The bladder is a balloon-shaped organ in the lower abdomen that stores urine. About 60,000 cases of bladder cancer are diagnosed in the U.S. each year.
Bladder cancer typically affects older adults, generally over the age of 55. It affects men four times as often as women, and is about twice as likely in Caucasians as it is in African-Americans.
The symptoms of bladder cancer differ from person to person. The following are common symptoms that should be discussed with your physician.
- Blood in the urine
- Red blood cells in the urine
- Painful urination
- Frequent urination
- Pain in the pelvis or flanks
- Feeling the need to urinate when you don’t have to
There are several types of bladder cancer.
Transitional cell carcinoma is the most common form of bladder cancer. It begins in the cells that line the inside of the bladder.
Squamous cell carcinoma begins in the thin, flat cells that form the lining of the bladder. Only about 4% of bladder cancer cases are of this type.
Adenocarcinoma begins in other glandular structures and then spreads to the bladder. This is the least common type of bladder cancer, accounting for about 2% of cases.
The exact causes of bladder cancer are not known. We do know that several factors can increase your risks.
- Cigarette smoking. Bladder cancer occurs in smokers about twice as often as non-smokers.
- Work environment. Exposure to certain dyes, organic chemicals and diesel fumes have been linked to bladder cancer.
- Chronic bladder irritation. Bladder infections and bladder stones may increase the risk of bladder cancer.
- Age, race and gender. Bladder cancer is more likely in those over 40, in Caucasians and in men.
- Personal and family history. If you have had bladder cancer before, or if bladder cancer runs in your family, you have an increased risk.
- Parasitic infections. Infection by certain parasites that are present in other parts of the world (but not in the U.S.) can lead to increased risk of bladder cancer.
There are several methods your doctor may use to help diagnose bladder cancer.
- Rectal or vaginal examination
- Cytoscopy. A thin, flexible scope is inserted into the urethra to examine the bladder.
- Intravenous pyelogram. A contrast dye is injected and X-rays are taken of the bladder and associated organs.
- Urinalysis. A sample of urine is checked in the lab for presence of abnormalities.
- Bladder tumor marker studies. Tests to determine if certain signs, or “markers”, of bladder cancer are present.
- Ultrasound. Sound waves are used to create images of the bladder and associated structures.
- Computed Tomography (CT). Provides highly-detailed cross-sectional images of the bladder.
- Bladder biopsy. A sample of tissue is removed and examined to determine if cancer is present.
Bladder cancer can be treated through surgery, radiation, hormone therapy and chemotherapy. Often, a combination of these treatments is used.
- Transurethral resection removes cancerous cells with a cytoscope, a thin, flexible tube that is inserted into the bladder through the urethra.
- Cystectomy is a surgical procedure that removes all or part of the bladder.
- Segmental cystectomy removes just that part of the bladder where cancerous cells are present.
- Radical cystectomy is surgery to remove the bladder and other nearby organs that contain cancer cells.
- External radiation means sending radiation directly into cancer cells with equipment that is outside your body.
- Internal radiation, or implant therapy, involves sending radiation into affected cells through small implants that are placed into the bladder tissue.
Side effects of radiation therapy may include diarrhea, nausea, vomiting, urinary discomfort and sexual dysfunction.
- Intravesical chemotherapy attacks cancerous cells through drugs that are administered directly in the bladder.
- Systemic chemotherapy is able to attack cancer cells that may be present throughout the body.
Side effects of chemotherapy may include nausea, vomiting, hair loss, bruising and fatigue. In the case of intravesical chemotherapy, side effects may include irritation or bleeding.
Biological therapy stimulates your body’s own immune system to kill the cancerous cells.
Academic medical centers like URMC are also engaged in clinical trials to test the effectiveness of new, leading edge treatments.
There is no clear-cut way to prevent bladder cancer. Since smoking is a risk factor, quitting reduces your risks. It is also important to avoid potentially harmful chemicals in the workplace.
Experts also avoid drinking plenty of fluids, since this reduces the time that any potentially harmful chemicals will be in contact with your bladder.
“Staging” means determining how advanced a cancer is. This is a critical step in planning the most appropriate treatment plan.
Stage 0 is the least advanced, when cancer cells are only present in the inner lining of the bladder. Stage IV is the most advanced, when cancer cells have spread into the abdominal cavity.
Grading is another important step in the diagnostic process. It helps doctors determine how quickly a tumor is likely to grow or spread.
Cancer cells are removed through a biopsy and then examined in a lab to see how closely they resemble normal cells. Cells that look nearly normal are usually less aggressive, while those whole appearance is significantly different from normal cells are more likely to be aggressive.