Bladder Cancer Disease

Definition

Bladder cancer is a disease in which certain cells in the bladder become abnormal and multiply without control or order. The bladder is a hollow, muscular organ in the lower abdomen that stores urine until it is ready to be excreted from the body. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (TCC).

It is the sixth most common cancer in the U.S.

Bladder cancer may cause blood in the urine, pain during urination, frequent urination, or the feeling that one needs to urinate without results. These signs and symptoms are not specific to bladder cancer, however. They also can be caused by noncancerous conditions such as infections.

If you smoke, quit. Smoking can increase your risk for bladder cancer. Avoid exposure to chemicals linked to bladder cancer.

According to Medscape, The incidence of bladder cancer is twice as high in white men as in Black men in the United States. However, blacks have a worse prognosis than whites.

Bladder cancer is usually diagnosed in the later stages in Black people, especially Black men.

Alternative Names

Also called: Malignant tumor of the urinary bladder, Malignant tumor of the urinary bladder, Malignant neoplasm of the urinary bladder, Carcinoma of the bladder, Carcinoma of the urinary bladder, Urinary bladder carcinoma

Causes

In the United States, bladder cancer often starts from the cells lining the bladder. These cells are called transitional cells.

These tumors are classified by the way they grow:

• Papillary tumors look like warts and are attached to a stalk.
• Nonpapillary (sessile) tumors are flat. They are much less common. But they are more invasive and have a worse outcome.

The exact cause of bladder cancer is not known. But several things may make you more likely to develop it:

• Cigarette smoking: Smoking greatly increases the risk of developing bladder cancer. Up to half of all bladder cancers in men and several in women may be caused by cigarette smoke.
• Chemical exposure at work: About 1 in 4 cases of bladder cancer is caused by coming into contact with cancer-causing chemicals at work. These chemicals are called carcinogens. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk.
• Chemotherapy: The chemotherapy drug cyclophosphamide may increase the risk for bladder cancer. Your doctor may prescribe a medicine to reduce this risk.
• Radiation treatment: Women who had radiation therapy to treat cervical cancer have an increased risk of developing bladder cancer.
• Bladder infection: A long-term (chronic) bladder infection or irritation may lead to a certain type of bladder cancer.

Research has not shown clear evidence that using artificial sweeteners leads to bladder cancer.

Symptoms

Symptoms of bladder cancer can include:

• Abdominal pain
• Blood in the urine
• Bone pain or tenderness if the cancer spreads to the bone
• Fatigue
• Painful urination
• Urinary frequency and urgency
• Urine leakage (incontinence)
• Weight loss

Exams and Tests

The health care provider will perform a physical examination, including a rectal and pelvic exam.

Tests that may be done include:

• Abdominal CT scan
• Abdominal MRI scan
• Cystoscopy (examining the inside of the bladder with a camera), with biopsy
• Intravenous pyelogram – IVP
• Pelvic CT scan
• Urinalysis
• Urine cytology

If tests confirm you have bladder cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

The TNM (tumor, nodes, metastasis) staging system is used to stage bladder cancer:

• Ta: The cancer is in the lining of the bladder only and has not spread.
• T1: The cancer goes through the bladder lining, but does not reach the bladder muscle.
• T2: The cancer spreads to the bladder muscle.
• T3: The cancer spreads past the bladder into the fatty tissue surrounding it.
• T4: The cancer has spread to nearby structures such as the prostate gland, uterus, vagina, rectum, abdominal wall, or pelvic wall.

Tumors are also grouped based on how they appear under a microscope. This is called grading the tumor. A high-grade tumor is fast growing and more likely to spread. Bladder cancer can spread into nearby areas, including the:

• Lymph nodes in the pelvis
• Bones
• Liver
• Lungs

Treatments

Different types of treatment are available for patients with bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Four types of standard treatment are used:

Surgery

One of the following types of surgery may be done:

• Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
• Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
• Partial cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery. This is also called segmental cystectomy.
• Urinary diversion: Surgery to make a new way for the body to store and pass urine.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after