer’s stage is important in deciding the best course of treatment.

Some of the tests used to stage bladder cancer include:

Chest X-ray
CT scan
MRI
Bone scan
The stages of bladder cancer range from 0 to IV, with additional sub-categories to describe the tumor and where the cancer has spread. The most advanced stage is IV.

The following are brief descriptions of each stage:

Stage 0: The cancer is non-invasive and has grown only on the inner lining of the bladder.

Stage I: The cancer has spread to the connective tissue beneath the inner lining of the bladder, but not to the muscle of the bladder wall.
Stage II: The cancer has spread to the muscle of the bladder wall, but not to the fatty tissue surrounding the bladder.

Stage III: The cancer has spread to the fatty tissue surrounding the bladder — and possibly to the prostate, vagina, or uterus — but not to lymph nodes or organs outside the region.

Stage IV: The cancer has spread to the pelvic or abdominal wall, lymph nodes, or distant organs such as the bones, lungs, or liver.

Bladder Cancer Treatment

Surgery, immunotherapy, chemotherapy, and radiation are common treatments for bladder cancer.

Several different procedures and drugs can be used to treat bladder cancer.

In some cases, more than one type of treatment will be necessary.

The course of treatment your doctor recommends will depend on the specific type of bladder cancer cells present, and how much the cancer has spread.

Common treatments for bladder cancer include surgery, immunotherapy, chemotherapy, and radiation therapy.

Surgery

Surgery is usually the first step in treating bladder cancer. Types of surgery for cancer removal include:

Transurethral resection: Surgical instruments are passed through the urinary opening (urethra) into the bladder.

Cancer cells can be cut away, burned away with an electrical device, or removed with a laser.

Segmental cystectomy: If the tumor is limited to one area of the bladder, then surgery may remove only that part of the bladder.

Leaving the rest of the bladder allows for more normal urinary functioning.

Complete cystectomy: If the tumor is more widely spread throughout the bladder, the entire bladder is removed.

If the entire bladder is removed, a new way to hold urine and excrete it from the body must be created. This is called bladder reconstruction. Several options exist:

Incontinent diversion: In some cases, urine may be diverted to a bag that you wear outside your body.

Urine continually collects in this bag, and you will be taught how to empty it regularly.
Continent diversion: A piece of your intestine may be used to create a new bladder-like sac to hold urine inside your body.

To drain the urine, a tube is passed through a valve into the sack several times a day.

Neobladder: This newer technique uses a segment of intestine to create a bladder that is placed in the pelvis where the original bladder was located.

This neobladder is attached to the urethra (the tube through which urine exits the body).

Many people can learn how to control urination from the neobladder during the day.

Immunotherapy

Also known as biologic therapy, immunotherapy stimulates your immune system to produce cells that can fight the cancer.

Immunotherapy drugs are usually administered directly into your bladder (a process called intravesical administration).

They may be given as the only treatment, or they may be given after surgery or another treatment to fight any cancer cells left behind.

Chemotherapy

Chemotherapy uses strong drugs to kill cancer cells or prevent them from dividing.

These medicines may be administered directly into your bladder, through an intravenous (IV) line into your bloodstream, or by mouth.

Chemotherapy can be given before surgery to shrink the tumor, or after surgery to kill any remaining cancer cells.
Sometimes more than one chemotherapy drug is used at the same time. Chemotherapy may be used in combination with radiation therapy.

Radiation

Radiation therapy uses high-energy beams to kill cancer cells.

Radiation is often used to kill any cancer cells that remain after surgery, but it can also be used to shrink a tumor before surgery.