The American Cancer Society estimates that, in 2012, approximately 73,510 new cases of bladder cancer will be diagnosed in the United States. In recent decades, there has been a steady increase in the incidence of bladder cancer, and it is now the sixth most common cancer in this country.
More than 90 percent of all bladder cancers originate in the urothelium, the inner lining of the bladder. This type of cancer is referred to as “superficial” bladder cancer and can recur after treatment is given.
Am I at risk?
The ways in which bladder cancers develop and progress are only partly understood. However, a number of substances that cause the cancers to develop have been identified. Chief among them are cancer-causing agents in cigarette smoke and various industrial chemicals. Cigarette smoking, alone, has been estimated to cause 50 percent of all bladder cancer cases in the United States. Long-term workplace exposure to chemical compounds, such as paints and solvents, has been estimated to cause another 20-to-25 percent of bladder cancer cases.
Carcinogens in the blood stream are filtered out by the kidneys to eliminate them from the body. However, these carcinogens remain in the bladder for a few hours, interacting with the lining of the bladder before they are removed by urination. Through this process, the bladder becomes a high-risk organ for cancer, particularly in smokers.
What are the symptoms of bladder cancer?
The most common symptom of bladder cancer is blood in the urine (hematuria). It eventually occurs in nearly all cases of bladder cancer, may not be visible with the naked eye, and is generally described as “painless.” Hematuria does not, by itself, indicate or confirm the existence of bladder cancer; a full diagnostic investigation is necessary to determine whether bladder cancer is present. Other symptoms of bladder cancer may include frequent urination and pain upon urination (dysuria).
How is bladder cancer diagnosed?
The diagnostic investigation begins with a thorough medical history and a physical examination. The doctor will ask about past exposure to known causes of bladder cancer, such as cigarette smoke (either through personal smoking or “second-hand” smoke) or chemicals.
Because hematuria can come from anywhere in the urinary tract, the doctor will typically order radiological imaging of the kidneys, ureter, and bladder to check for problems in these organs. This is most often accomplished by a CT urogram (CT scan focused on the urinary tract).
Diagnostic tools to check for bladder cancer include various types of urinalysis. In one type, the urine is examined under a microscope to look for cancer cells that may have been shed into the urine from the bladder lining (urinary cytology). Urine can also be tested for substances known to be closely associated with cancer cells (tumor markers).
The urologist’s most important diagnostic tool is cystoscopy, a procedure that allows direct viewing of the inside of the bladder. This is commonly performed as an office procedure under local anesthesia or light sedation. The doctor inserts a viewing instrument (cystoscope) through the urethra and into the bladder to examine the bladder’s inner surfaces for signs of cancer.
If tumors are present, the doctor notes their appearance, number, location, and size. At this time, the doctor may remove very small samples of tissue of any suspicious-looking areas of the bladder for further examination by a pathologist, a physician trained in the examination of tissue and cellular changes. If cancer is found, the pathologist will help your physician determine the aggressiveness and extent of the disease.
What treatment options are available for bladder cancer?
There are several options available for treating bladder cancer. Selection of an option is dependent on a number of factors, including the stage and extent of the disease, the patient’s age and general health, the patient’s concerns regarding treatment, and potential side effects.
Transurethral resection of the bladder (TURBT). This is the usual treatment method for patients who, when examined with a cystoscope, are found to have abnormal growths on the urothelium (stage Ta) and/or in the lamina propria (stage T1). Alternative methods, such as laser therapy, compare favorably with TURBT in terms of treatment results. However, TURBT has the major advantage of providing tissue suitable for a pathologist to use in determining a tumor’s grade and stage. The tumor structure may be too distorted for this purpose after an alternative treatment method; therefore, biopsies of the tumor must be taken before treatment.
Intravesical chemotherapy and immunotherapy. Following tumor removal, intravesical (within the bladder) chemotherapy or intravesical immunotherapy may be used to try to prevent tumor recurrences. These therapeutic agents are placed directly into the bladder via a catheter in the urethra (the catheter remains in place for only a few minutes), are retained for one-to-two hours, and are then urinated out.
Cystectomy. Surgical removal of the bladder may be an option for patients with carcinoma in situ (CIS) or high-grade T1 cancers that have persisted or recurred after initial intravesical treatment. There is a substantial risk of progression to muscle-invasive cancer in such cases, and some patients may want to consider cystectomy as a first choice of treatment. If so, they should ask their doctor for information about both the risks of cystectomy and the methods of urinary reconstruction (urinary diversion).
This information is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon your medical history and current condition. Only your physician and you can determine your best treatment option.
For more information:
American Cancer Society
250 Williams Street NW
Atlanta, Georgia, 30303
American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090