Bladder cancer is a cancer that starts in the bladder. The bladder is the body part that holds and releases urine. It is in the center of the lower belly area.
Causes, incidence, and risk factors
Bladder cancers usually start from the cells lining the bladder (called transitional cells). These tumors are classified based on the way they grow:
- Papillary tumors have a wart-like appearance and are attached to a stalk.
- Nonpapillary (sessile) tumors are flat. They are much less common. However, they are more invasive and have a worse outcome.
The exact cause of bladder cancer is uncertain. However, 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 one in four cases of bladder cancer is caused by coming into contact with to 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 (Cytoxan) may increase the risk of 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.
Symptoms of bladder cancer can include:
- Abdominal pain
- Blood in the urine
- Bone pain or tenderness if the cancer spreads to the bone
- Painful urination
- Urinary frequency
- Urinary urgency
- Urine leakage (incontinence)
- Weight loss
Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.
Stage 0 and I treatments:
- Surgery to remove the tumor without removing the rest of the bladder
- Chemotherapy or immunotherapy placed directly into the bladder
Stage II and III treatments:
- Surgery to remove the entire bladder (radical cystectomy) and nearby lymph nodes
- Surgery to remove only part of the bladder, followed by radiation and chemotherapy
- Chemotherapy to shrink the tumor before surgery
- A combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery)
Most patients with stage IV tumors cannot be cured and surgery is not appropriate. In these patients, chemotherapy is often considered.
Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning. For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder. A Foley catheter can be used to deliver the medication into the bladder. Common side effects include bladder wall irritation and pain when urinating. For more advanced stages (II-IV), chemotherapy is usually given by vein (intravenously).
Bladder cancers are often treated with immunotherapy. In this treatment, a medication triggers your immune system to attack and kill the cancer cells. Immunotherapy for bladder cancer is usually performed using the Bacille Calmette-Guerin vaccine (commonly known as BCG). A medicine called Interferon is sometimes used. It is given through a Foley catheter directly into the bladder. If BCG does not work, patients may receive interferon.
Surgery for bladder cancer includes:
- Transurethral resection of the bladder (TURB): Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is usually used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells. Bladder cancer can come back after this surgery, so repeat TURs are sometimes needed.
- Radical cystectomy: Many people with stage II or III bladder cancer may need to have their bladder removed (radical cystectomy). Sometimes only part of the bladder is removed. Radiation and chemotherapy is usually given after this surgery.
- Ileal conduit: A small urine reservoir is surgically created from a short piece of your small intestine. The ureters that drain urine from the kidneys are attached to one end of this piece. The other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir.
- Continent urinary reservoir: A pouch to collect urine is created inside your body using a piece of your intestine. You will need to insert a tube into an opening in your skin (stoma) into this pouch to drain the urine.
- Orthotopic Neobladder: This surgery is becoming more common in patients who had their bladder removed. A part of your bowel is folded over to make a pouch that collects urine. It is attached to the place in the body where the urine normally empties from the bladder. This procedure allows you to maintain some normal urinary control.