What Is Bladder Cancer?
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.
Warning Sign: Blood in Urine
One sign of bladder cancer is blood in the urine, although this is not a specific sign. Blood in the urine 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 or only detected on urine testing. The urine may be discolored and appear brownish or darker than usual or, rarely, bright red in color.
Warning Sign: Bladder Changes
Bladder cancer sometimes causes changes in bladder habits like feeling an urgent need to urinate, urinating more frequently than usual, pain on urination, or difficulty with urination. But these symptoms of bladder problems, like bleeding, are usually caused by conditions other than cancer.
Risk Factor: Smoking
Smoking 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.
Risk Factor: Chemical Exposure
Exposure 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. 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.
Other Risk Factors
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, certain birth defects involving the bladder, chronic irritation of the bladder, and previous cancer treatment.
There are no lab tests that can specifically screen for and diagnose bladder cancer early 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. None of these are presently reliable enough yet to be used for screening the population at average risk of developing bladder cancer.
A procedure known as cystoscopy allows visualization of the inside of the bladder through a thin, lighted tube that contains a camera. The instrument can also take small samples (biopsies) if abnormal areas are seen. The biopsy is the most reliable way to diagnose cancer.
Further imaging tests can be done to see how far a cancer has spread. An intravenous pyelogram is an X-ray test with contrast material to show the kidneys, ureters, and bladder. MRI and CT scans are other imaging tests that can provide more detailed images and can show how far the cancer has spread. Ultrasound imaging uses sound waves to create images of internal organs.
Types of Bladder Cancer
Bladder 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.
Stages of Bladder Cancer
The stage of a cancer is the extent to which it has spread. Bladder cancers are staged as follows:
Stage 0: Cancerous cells in the inner lining tissue of the bladder.
Stage I: Tumor has spread onto the bladder wall.
Stage II: Tumor has penetrated the inner wall and is present in muscle of the bladder wall.
Stage III: Tumor has spread through the bladder to fat around the bladder.
Stage IV: Tumor has spread to the wall of the pelvis or abdomen, to the lymph nodes, or to areas away from the bladder such as the lungs, liver, or bones.
Early stage cancers are most commonly treated by transurethral (through the urethra or tube from which urine exits the body) surgery. If cancers have spread, a portion of the bladder (partial cystectomy) or the entire bladder (radical cystectomy) may be performed. Other organs may also be removed such as the uterus and ovaries in women and the prostate in men, if the cancers have spread.
Treatment: After Surgery
When the entire bladder is removed, the surgeon will create an alternate way for urine to be stored and passed. This may involve using a portion of the intestine to flow into a urostomy bag. Creation of an artificial bladder is a newer surgical option.
Chemotherapy is given in some cases before surgery to shrink the tumor. It can also be used after surgery to destroy any remaining tumor cells. Chemotherapy may be given intravenously or administered directly into the bladder. Side effects of the drugs can include nausea, hair loss, and fatigue, and a temporary lowering of some of the blood counts.
Immunotherapy 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. Bacillus Calmette-Guerin (BCG) is a type of bacteria used in this therapy. BCG treatment is given once a week and can be used after surgery to lower the chance of tumor recurrence. Side effects can include flu-like symptoms.
Radiation therapy uses high-energy beams to attack cancer cells. It is often used together with chemotherapy or surgery. It may be used alone for people who are unable to have surgery. Radiation therapy also has side effects, which can include fatigue, nausea, skin irritation, pain with urination, and diarrhea.
There 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
As 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.
Sex After Bladder Cancer Treatment
The surgery for bladder cancer can damage nerves in the pelvis, making sex difficult. Some 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. Women who undergo surgery for bladder cancer may also find that sex is less comfortable, and achieving orgasm may be difficult.
Living With Bladder Cancer
There is no known way to prevent a recurrence of the cancer after treatment, 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.
New and Experimental Treatments
New treatments are being investigated for bladder cancer. These include photodynamic therapy, which uses a laser light and a chemical that kills cancer cells. Gene therapy uses viruses created in the lab that attack cancer cells. Targeted therapies are directed at limiting growth of cancer cells. Clinical trials are available to test some of these or other new therapies.
More Reading on Cancer
Reviewed by Jay B. Zatzkin, MD on Wednesday, May 11, 2016
Slideshow Pictures: Bladder Cancer -- Symptoms, Stages & Treatment
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