Bladder Cancer

What is bladder cancer?

The bladder is a hollow organ in your lower belly (abdomen). Urine is stored in it.

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 up the inside lining of the bladder. This cancer is called urothelial carcinoma or transitional cell carcinoma. From the lining, it can move deeper into the other layers of the bladder wall.

When cancer spreads, it’s called metastasis. The more cancer spreads (metastasizes), the harder it is to treat.

Overview

The bladder wall is made of many layers, including:

• Urothelium or transitional epithelium. This is the layer of cells that lines the inside of the kidneys, ureters, bladder and urethra. Cells in this layer are called urothelial cells or transitional cells.
• Lamina propria. This is the next layer around the urothelium. It’s a type of connective tissue.
• Detrusor muscle (muscularis propria). This is the outer layer. It’s the thick, smooth muscle tissue outside the lamina propria.
• Fatty connective tissue. This covers the outside of the bladder and separates it from other organs.

In rare cases, other cancers can start in the bladder. These include lymphoma, sarcoma and small-cell carcinoma.

What are the common types of bladder cancer?

Another way to talk about bladder cancer is by how deeply it spreads into the layers of the bladder wall. This puts the cancer into one of two groups:

• Non-muscle invasive. This type of cancer affects only the inner lining of the bladder. It's urothelial carcinoma or transitional cell carcinoma. It hasn't grown deeper into the bladder's muscle layer. After treatment, non-muscle invasive bladder cancer often comes back, often as another non-muscle invasive cancer.
• Muscle-invasive. This cancer affects deeper muscle layers of the bladder and maybe the fatty tissue around the bladder. Invasive bladder cancer is more likely to spread to nearby organs. These can include the kidneys, prostate gland, and the uterus and vagina.

It may also spread to the lymph nodes. Lymph nodes are small groups of special cells that fight infections. Almost all squamous cell bladder cancers and adenocarcinomas are invasive.

Subtypes of transitional cell carcinomas

Transitional cell carcinomas (TCCs) may also be described as being either papillary or flat:

• Papillary tumors. These look like small mushrooms and grow into the open part of the bladder. They rarely go deeper into other layers of the bladder. Some types of papillary tumors tend to come back. But they can be removed without damaging the bladder.
• Flat tumors. These don't grow into the open part of the bladder. They spread along the lining.

If either of these grow into the deeper layers of the bladder, it's called invasive TCC.

Symptoms

What are the symptoms of bladder cancer?

These are some of the early symptoms of bladder cancer:

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

Change in urinary habits
These changes can be a sign of bladder cancer:

• Urinating more often than normal
• Burning, discomfort, or pain when urinating
• Need to urinate right away
• Trouble urinating
• Weak urine stream
• Need to get up to urinate many times during the night

Risk Factors

These are the risk of developing bladder cancer:

Smoking
Smoking is the biggest risk factor for bladder cancer. People who smoke are at least three times more likely to get bladder cancer than those who don't. In fact, smoking is linked to 50% of all bladder cancers.

When you smoke, cancer-causing chemicals called carcinogens harm cells in your bladder. The 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 there’s no reason to quit smoking because the damage has already been done. That's not true.

Quitting greatly lowers your risk for bladder and many other kinds of cancer. And the longer you don't smoke, the more your risk decreases. 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 Black people or Hispanic Americans.

Gender
Men get bladder cancer much more often than women.

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

Chemical exposure at work
Exposure to certain chemicals and dyes at work can increase your risk for bladder cancer. But these exposures are linked to only a small percentage of bladder cancers.

You may have been exposed if you work in the dye industry or as a hairdresser or truck driver. 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. If you have questions, call:

• National Institute for Occupational Safety and Health at (800) CDC-INFO (800) 232-4636)
• Occupational Safety and Health Administration at (800) 321-OSHA (800) 321-6742)

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 the diabetes medicine pioglitazone for over a year has been linked to bladder cancer.

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 at an early stage, you have a higher risk of getting it again.

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

Arsenic
High levels of arsenic in drinking water have been linked with a higher risk for bladder cancer. This is rare in the U.S.

Past cancer treatment
You may be at a higher risk of bladder cancer if you had previous cancer treatments targeting your pelvic region for another cancer type. 

Prevention

Can you prevent bladder cancer?

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 fruit 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.

Diagnosis

How is bladder cancer diagnosed?

Diagnosing bladder cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, symptoms, risk factors, and family history of disease. A physical exam, which may include a rectal or vaginal exam, will be done. This is done to check for tumors that are large enough to be felt.

What tests might I need?

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
• Imaging

After a diagnosis of bladder cancer, you’ll likely need other tests. These help your health care providers learn more about the cancer. They can help determine the stage of the cancer.

The stage is determined by many factors including how much it has spread into the muscle wall, if it has invaded nearby tissues or has spread to other parts of the body.

Once your cancer is staged, your health care provider will discuss what the stage means for your treatment. Ask your health care provider to explain the stage of your cancer to you in a way you can understand.

Treatment

How is bladder cancer treated?

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

Types of treatment for bladder 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 destroys or controls cancer cells that may have traveled around your body. When taken by pill, injection or intravenously, 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
• Radiation therapy
• Immunotherapy
• Targeted therapy

Is bladder cancer curable?

Yes. Survivability largely depends on the stage of bladder cancer. The American Cancer Society reports a five-year survival rate for bladder cancer that hasn’t spread and remained localized at 96%. If the cancer has spread outside of the immediate region, the survival rate is 70%.