Bladder Cancer

Overview 

The bladder is an organ in the lower part of the abdomen. The muscle wall allows it to get larger or smaller in order to store urine. The bladder holds urine until it passes through the urethra to leave the body. Bladder cancer occurs when cancer cells form in the tissues of the bladder. There are three different types of bladder cancer that begin in the cells within the lining of the bladder:

• Transitional cell carcinoma - cancer that starts in the inner tissue layer of the bladder.
• Squamous cell carcinoma - cancer that starts in the cells that line the inside of the bladder.
• Adenocarcinoma - cancer that begins in the glandular cells found in the lining of the bladder.

Bladder cancer causes

Researchers continue to work to uncover the causes of bladder cancer. But today, there is no exact known cause. Certain risk factors may contribute to the development of bladder cells becoming cancer cells. What we do know is that bladder cancer occurs when changes happen in the DNA of normal bladder cells. However, some risk factors may contribute to the onset of bladder cancer. 

Bladder cancer risk factors

Understanding what raises your risk for certain cancers can help you make an informed decision about the risk factors you can change. There are other risk factors, such as a person’s age or family history, that cannot be changed.

Several factors may influence the risk of getting bladder cancer. These include:

• Being exposed to chemicals, such as paints, dyes, metals or petroleum products
• Drinking well water with high levels of arsenic
• Family history of bladder cancer
• Having a history of bladder infections
• Inflammation of the prostate, including prostatitis
• Inherited genes that are linked to bladder cancer
• Taking Aristolochia fangchi (a Chinese herb)
• Using tobacco products, especially smoking
• Using urinary catheters for a long time

Bladder cancer symptoms

Blood in the urine may be a sign of bladder cancer. The diagnosis of bladder cancer can occur if other urinary symptoms cause you to see your doctor. Some of the following may be related to bladder cancer symptoms:

• Blood in the urine 
• Changes in bladder habits 
• Having difficulty urinating
• Having to urinate more often than usual
• Loss of appetite and weight loss
• Lower back pain on one side
• Pain or burning during urination
• Swelling in the legs or feet

Bladder cancer diagnosis

Often, bladder cancer is discovered because of symptoms a person is having. We may also find it if tests are completed for another reason. If your urologist suspects bladder cancer, the following methods can help determine the cause of your symptoms:

• Medical history and physical exam - this helps doctors understand your current symptoms and how long you’ve had them. 
• Imaging tests - doctors use X-rays, magnetic fields, sound waves or radioactive substances to take pictures of the inside of your body. If you have bladder cancer, your doctor may order some of these tests to see if the cancer has spread to tissues and organs near the bladder.
• Intravenous pyelogram (IVP) - this is a type of X-ray that provides images of the urinary tract.
• Urinalysis - this test checks for blood or other substances in the urine. 
• Urine cytology - this test takes a sample of urine and examines it to determine if there are any cancer or pre-cancer cells in it. 
• Urine culture - this test checks whether an infection (rather than cancer) is the cause of any symptoms. 
• Cystoscopy - this procedure uses a long, thin, flexible tube to look at the inside of the bladder and urethra.
• Transurethral resection of bladder tumor (TURBT) - doctors use this procedure to biopsy an abnormal area. During this procedure, the tumor is removed along with some of the surrounding muscle. The tumor is examined in a lab to determine if cancer is present. 

Bladder cancer treatments

One of the most important factors in treatment is the staging. Staging is based on how much cancer has spread within the bladder lining or other parts of the body. Treatment may include:

• Chemotherapy - therapy that uses drugs injected through IV, taken orally (by mouth) or applied to the skin to attack and kill cancer cells.
• Clinical trials - participation in clinical trials for bladder cancer is an effective treatment approach. 
• Radiation therapy - therapy that uses high-energy radiation to shrink tumors and kill cancer cells.
• Surgery - a procedure to remove cancer while preserving as much healthy tissue as possible. There are different surgery approaches depending on the cancer, including radical cystectomy, partial cystectomy and urinary diversion.
• Immunotherapy - this is a treatment that uses your immune system to fight cancer. 
• Targeted therapy - this type of treatment uses medicine or other substances to identify and attack certain cancer cells while causing less harm to normal cells. 

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing an oncologist for more specialized treatment.