Bladder Cancer

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

The bladder is a hollow organ in your lower belly (abdomen). Urine is stored in it. This is the liquid waste that is made by the kidneys.

The bladder wall is made up of layers of tissue. It has an outer layer of muscle cells and an inner lining of other kinds of cells. Bladder cancer most often starts in the cells that make the inside lining of the bladder. This is called urothelial carcinoma or transitional cell carcinoma (TCC). From the lining it can move deeper into the other layers of the bladder wall.

Most bladder cancers are urothelial carcinomas, also called transitional cell carcinomas. They start in the cells that line the inside of the bladder. Bladder cancer may grow in different ways:

• Papillary tumors stick out from the bladder lining on a stalk. They tend to grow toward the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall.

• Flat tumors do not stick out from the bladder lining. These tumors are more likely than papillary tumors to grow deeper into the layers of the bladder wall.

• Carcinoma in situ (CIS) is a cancerous patch of flat tumor cells that is only in the inner layer of the bladder lining and has not spread to deeper tissue. The patch may look almost normal or may look inflamed.

Each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time.

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. The risk factors for bladder cancer include:

Smoking

Smoking is the biggest risk factor for bladder cancer. People who smoke are at least 3 to 4 times more likely to get bladder cancer as those who don't.

When you smoke, cancer-causing chemicals called carcinogens harm cells in your bladder. Carcinogens from smoke enter the blood through the lungs. The kidneys filter the blood to remove these carcinogens and send them into the urine. The urine goes to the bladder, where it's stored until you urinate. This causes the carcinogens to build up in the urine. They can harm the cells in your bladder. Over time, these damaged cells may turn into cancer.

The younger you were when you started smoking, and the more you smoke, the higher your risk of getting cancer. Some people think that there’s no reason to quit smoking because the damage has already been done. That's not true. Quitting greatly lowers your risk for cancer. And the longer you don't smoke, the more your risk goes down. So, it's worth the effort to do all you can to stop smoking.

Race

White people are twice as likely to get bladder cancer as African Americans or Hispanic Americans.

Gender

Bladder cancer happens much more often in men than in women.

Age

The risk for bladder cancer goes up with age. It's rare in people younger than age 40. Most people with bladder cancer are age 65 or older.

Chemical exposure at work

Exposure to certain chemicals and dyes can increase your risk for bladder cancer. But exposure to chemicals at work makes up only a small percentage of bladder cancers. If you work in the dye industry or as a hairdresser or truck driver, you may have been exposed to chemicals that increase your risk for bladder cancer. This may also be true if you work with rubber, textiles, leather, paint, metalwork, or printing. Talk with your employer about risk factors involving chemicals. Make sure you follow the guidelines for working with chemicals safely.

Chronic bladder problems

Urinary tract infections and kidney and bladder stones have been linked to bladder cancer.

Using a urinary catheter for a long time has also been linked to bladder cancer.

Certain medicines and supplements

Using pioglitazone hydrochloride for more than one year has been linked to bladder cancer. This is a diabetes medicine.

Supplements containing Aristolochia fangchi or aristolochic acid have been linked to bladder cancer. This is an herb used in some weight-loss products.

History of bladder cancer

If you've had bladder cancer in the past, even if it was at an early stage, you have a higher risk of getting it again.

Your risk also goes up if you have a family history of bladder cancer. It also goes up if you have certain inherited genetic problems.

Past cancer treatment

Your risk for bladder cancer may be higher if you’ve had certain chemotherapy medicines or radiation directed at your pelvis to treat another cancer in the past.

Arsenic

High levels of arsenic in drinking water has been linked with a higher risk for bladder cancer.

Talk with your healthcare provider about your risk factors for bladder cancer and what you can do about them.

There is no sure way to prevent bladder cancer. But some risk factors can be controlled to help reduce your risk. Don’t smoke and limit exposure and protect yourself from chemicals. It may also help to drink a lot of water and eat a healthy diet with lots of fruits and vegetables.

Are there screening tests for bladder cancer?

There are no regular screening tests for bladder cancer. Screening tests are done to check for disease in people who don’t have symptoms.

People at high risk, such as those who have had bladder before, may be screened with cystoscopy. This is a test that lets the doctor look inside the bladder using a thin tube that’s put in through the urethra. Urine tests can also be done to look for blood or abnormal cells.

Common symptoms of bladder include:

• Blood in your urine. Blood is often the first sign of bladder cancer. The color of urine may be pink or deep red, depending on the amount of blood. You may have clots of blood in the urine.

• Change in urinary habits. This can include urinating more often than normal. You may feel an urgent need to urinate, have trouble urinating, or have a weak stream of urine. You may experience burning or pain when urinating.

• Lower back pain.

Many of these may be caused by other health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. Your provider will do a physical exam. This may include a rectal or vaginal exam. They may do this to check for tumors that may be large enough to feel.

You may also have one or more of these tests:

• Urinalysis and urine culture.

• Urine cytology test.

• Urine tests for bladder cancer tumor markers.

• Cystoscopy.

• Intravenous pyelogram (IVP).

• Bladder biopsy.

Once cancer has been diagnosed, the next step is to choose the best way to treat it. To help do this, your healthcare provider uses exams and tests to find out how much and how far the cancer has spread, or metastasized, in your body (This is called the cancer stage.). It is one of the most important things to know when deciding how to treat the cancer.

Stages: How much the cancer has grown and spread

As cancer cells multiply, the tumor grows. Bladder cancer begins in the inner lining of the bladder and often doesn’t grow beyond that layer. As the tumor gets larger, it may grow into deeper layers of the bladder. It may also spread to nearby organs, such as the prostate in men or the uterus in women. Cells can break off from the main tumor and enter the bloodstream or lymph nodes. Blood or lymph then carries the cells to other parts of the body, such as the bones, liver, or lungs, where a new tumor may form (metastasis.) The stage of cancer is based on where the cancer is and how much it has grown and spread. The stage is found by looking inside the bladder during cystoscopy and using tests that show images of the bladder, the areas around it, and parts of the body that the cancer may spread to. The staging system described below is a simplified one. Your healthcare provider will most likely use a similar, but more detailed, system.

Your treatment choices depend on the type of bladder cancer you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or to help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just one treatment or a combination of treatments.

Bladder cancer may be treated with:

• Surgery.

• Intravesical therapy.

• Chemotherapy (chemo).

• Radiation therapy.

• Immunotherapy.

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

Cancer treatment such as chemotherapy and radiation can damage normal cells. This can cause side effects like hair loss, mouth sores, and vomiting.

Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effects of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse.

• Signs of an infection, such as a fever.

• Side effects of treatment that affect your daily function or don’t get better with treatment.

Ask your healthcare provider what signs to watch for, and when to call. Know how to get help after office hours and on weekends and holidays.