Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses called tumors. In bladder cancer, these tumors form in the bladder. The bladder is where urine (liquid waste made by the kidneys) is stored in the body.
In 2017, more than 79,000 Americans will be diagnosed with bladder cancer. Men are almost 4 times more likely than women to be diagnosed. About 16,000 Americans will die of bladder cancer this year. Over time, doctors have made progress with better treatments, and more people survive.
Symptoms
Hematuria (blood in the urine)
Blood in the urine is the most common symptom of bladder cancer. It is generally painless. Although blood may be visible, in most cases it is invisible except under a microscope. In these cases, blood is found when your urine is tested by your health care provider.
Blood alone does not mean that you have bladder cancer. There could be many reasons for blood in the urine, such as a urinary tract infection or kidney stones. Microscopic amounts of blood might even be normal in some people.
Frequent Urination and Pain on Urination (dysuria)
Frequent or painful urination is less common. If you have these symptoms, and do not have a urinary tract infection, you should talk to your health care provider to find out if bladder cancer is the cause.
Causes
Smoking
Cigarette, cigar, and pipe smoking increases your risk of bladder cancer. In fact, half of all bladder cancer cases in the United States are caused by cigarette smoke. Bladder cancer develops in smokers 2 to 3 times more than in nonsmokers.
When you smoke, you inhale chemicals from the tobacco. The chemicals move from your lungs into your blood. Your kidneys filter the chemicals out of your blood and send them to your bladder. Over time, these chemicals can damage the cells that line the inside of your bladder. This damage increases the chance of cancer developing.
Chemicals in the Workplace
Long-term exposure to chemicals used to make plastics, paints, textiles, leather and rubber may also cause bladder cancer. Hairdressers, machinists, printers, painters and truck drivers may be at risk for bladder cancer. Chemicals may cause about 23 out of every 100 bladder cancer cases. Like the chemicals in cigarette smoke, these chemicals (carcinogens) can remain in the bladder for a few hours before you urinate. In that way, the bladder becomes a place where cancer can develop.
Other Risk Factors
- Frequent or long lasting bladder infections
- Certain drugs for other cancers, such as cyclophosphamide (Cytoxan®)
- Radiation therapy in the pelvic area, such as for cervical cancer or prostate cancer
- High levels of arsenic in drinking water
More than 90% of all bladder cancers begin in the inner lining of the bladder (urothelium). Most tumors in the bladder stay in this area or in the next layer (the lamina propria) and don’t move into the bladder muscle.
Diagnosis
A urologist is a doctor who specializes in problems of the urinary system and male reproductive system.
There is no single test to check for bladder cancer. If you have symptoms of bladder cancer, your doctor may perform 1 or more of the following tests.
Medical History and Physical Exam
Your doctor will ask about your contact with things known to cause bladder cancer such as tobacco smoke (from your own use or secondhand smoke) or chemicals. You will also be asked if there is a family history of bladder cancer. Your doctor will check you for signs of disease.
Urinalysis
For this test you will provide a urine sample. Specialists will check the color of the urine and its contents. They may also perform urine cytology. For this, your urine is viewed under a microscope to look for cancer cells test . Urine can also be tested for other things linked with cancer cells (tumor markers).
Imaging Tests
Your doctor may request a computerized tomography (CT) scan. These scans are like X-rays, but they take more detailed pictures of your organs. Your doctor may order images of the kidneys, ureters and bladder to check for problems. If there is blood in the urine, it could have come from anywhere in the urinary tract. The scans will help the doctor see the problem. This is most often done with a CT urogram (CT scan focused on the urinary tract).
Cystoscopy
Cystoscopy allows your doctor to see directly inside the bladder and inspect the inner surfaces for signs of cancer. It is most often done in the doctor’s office. To make the test more comfortable, you will have local anesthesia (medicine to block pain in the area) or light sedation (to help you relax and to block pain). In some cases you may receive general anesthesia (to put you to sleep).
The urologist uses a cystoscope, which is a soft, thin tube with a light and a lens or a small video camera on the end. The cystoscope is moved through the opening of the urethra (where urine leaves your body) and into the bladder. The scope inserts sterile salt water to expand the bladder. This allows the doctor to get a better look at the bladder lining.
If tumors are present, the doctor notes their appearance, number, location and size.
Because removal (resection) of the tumors often cannot be done with local anesthesia alone, you may be scheduled to return for surgery to remove the tumor under general or spinal anesthesia. This surgery is called transurethral resection of bladder tumor (TURBT). (See Treatment section for more information on TURBT.)
Biopsy
If you are put to sleep for cystoscopy , your doctor can also do a biopsy. A biopsy is when samples of tissue are removed to see if cancer is present. A pathologist (a specialist who identifies changes in body tissue) examines the tissue under a microscope to check for cancer cells.
To remove tissue, the doctor inserts a resectoscope through the urethra into the bladder. This is a viewing instrument similar to the cystoscope, but it contains a wire loop at the end to remove the tissue.
Treatment
A diagnosis of cancer is scary. The best treatment for you will depend on the type, grade, and stage of your bladder cancer. It also depends on your general health and age. You will want to work closely with your doctor to decide on a good treatment plan for you.
Treatment options for bladder cancer that has not entered the muscle (stages Ta, T1 and Tis) include:
- Surgery to remove the tumor
- Intravesical therapy
- Surgery to remove the bladder
Treatment options for bladder cancer that has entered the bladder muscle (stages T2, T3 and T4) include:
- Intravesical therap
- Surgery to remove the bladder
- Chemotherapy
- Radiation therapy