standard-title Bladder Cancer
Bladder cancer is a type of cancer that begins in your bladder — a balloon-shaped organ in your pelvic area that stores urine.
Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age.
The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests for years after treatment to look for bladder cancer recurrence.top
Bladder cancer signs and symptoms may include:
- Blood in urine (hematuria) — urine may appear bright red or cola colored. Or urine may appear normal, but blood may be detected in a microscopic examination of the urine.
- Frequent urination.
- Painful urination.
- Back pain.
- Pelvic pain.
Factors that may increase your risk of bladder cancer include:
- Smoking. Smoking cigarettes, cigars or pipes may increase your risk of bladder cancer by causing harmful chemicals to accumulate in your urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
- Increasing age. Your risk of bladder cancer increases as you age. Bladder cancer can occur at any age, but it’s rarely found in people younger than 40.
- Being white. Whites have a greater risk of bladder cancer than do people of other races.
- Being a man. Men are more likely to develop bladder cancer than women are.
- Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it’s thought that being around certain chemicals may increase your risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
- Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases your risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have an elevated risk of developing bladder cancer.
- Taking a certain diabetes medication. People who take the diabetes medication pioglitazone (Actos) for more than a year have an increased risk of bladder cancer. Other diabetes medications contain pioglitazone, including pioglitazone and metformin (Actoplus Met) and pioglitazone and glimepiride (Duetact).
- Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase your risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis.
- Personal or family history of cancer. If you’ve had bladder cancer, you’re more likely to get it again. If one or more of your immediate relatives have a history of bladder cancer, you may have an increased risk of the disease, although it’s rare for bladder cancer to run in families. A family history of hereditary nonpolyposis colorectal cancer, also called Lynch syndrome, can increase your risk of cancer in your urinary system, as well as in your colon, uterus, ovaries and other organs.
Tests and procedures used to diagnose bladder cancer may include:
- Cystoscopy. During cystoscopy, your doctor inserts a narrow tube (cystoscope) through your urethra. The cystoscope has a lens and fiber-optic lighting system, allowing your doctor to see and examine the inside of your urethra and bladder. You usually receive a local anesthetic during cystoscopy to help make you comfortable.
- Biopsy. During cystoscopy, your doctor may pass a special tool through the scope and into your bladder in order to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer. TURBT is usually performed under general anesthesia.
- Urine cytology. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
- Imaging tests. Imaging tests allow your doctor to examine the structures of your urinary tract. Tests to highlight the urinary tract sometimes use a dye, which is injected into a vein before the procedure. An intravenous pyelogram is a type of X-ray imaging test that uses a dye to highlight your kidneys, ureters and bladder. A computerized tomography (CT) scan is a type of X-ray test that allows your doctor to better see your urinary tract and the surrounding tissues.
Staging bladder cancer
Once it’s confirmed that you have bladder cancer, your doctor may order additional tests to determine the extent (stage) of the cancer. Staging tests may include:
- CT scan
- Magnetic resonance imaging (MRI)
- Bone scan
- Chest X-ray
Bladder cancer stages
The stages of bladder cancer are:
- Stage I. Cancer at this stage occurs in the bladder’s inner lining but hasn’t invaded the muscular bladder wall.
- Stage II. At this stage, cancer 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.
- Stage IV. By this stage, cancer cells may have spread to the lymph nodes and other organs, such as your bones, liver or lungs.
Your treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer, your overall health, and your treatment preferences. Discuss your options with your doctor to determine what treatments are best for you.
Treatments for early-stage bladder cancer
If your cancer is very small and hasn’t invaded the wall of your bladder, your doctor may recommend:
- Surgery to remove the tumor. Transurethral resection of bladder tumor (TURBT) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TURBT, your doctor passes a small wire loop through a cystoscope and into your bladder. The loop is used to burn away cancer cells with an electric current. In some cases, a high-energy laser may be used instead of electric current. TURBT may cause painful or bloody urination for a few days following the procedure.
- Surgery to remove the tumor and a small portion of the bladder. During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy is rarely used and may only be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function.
Biological therapy (immunotherapy). Biological therapy, sometimes called immunotherapy, works by signaling your body’s immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).
One biological therapy drug used to treat bladder cancer is bacille Calmette-Guerin (BCG), which is a bacterium used in tuberculosis vaccines. Another biological therapy drug is a synthetic version of interferon, which is a protein your immune system makes to help fight infections. The synthetic version, called interferon alfa-2b (Intron A), is sometimes used in combination with BCG.
Biological therapy drugs often cause flu-like symptoms and can irritate your bladder.
Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:
Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.
Increasingly, radical cystectomy is performed using robotic surgery, which means the surgeon sits nearby and uses hand controls to precisely move the surgical instruments.
Cystectomy carries a risk of infection and bleeding. In men, removal of the prostate and seminal vesicles may cause erectile dysfunction. But in select cases, your surgeon can attempt to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause.
Surgery to create a new way for urine to leave your body.Immediately after your radical cystectomy, your surgeon works to create a new way for you to expel urine. Several options exist. Which option is best for you depends on your situation and your preferences.
Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your ureters, which drain your kidneys, to the outside of your body, where your urine empties into a pouch (urostomy bag) you wear on your abdomen.
In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.
In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your neobladder.
Ryan J. Street, MD
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