Bladder Cancer

The vast majority of patients diagnosed with bladder cancer have transitional cell cancer, also referred to as urothelial carcinoma. The remaining minority of patients have other types including squamous cell carcinoma, adenocarcinoma or small cell cancer. Your bladder cancer type determines which treatment may work best for you.

• Transitional cell cancer (urothelial carcinoma): This is by far the most common type of bladder cancer. It starts in the cells that line the inside of your bladder – the urothelial cells. These same cells line the inside of your ureters and your urethra, and tumors can form in those places as well. These tumors are named based on whether they have grown into the bladder wall. If they grow deeper into the bladder wall they are called invasive; if not, they are non-invasive.
• Squamous cell carcinoma: Squamous cells appear in your bladder in response to infection and irritation and can become cancerous over time. This type is more common in parts of the world where a certain parasitic infection (schistosomiasis) is prevalent, however much less common than transitional cell cancer. Squamous cell carcinoma is usually invasive.
• Adenocarcinoma: Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Almost all adenocarcinomas are invasive. This type of bladder cancer is also uncommon.
• Small-cell carcinoma: Small-cell carcinoma is a rare, yet very aggressive type of bladder cancer. It is mostly diagnosed at advanced stage and generally known to grow quickly.

What causes bladder cancer?

Researchers are not yet certain what causes bladder cancer. There are, however, a number of factors, such as smoking cigarettes or exposure to certain chemicals, that are known to raise your risk. To find out more about these risk factors or the measures you can take to prevent bladder cancer, see prevention.

Bladder cancer is most treatable when caught early. It is highly advisable to speak with your doctor about your risk factors and any symptoms you might be experiencing. Symptoms associated with bladder cancer include:

• Blood in urine (hematuria), which is identified by the American Urological Association as the main warning sign of bladder cancer
• Frequent urination, or feeling as if you need to go urgently even when your bladder is not full
• Painful or burning feeling when passing urine
• Pelvic or lower back pain, in more advanced cases of bladder cancer

If your symptoms indicate you might have bladder cancer, your doctor will use one or more of the following methods to determine whether you have the disease.

• Medical history and physical exam: Your doctor will most likely ask you questions relating to your risk factors, such as your smoking history, possible exposure to cancer-causing chemicals, and your family history of cancer. Your doctor might also conduct a rectal, pelvic or prostate exam to look for tumors.
• Cystoscopy: A cystoscope is a thin tube with a lens and a light on the end. During a cystoscopy, it is inserted into the bladder through the urethra, allowing your doctor to see the inside of the bladder. If there is anything that appears suspicions, a small piece of tissue is removed (biopsied) for further examination under a microscope. You will generally receive a local anesthetic during cystoscopy.
• Urine cytology: In this test, a sample of your urine is sent to the lab to see if cancer cells (or pre-cancer cells) are present. This test can help find some cancers, but it is not definitive.
• Biopsy: During a biopsy, a piece of tissue is removed to see if it contains cancer cells. Bladder biopsy samples are most often taken during cystoscopy. This test can determine if bladder cancer is present, what type of cancer it is, and how deep it has grown into (invaded) the bladder wall.

Stages of bladder cancer

Once bladder cancer is confirmed, your doctor may order additional tests to determine how far the cancer has spread. These may include imaging tests, bone scans and chest x-rays.

The extent of your cancer is expressed as stages I to IV. As a rule, the lower the number, the less the cancer has spread. Knowing your stage of bladder cancer is extremely important when choosing the best treatment.

• Stage I: At this stage, the cancer is in the bladder’s inner lining but hasn't invaded the muscular bladder wall.
• Stage II: Cancer at this stage has invaded the bladder wall but is still confined to the bladder.
• Stage III: The cancer cells have spread through the bladder wall to surrounding tissue. They may also have spread to the prostate in men or the uterus or vagina in women.
• Stage IV: This is the most advanced stage, with cancer cells commonly spreading to the lymph nodes and other organs, such as the lungs, bones or liver.

The treatments available to you depend on a number of factors including the type and stage of your bladder cancer, your age and your overall health. There is a lot for you to think about when choosing the best way to treat or manage your cancer, so talk to your doctor about your treatment options and ask him or her any question you might have.

The main types of treatment for bladder cancer are:

• Surgery: Surgery, alone or along with other treatments, is used in nearly all cases. If your cancer is small and hasn’t invaded the wall of your bladder, surgery can be done to remove the tumor and possibly a small portion of your bladder. Surgery for more progressive cancer that has invaded the deeper layers of the bladder wall can include the removal of your entire bladder (radical cystectomy). After removal of the bladder, your surgeon will create a new method for the storage and elimination of urine. A radical cystectomy also typically includes removal of the prostate in men, and removal of the uterus, ovaries and part of the vagina in women. Surgery in general carries a risk of bleeding and infection. Side effects of a radical cystectomy can include erectile dysfunction in men and infertility and premature menopause in women.
• Immunotherapy (also known as biological therapy): Immunotherapy drugs work by signaling your body’s immune system to attack cancer cells. This is commonly administered directly into the bladder through the urethra.
• Chemotherapy: Chemotherapy destroys cancer cells using drugs. For bladder cancer, this form of treatment usually involves 2 or more chemotherapy drugs used in combination. Patients suffering from invasive cancer are often treated with chemotherapy before or after surgery. In cases where it is used before surgery, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Otherwise, chemotherapy is used to kill cancer cells that might remain after surgery.
• Radiation therapy: Radiation therapy uses high-energy rays to destroy cancer cells. Radiation therapy may also be given before or after surgery and is sometimes used in combination with chemotherapy.

While there is no sure way to prevent bladder cancer, you may be able to reduce some of your risk of getting it. This includes:

• Not smoking: The World Health Organization states that tobacco is the single most important cause of bladder cancer, accounting for an estimated 40-70% of all cases. Although the bladder is not directly exposed to tobacco smoke, cancer-causing chemicals in the smoke are absorbed into the blood where it collects in the bladder damaging cells. If you are a smoker, speak with your doctor about a plan to help you quit.
• Follow good work safety habits with chemicals: If you work with a group of chemicals called aromatic amines, follow all safety instructions to avoid exposure. These chemicals are commonly used by the makers of rubber, leather, printing materials, textiles, and paint products. They are also found in many hair dyes.
• Drink plenty of water: Some studies have found that drinking fluids, especially water, may dilute toxic substances concentrated in your urine and flush them out of your bladder more rapidly, decreasing your risk of bladder cancer.
• Have a healthy diet: A diet rich in a variety of fruits and vegetable may help protect against bladder cancer. Although studies are inconclusive on this, diets high in fruit and vegetables are shown to have many health benefits, including lowering the risk of other types of cancer.