Bladder Cancer

Bladder cancer typically begins in the lining of the bladder, an elastic, muscular sac situated in the anterior part of the pelvic cavity in which urine collects before excretion. Some bladder cancer remains confined to the lining, while other cases may invade other areas.

According to the American Cancer Society, there were approximately 67,160 new cases of bladder cancer diagnosed in the United States in 2007, with an estimated 13,750 deaths. Bladder cancer incidence is nearly four times higher in men than in women and almost two times higher in whites than in African Americans. Mortality rates have continued to decrease since the late 1970's, although the rate of decrease slowed in the most recent time period.

Bladder Cancer Questions & Answers

  • What causes bladder cancer?

    The cause of bladder cancer is unclear. Cancer develops when DNA is damaged. When DNA is damaged it may result in the cells growing out of control forming a tumor (a mass of malignant cells).

    Some bladder cancers form and remain confined to the bladder lining while others cancers grow into or through the bladder wall and eventually into nearby organs including the lungs, liver and bones.

  • What are some of the signs and symptoms of bladder cancer?

    The first sign is usually blood in your urine (hematuria). The blood may show up on a urine test, or your urine may appear slightly rusty to deep red.

    Blood in the urine does not mean you have bladder cancer. Other conditions including a urinary tract infection, kidney disease, kidney or bladder stones, and prostate problems can also cause hematuria. If you develop any of the signs and symptoms below, your doctor can help determine the exact cause:

    Pain during urination
    Frequent urination or feeling you need to urinate without results
    Pain or discomfort in the lower abdomen
     

  • What are the risk factors of bladder cancer?

    People who get bladder cancer are more likely than other people to have certain risk factors. A risk factor is something that increases a person's chance of developing the disease.

    Most people with known risk factors do not get bladder cancer and many people who do get this disease have none of these factors.

    Studies have found the following risk factors for bladder cancer:

    Age: The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.

    Tobacco: The use of tobacco is a major risk factor. Cigarette smokers are two or three times more likely than non-smokers to get bladder cancer. Pipe and cigar smokers are also at increased risk.

    Occupation: Some workers have a higher risk of getting bladder cancer because of carcinogens in the workplace. Workers in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers. Red dye in particular is a chemical reagent that has potentially been implicated. Also, exposure to coal and gas by-products is another potential occupational hazard.

    Infections: Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas but not in the United States.

    Treatment with cyclophosphamide or arsenic: These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.

    Race: Caucasians get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.

    Gender: Men are two to three times more likely than women to get bladder cancer.

    Family history: People with family members who have bladder cancer are more likely to get the disease. Researchers are studying changes in certain genes that may increase the risk of bladder cancer.

    Personal history: People who have had bladder cancer have an increased chance of getting the disease again.

    Location: Individuals who live in urban environments are two times more likely to get bladder cancer.

  • What are my treatment options for bladder cancer?

    People with bladder cancer have many treatment options. They may have surgery, radiation therapy, chemotherapy or biological therapy. Some patients get a combination of therapies.

    Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. The doctor can explain each type of surgery and discuss which is most suitable for the patient.

    Transurethral Resection (TUR) may be used to treat early (superficial) bladder cancer. During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and to burn away any remaining cancer cells with an electric current. 

    Radical Cystectomy is the most common type of surgery for invasive bladder cancer. The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed.

    Segmental Cystectomy is used in cases to remove only part of the bladder. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.

    Radiation Therapy uses high-energy radiation to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.

    A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may resurface in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

    Doctors use two types of radiation therapy to treat bladder cancer:

    External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated five days a week for five to seven weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.

    Internal Radiation: A small container of a radioactive substance is placed into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during the treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.

    Chemotherapy uses drugs to kill cancer. The doctor may use one drug or a combination of drugs.

    For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.

    Chemotherapy attacks the cells lining the inside o the bladder.

    Immunotherapy causes the patient's own body to attack the cells lining the inside of the bladder.

    Intravesical Chemotherapy is often done with Thiotepa or Mitomycin C.

    If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through the vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.

    The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.

  • How can I prevent bladder cancer?

    Bladder Cancer cannot be prevented but you can help to reduce your risk:

    Don't smoke: By not smoking you can reduce your risk by not allowing cancer-causing chemicals to enter your body.

    Drink water: Drinking water helps dilute the toxic substances in your urine and helps to flush them out.

    If you see blood in your urine (hematuria), see your doctor.