Bladder Cancer

The bladder is a balloon shaped organ that collects urine from the kidneys and stores it until it is eliminated through a channel called the urethra. The most common type of bladder cancer, transitional cell or urothelial cell, starts in the lining of the bladder.

In the United States, bladder cancer is the fourth most common type of cancer in men and the ninth most common cancer in women. More than 47,000 men and 16,000 women are diagnosed with bladder cancer each year.

Signs and Symptoms

Early stages of bladder cancer often produce no symptoms. Your first warning sign may be blood in your urine that may be visible but may also be microscopic. Microscopic blood in the urine is called microhematuria. This can be detected in urine through a dipstick in either the primary, gynecologist, or urologist's office.

Other common symptoms include:
  • Painful urination
  • Frequent urination or urgency
  • Slow or intermittent urine stream
  • Pelvic pain or pressure

These symptoms may instead indicate other medical problems, such as urinary tract infections, bladder stones or prostate disorders; you will need a thorough evaluation to determine the cause.


Risk Factors of Bladder Cancer

The following factors increase your risk of bladder cancer:

  • Cigarette smoking - the single greatest risk factor
  • Environmental exposure to toxic chemicals
  • Age: risk increases after 40
  • Sex - men are at much higher risk
  • Race - Caucasians are at higher risk
  • Family or personal history of bladder cancer
  • Chronic bladder inflammation or foley catheter use
  • Chemotherapy or radiation therapy for other cancers
  • A high fat diet

Exposure to environmental carcinogens of various types is responsible for the development of most bladder cancers. Tobacco abuse (specifically cigarette smoking) is thought to cause 50% of bladder cancers discovered in male patients and 30% of those found in female patients. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. Approximately 20% of bladder cancers occur in patients without predisposing risk factors. 

Genetics

Mutations in the gene that arise in the bladder are another important risk factor for developing bladder cancer. Several genes have been identified which play a role in regulating the cycle of cell division, preventing cells from dividing too rapidly or in an uncontrolled way. Alterations in these genes may help explain why some bladder cancers grow and spread more rapidly than others.

Bladder cancer is generally not inherited. Tumors usually result from genetic mutations that occur in certain bladder cells during a person's lifetime. These noninherited genetic changes are called somatic mutations. A family history of bladder cancer is, however, a risk factor for the disease. Along these lines, some people appear to inherit a reduced ability to break down certain chemicals, which makes them more sensitive to the cancer-causing effects of tobacco smoke and certain industrial chemicals.


Diagnosis

Your doctor will first perform a thorough history and physical exam. Other tests may include:
  • Urine Cytology - examining urine cells under the microscope to look for atypia or cancerous cells
  • CT Urography - imaging that includes contrast dye, to view the kidneys, bladder and ureters
  • Cystoscopy - where a thin scope is passed into the urethra to view the bladder; if a mass is seen, a biopsy may be performed at that time or during more formal treatment
  • Tumor Marker Tests - the FDA has approved several tests that look for BTA or NMP22, proteins in the urine that may indicate cancer
  • Flourescence in Situ Hybridization (FISH) - a urine test that looks for chromosomal abnormalities and may provide early detection of transitional cell bladder cancer


Staging of Bladder Cancer

Once it has been determined that you have bladder cancer, your doctor will determine what "stage" your cancer is in:

  • Stage 1 - confined to the bladder lining

  • Stage 2 - invasion into the muscular wall of the bladder

  • Stage 3 - invasion through the bladder wall into adjacent tissues 

  • Stage 4 - spread to other organs


Treatment of Bladder Cancer

The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors can be "shaved off" using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors. 

Immunotherapy - is where a substance called BCG is injected into the bladder weekly for a six week course to trigger the body's immune response against the cancer cells. 

Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder require more radical surgery where part or all of the bladder is removed and the urinary stream is diverted. In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon patient preference, age of patient, renal function, and the site of the disease.

A combination of radiation and chemotherapy can also be used to treat invasive disease.