Bladder Cancer

Bladder cancer occurs in both men and women when cells in the bladder begin to rapidly grow out of control. Bladder cancers develop on the inner layer of bladder and become more difficult to treat as the cancer cells spread to the wall of the bladder.

Types & Stages

Types of bladder cancer include:

• Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well. This is the most common type of bladder cancer in the U.S.
   
• Squamous cell carcinoma is associated with chronic irritation of the bladder such as from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the U.S. 
   
• Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder and is very rare.

Some bladder cancers include more than one type of cell.

Signs & Symptoms

Visit a doctor if you are experiencing any of these symptoms:

• Blood in the urine
• Unable to urinate
• Lower back pain

Diagnosis

Tests and procedures used to diagnose bladder cancer may include:

• Using a scope to examine the inside of your bladder (cystoscopy). Your doctor inserts a small, narrow tube (cystoscope) through your urethra. The cystoscope has a lens that allows your doctor to see the inside of your urethra and bladder. Cystoscopy can be done in a doctor's office or in the hospital.
   
• Removing a sample of tissue for testing (biopsy). During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT), which can also be used to treat bladder cancer.
   
• Examining a urine sample is when a sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
   
• Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, allow your doctor to examine the structures of your urinary tract.
   
  • During a CT urogram, a contrast dye is injected into a vein in your hand and eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.
     
  • Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

Treatment

Treatment of bladder cancer will be determined by the stage and grade of cancer, and your overall health and can include:

• Robotic cystectomy (surgical removal of the bladder) works best with preoperative chemotherapy for high-grade T1 cancers—meaning the cancer has grown into the inner layer of the bladder (the lamina propria) but not yet into the muscle layer. In men this requires removal the bladder, prostate and seminal vesicles. In women this requires removal of the bladder, uterus, cervix and upper vagina.
   
• Bladder preservation (partial removal of the bladder) works for patients who wouldn’t be able to tolerate major surgery. However, bladder cancer may be more likely to recur.
   
• Adstiladrin is a new gene therapy for Non-Muscle Invasive Bladder Cancer (NMIBC). Treatment is delivered directly into the bladder by catheter once every three months, using localized, non-replicating gene therapy that results in anti-tumor effects. 

Causes & Risk Factors

Factors that may increase bladder cancer risk include:

• Smoking may cause harmful chemicals to accumulate in the urine. 
   
• Bladder cancer risk increases as you age. Though it can occur at any age, most people diagnosed with bladder cancer are older than 55.
   
• Being male. Men are more likely to develop bladder cancer than women are.
   
• Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. So being around certain chemicals — like arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products — may increase the risk. 
   
• Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer as does receiving radiation treatments aimed at the pelvis for a previous cancer.
   
• Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. 
   
• Personal or family history of cancer. If you've had bladder cancer, you're more likely to get it again. If one of your blood relatives — a parent, sibling or child — has a history of bladder cancer, you may have an increased risk of the disease, although it's rare for bladder cancer to run in families.
   
• A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organs.

Screening

There is no standard screening test for bladder cancer in people at average risk. But certain tests may be used to screen for bladder cancer in people who have had it in the past or who are at an increased risk of developing it.

• Hematuria testing is used to check for red blood cells in a sample of urine by viewing it under a microscope or using a special test strip.  
   
• Urine cytology is a lab test in which a sample of urine is checked under a microscope for abnormal cells.
   
• Urine tumor markers are substances found in the urine that are either made by bladder cancer cells or that the body makes in response to bladder cancer. For this test, a sample of urine is checked in the lab to detect the presence of these substances. Urine tumor marker tests may also be used to help diagnose some types of bladder cancer.