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.

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

• Transitional cell (urothelial) carcinoma
• Squamous cell carcinoma
• Adenocarcinoma

Causes

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.

What causes the changes in the cells is not clear. It is likely to be a combination of genetic and environmental factors.

Risk Factors

This condition is more common in adults between 65 and 85 years old. It is also more common in men and people who are Caucasian. Factors that may increase your chance of developing bladder cancer include:

• Smoking
• Occupational exposures:
  • Rubber, leather, and textiles
  • Painting
  • Chemicals used in hairdressing
  • Machines
  • Printing
  • Truck driving
  • Petroleum industry
• Genetics
• Chronic bladder inflammation or urinary tract infections
• Personal or family history of bladder cancer
• Chemotherapy drugs, such as cyclophosphamide and ifosfamide
• Obesity
• The use of pioglitazone to treat diabetes
• Exposure to arsenic
• Radiation treatment of the pelvis
• Bladder birth defects
• Chemicals such as nitrosamines and benzidine
• Recurrent urinary stones
• Long-term in-dwelling catheter
• 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
• Frequent urination, or feeling the need to urinate without being able to
• Painful urination
• Lower back pain
• Weight loss, bone pain, or abdominal pain in advanced cases

Diagnosis

You will be asked 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.

• Urine can be evaluated with:
  • Urine cytology
  • Urine culture
• Imaging tests assess the bladder and surrounding structures. These may include:
  • Cystoscopy
  • IV pyelogram (IVP)
  • CT scan
  • MRI scan
  • Ultrasound
  • Bone scan
• A sample of bladder tissue may need to be tested. This can be done with a biopsy.

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Bladder cancer is staged from 0-IV. Stage 0 is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Stages of Bladder Cancer

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Treatment

Treatment options depend on the stage and may include:

Surgery

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

• 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 can be done during this procedure. It uses electrical current to burn away remaining cancer cells.
• Cystectomy is the surgical removal of all or part of the bladder—This is done when bladder cancer is invasive. Segmental or 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 may be removed. In women, the uterus, ovaries, part of the vagina, and the fallopian tubes may 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 therapy may be:

• External—Radiation is directed at the tumor from a source outside the body.
• Internal (brachytherapy)—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 given directly into the bladder. This is called intravesical chemotherapy.

Biologic Therapy

Biologic therapy (immunotherapy) uses the body’s immune system to fight cancer. Substances made by the body or in a laboratory are given 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

To help reduce your chance of bladder cancer:

• If you smoke or use tobacco products, talk to your doctor about ways to 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 foods.