Bladder Cancer

What is Bladder cancer

Bladder cancer is an abnormal growth of tissue in the bladder. The bladder is the balloon-like sac in the pelvis. It collects and stores urine that comes from the kidneys through the ureters.

The bladder wall is made of layers. If cancer spreads into these layers and through the wall of the bladder, it becomes more difficult to treat.

How common is bladder cancer?

Bladder cancer is the second most common genitourinary malignancy in the United States (where prostate cancer is the most common), most often arising in patients in the sixth to eighth decades of life, and occurring three times more commonly in men than in women.

Ninety percent are due to urothelial (transitional cell) carcinoma, 5% are due to squamous cell carcinoma, 2% are due to adenocarcinoma, and 3% are due to other histologic subtypes.

Tobacco use is the most common risk factor.

What are the causes?

The cause of this condition is not known.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Smoking.
• Workplace risks (occupational exposures), such as rubber, leather, textile, dyes, chemicals, and paint.
• Being white.
• Your age. Most people with bladder cancer are over the age of 55.
• Being male.
• Having chronic bladder inflammation.
• Having a personal history of bladder cancer.
• Having a family history of bladder cancer (heredity).
• Having had chemotherapy or radiation therapy to the pelvis.
• Having been exposed to arsenic.

What are the symptoms of Bladder cancer?

Initial symptoms of this condition include:

• Blood in the urine.
• Painful urination.
• Frequent bladder or urine infections.
• Increase in urgency and frequency of urination.

Advanced symptoms of this condition include:

• Not being able to urinate.
• Low back pain on one side.
• Loss of appetite.
• Weight loss.
• Fatigue.
• Swelling in the feet.
• Bone pain.

How is this diagnosed?

This condition is diagnosed based on your medical history, a physical exam, urine tests, lab tests, imaging tests, and your symptoms. You may also have other tests or procedures done, such as:

• A narrow tube being inserted into your bladder through your urethra (cystoscopy) in order to view the lining of your bladder for tumors.
• A biopsy to sample the tumor to see if cancer is present.

If cancer is present, it will then be staged to determine its severity and extent. Staging is an assessment of:

• The size of the tumor.
• Whether the cancer has spread.
• Where the cancer has spread.

It is important to know how deeply into the bladder wall cancer has grown and whether cancer has spread to any other parts of your body. Staging may require blood tests or imaging tests, such as a CT scan, MRI, bone scan, or chest X-ray.

How is this treated?

Based on the stage of cancer, one treatment or a combination of treatments may be recommended. The most common forms of treatment are:

• Surgery to remove the cancer. Procedures that may be done include transurethral resection and cystectomy.
• Radiation therapy. This is high-energy X-rays or other particles. This is often used in combination with chemotherapy.
• Chemotherapy. During this treatment, medicines are used to kill cancer cells.
• Immunotherapy. This uses medicines to help your own immune system destroy cancer cells.

Seventy percent of bladder cancers are superficial to the detrusor muscle layer at presentation. Superficial bladder cancers are treated with transurethral resection of bladder tumor (TURBT) during cystoscopy as well as intravesical bacillus Calmette-Guérin (BCG) therapy.

However, ≈70% of superficial bladder cancers recur, and up to 25% become muscle invasive. Thirty percent of bladder cancers are muscle invasive (i.e., involve the detrusor muscle) at presentation, and may sometimes extend beyond the bladder either locally or through lymphatic or hematogenous routes of metastatic spread.

These more advanced stage tumors are treated with radical cystectomy or cystoprostatectomy, pelvic lymphadenectomy, radiation therapy, and/or chemotherapy depending on the spatial extent of disease.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Maintain a healthy diet. Some of your treatments might affect your appetite.
• Consider joining a support group. This may help you learn to cope with the stress of having bladder cancer.
• Tell your cancer care team if you develop side effects. They may be able to recommend ways to relieve them.
• Keep all follow-up visits as told by your health care provider. This is important.

Where to find more information

• American Cancer Society: www.cancer.org
• National Cancer Institute (NCI): www.cancer.gov

Contact a health care provider if:

• You have symptoms of a urinary tract infection. These include:
  • Fever.
  • Chills.
  • Weakness.
  • Muscle aches.
  • Abdominal pain.
  • Frequent and intense urge to urinate.
  • Burning feeling in the bladder or urethra during urination.

Get help right away if:

• There is blood in your urine.
• You cannot urinate.
• You have severe pain or other symptoms that do not go away.

Summary

• Bladder cancer is an abnormal growth of tissue in the bladder.
• This condition is diagnosed based on your medical history, a physical exam, urine tests, lab tests, imaging tests, and your symptoms.
• Based on the stage of cancer, surgery, chemotherapy, or a combination of treatments may be recommended.
• Consider joining a support group. This may help you learn to cope with the stress of having bladder cancer.