Bladder Cancer

Definition

The bladder is located in the lower abdomen. It is a hollow organ with flexible muscular walls. It stores urine until a person is ready to urinate. Bladder cancer is a disease in which cancer cells grow in the bladder.

Cancer occurs when cells in the body (in this case bladder cells) divide without control or order. Sometimes cells divide uncontrollably when new cells are not needed. A mass of tissue called a growth or tumor can form. The term cancer refers to malignant tumors. Malignant tumors can invade nearby tissue and spread to other parts of the body.

Three main types of cancer affect the bladder. They are named for the type of cell that becomes cancerous:

Transitional cell (urothelial) carcinoma—more than 90% of bladder cancers
Squamous cell carcinoma—about 4% of bladder cancers
Adenocarcinoma—about 1%-2% of bladder cancers

Bladder Cancer

Causes

The cause of bladder cancer is unknown. However, several risk factors have been identified.

Risk Factors

Risk factors that increase your chance of developing bladder cancer include:

Smoking
Increasing age: The majority of people with bladder cancer are between 65 and 85 years old.
Occupation (due to exposure to certain substances)
- Those at risk include:
  - Rubber, leather, and textile workers
  - Painters
  - Hairdressers
  - Machinists
  - Printers
  - Truck drivers
  - Petroleum industry workers
Race: White
Sex: male
Genetics
Chronic bladder inflammation or infection (such as schistosomiasis, an infection caused by a parasitic worm)
Personal or family history of bladder cancer
Chemotherapeutic drugs: cyclophosphamide and ifosfamide
Exposure to arsenic
Radiation treatment of the pelvis
Bladder birth defects
Chemicals (such as nitrosamines, benzidine)
Urinary stones for many years
In-dwelling catheter for many years
Bladder diverticuli: an area of weakness in the bladder wall through which some of the lining of the bladder is forced out
Metastasis from another cancer

Symptoms

Symptoms include:

Blood in the urine (hematuria)
Frequent urination, or feeling the need to urinate without being able
Painful urination
Lower back pain
Weight loss, bone pain, or abdominal pain in advanced cases

These symptoms may be caused by other less serious health conditions, such as bladder stones or infection. If you are experiencing any of these symptoms, see your physician.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will feel the abdomen and pelvis for abnormalities. The physical exam may include a rectal or vaginal exam.

Tests include:

Your doctor may need to examine your urine. This can be done with:
- Urine cytology
- Urine culture
Your doctor may to look at your bladder and the surrounding area. This can be done with:
- Cystoscopy
- Intravenous pyelogram (IVP)
- CT scan
- MRI
- Ultrasound
- Bone scan
Your doctor may also order a biopsy to remove a sample of bladder tissue to test for cancer cells.

Treatment

Staging tests are done after bladder cancer is found. These tests find out if the cancer has spread and, if so, to what parts of the body. Treatments for bladder cancer depend on the stage of the cancer. The stages of bladder cancer are:

Stage 0: cancer cells are found only on the surface of the inner lining of the bladder.
Stage 1: cancer cells are found deep in the inner lining of the bladder; no lymph nodes are involved.
Stage 2: cancer cells have spread to the muscle of the bladder; no lymph nodes are involved.
Stage 3: cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder OR possibly to the reproductive organs including the prostate glands; no lymph nodes are involved.
Stage 4: cancer cells extending outside the bladder to the wall of the abdomen or to the wall of the pelvis without lymph node involvement OR have spread to one or more lymph nodes and other parts of the body.

Treatment options include:

Surgery

Surgery involves removing cancerous cells and nearby tissue. Types of surgery to treat bladder cancer include transurethral resection and cystectomy.

Transurethral resection—This is done for early stage or superficial bladder cancer. A cystoscope is placed into the bladder through the urethra. A small wire loop at the end of the cystoscope is used to remove cancer cells. Fulguration (using electrical current to burn away remaining cancer cells) can be done during this procedure.
Cystectomy (surgical removal of all or part of the bladder)—This is done when bladder cancer is invasive. Segmental (partial) cystectomy is the removal of part of the bladder. Radical cystectomy is the removal of the entire bladder and nearby lymph nodes. In men, the prostate is usually also removed. In women, the uterus, ovaries, part of the vagina, and the fallopian tubes might also be removed. A form of urinary diversion must be created to store the urine if the bladder is removed.

Radiation Therapy

Radiation Therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

External radiation therapy—Radiation is directed at the tumor from a source outside the body.
Internal radiation therapy—Radioactive materials are placed near the cancer cells in the bladder through the urethra or through an incision in the abdomen.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including pill, injection, or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. For bladder cancer, chemotherapy is often administered directly into the bladder. This is called intravesical chemotherapy.

Biologic Therapy (Immunotherapy)

Biologic therapy is the use of the body’s immune system to fight cancer. Substances made by the body or in a laboratory are administered directly into the bladder to help boost, direct, or restore the body’s defenses against the cancer. This type of therapy is used only for superficial low-grade cancers that have been resected transurethrally.

Prevention

The following steps can reduce your risk of getting bladder cancer:

Don't smoke or use tobacco products. If you do, quit.
Avoid or minimize occupational exposure to certain chemicals; follow good work safety practices.
Eat a diet rich in fruits and vegetables.
Avoid excess intake of high fat or high cholesterol.
Minimize the use of phenacetin, a medication.

RESOURCES

American Cancer Society http://www.cancer.org

National Cancer Institute http://www.cancer.gov

CANADIAN RESOURCES

BC Cancer Agency http://www.bccancer.bc.ca

Canadian Cancer Society http://www.cancer.ca

References

Abeloff MD, Armitage JO, et al, eds. Clinical Oncology. 3rd ed. Philadelphia, PA: Churchill Livingstone, Elsevier; 2004.

Bladder cancer (PDQ): treatment patient version. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/Patient/allpages/print. Updated August 24, 2012. Accessed November 15, 2012.

Casciato DA. Manual of Clinical Oncology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

Detailed guide: Bladder cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI%5F2%5F3x.asp?rnav=cridg&dt=44. Accessed November 15, 2012.

Soloway M, Carmack A, et al, eds. First International Consultation on Bladder Tumors. Paris, France: Editions 21;2006.

Torpy JM. Bladder cancer. JAMA . 2005;293(7):890. Available at: http://jama.ama-assn.org/cgi/content/full/293/7/890. Accessed November 15, 2012.

Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

What you need to know about bladder cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/bladder/allpages. Updated August 30, 2010. Accessed November 15, 2012.

Revision Information

Reviewer: Mohei Abouzied, MD
Review Date: 11/2012 -
Update Date: 11/15/2012 -

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