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:
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:
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.
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.
Your doctor will first perform a thorough history and physical exam. Other tests may include:
Staging of Bladder Cancer
Once it has been determined that you have bladder cancer, your doctor will determine what "stage" your cancer is in:
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.