Bladder cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 28, 2016
StartDiseasesBladder cancer

Each year bladder cancer affects more than 74,000 Americans and kills another 16,000. This is the sixth most common type of cancer in the United States. It occurs in the bladder, a balloon-shaped organ that collects and stores urine. Most cases of cancer are diagnosed in early stages, which may increase survival rates.

Contents

Definition & Facts

This disease starts when malignant cells form in the tissues of the bladder. This hollow organ is located in the pelvic area and has a muscular wall that stretches. Its role is to store urine made by the kidneys and then pass it through the urethra.

There are three forms of bladder cancer, and each has unique characteristics. The most common type is transitional cell carcinoma, which affects the urothelial cells lining the innermost tissue layer of the bladder. Patients can also develop adenocarcinoma and squamous cell carcinoma.

Superficial bladder cancer describes cancer in the lining of the bladder. If the cancer invades the muscle wall of the bladder or other internal organs, it becomes invasive bladder cancer. Bladder cancer may cause severe damage to the kidneys and function of the bowel.

Symptoms & Complaints

The most common symptom of bladder cancer is blood in urine. Most patients experience pain during urination, changes in bladder habits, lower back pain, or flank pain. Some also report an inability to pass urine, a swollen gallbladder, cough, and urine with a slightly pink or orange hue.

In severe cases, bladder cancer causes pelvic pain and lower-extremity edema. Hematuria (blood in urine) occurs in up to 90 percent of patients. Bladder cancer symptoms are also non-specific and mimic those of other diseases, such as cystitis, overactive bladder, prostate infection, or kidney disease.

This disorder usually causes no symptoms at all until it reaches an advanced stage when treatment options are limited. For this reason, people who are at risk for bladder cancer should have screening tests done regularly.

Causes

Bladder cancer has several possible causes and risk factors. In rare cases, it can be passed down from one generation to the next. Almost all patients who develop this condition are over 55 years old. Men are four times as likely as women to get cancer. This disorder occurs twice as often in Caucasians as it does in Hispanics and African-Americans.

Smoking is a risk factor as smokers are two to three times more likely to develop bladder cancer. It seems that the chemicals in cigarette smoke enter the bloodstream and pass through the kidneys, causing serious damage to the bladder. The risk of cancer also increases with age. Research shows that painters, printers, metal workers, machinists, hairdressers, truck drivers, and people who work in the chemical, rubber, and leather industries are at high risk.

Patients who survived bladder cancer are up to 80 percent more likely to develop this condition in the future. Other risk factors include certain parasites, hereditary nonpolyposis colorectal cancer, kidney transplant, kidney stones and kidney infections, treatment with arsenic or cyclophosphamide, chronic bladder problems, radiotherapy, and selenium deficiency.

Diabetics are three times more likely to develop bladder cancer compared to healthy individuals. This usually happens because of pioglitazone, a drug used for treating type 2 diabetes. Early menopause can increase the risk of bladder cancer by half.

Diagnosis & Tests

Blood tests, urine tests, imaging tests, and surgery are typically used for diagnosing bladder cancer. Most physicians will request a cystoscopy, CT urogram, a bone scan, CT scan, MRI, PET scan, chest X-rays, and intravenous pyelogram (IVP). A physical may be required too.

Cystoscopy is the most widely used test for bladder cancer. During this procedure, the doctor inserts a thin tube with a camera into the bladder in order to check the affected area or take tissue samples for biopsy. This test is done under anesthesia and only takes a few minutes.

The doctor can also request a three-phase renal CT scan to take photos of the bladder and other organs. CT scans are typically done at a radiology clinic or a hospital. During an MRI scan, the patient is injected with a dye that highlights the organs in the pelvic region. This procedure should not be performed on individuals who are allergic to fish, iodine, or dyes.

Other common tests for bladder cancer include radioisotope scans and ultrasound scans. Doctors use the TNM classification of malignant tumors to determine the extent of the cancer as well as the size and depth of tumor invasion.

Treatment & Therapy

This condition can be successfully treated, especially if it is diagnosed at an early stage before it spreads outside the bladder. Treatment usually includes a combination of surgery, immunotherapy, intravesicle chemotherapy, and medications. In some cases, the surgeon may be able to remove the tumor during a cystoscopy.

Patients can also benefit from systemic chemotherapy, transurethral resection (TUR), radical cystectomy, and organ preservation therapy. All procedures have risks, such as bladder infection, blood in urine, skin rash, hair loss, tiredness, fatigue, lymphedema, loss of bladder function, infertility, sexual dysfunction, and blockage of urinary flow. Kidney damage, taste changes, ulcers, and hearing loss may occur too. Treatment options should be discussed according to the balance between benefits and risks.

Prevention & Prophylaxis

Bladder cancer can not be prevented. However, people who smoke or have a family history of cancer can lower their risk of developing this disease by making lifestyle changes. Simple things, such as healthy diet and quitting cigarettes can dramatically reduce cancer risk.

It is also recommended to limit exposure to certain chemicals in the workplace, use natural hair dyes, and follow good work safety practices. A diet based on fruits and vegetables can enhance the body's ability to fight cancer. Adequate hydration is essential to preventing this disease. Recent studies have found that people who are physically active are less likely to get bladder cancer than those with a sedentary lifestyle. Regular exercise can boost the immune system and protect against most types of cancer.