Bladder Cancer

Bladder cancer is a common cancer that usually develops in the bladder lining. In some cases, it may spread into the bladder muscle. This condition is the ninth most common cancer, occurring more often in men than women. Men are about three times more likely to be diagnosed with bladder cancer than women. 1 The most common symptom is blood in the urine. Treatment and prognosis depend on the size and type of bladder cancer.

The bladder is lined with a type of cells known as transitional cells or urothelial cells, and is surrounded by a thick layer of muscle.

The majority of bladder cancers originate in the transitional cells. This resource deals with transitional cell bladder cancer, the most common type of bladder cancer.

Transitional cell bladder cancer may be divided into two overall groups: 2 3

Superficial or non-muscle invasive tumors. These tumors are more common and occur in about four in five cases of transitional cell bladder cancer. They are confined to the inner lining or just under the inside lining of the bladder. This type of cancer is usually curable as it normally does not metastasize, i.e. spread from where it originally develops to other parts of the body. However, if left untreated, they can develop into muscle-invasive tumors.

Muscle-invasive tumors. These tumors have spread to the muscle layer of the bladder or through the outer wall of the bladder. These tumors have a high chance of metastasis, so they are harder to cure.

The treatment for these two types of bladder cancer are very different (see treatment).

The main symptom of bladder cancer is blood in the urine. This is not usually painful and can come and go. While you should always see a doctor if there is blood in your urine, the Ada app can give you a free initial symptom assessment.

Other early symptoms may include: 2 4

• Needing to urinate more frequently than usual
• Needing to urinate very urgently
• Pain on urination

If the cancer is muscle-invasive, other symptoms may develop over time, such as pain in the lower abdomen. If the cancer metastasizes, further signs and symptoms can develop.

Good to know: Women are more likely to be diagnosed with later stages of bladder cancer. Bladder cancer symptoms in women are likely to be the same as in men, but many women ignore the main symptom of blood in the urine, which they may associate with menstruation or menopause. Doctors may also initially misdiagnose the bleeding as post-menopausal bleeding or a urinary tract infection, which are more common causes of blood in the urine for women. 5

Our cells normally divide to make new cells in a controlled way. Cancer first develops in the genes of one cell that becomes abnormal, so that it divides in an uncontrolled way. The abnormal cells often form a tumor, a mass of cells in one area of the body. As the tumor grows, cancer may invade nearby tissues and organs.

It is not clear why a cell becomes cancerous or why some people develop cancer while others do not. However, certain factors have been found to be more common in people who develop bladder cancer.

Risk factors for developing bladder cancer that cannot be changed may include: 2 6

Ethnicity. In the United States, white people develop bladder cancer about twice as often as African American or Hispanic people, while Asian Americans and Native Americans tend to develop bladder cancer slightly less often than many other ethnicities.

Increasing age. Over 90 percent of new cases occur in people over the age of 55.

Being male. Bladder cancer occurs about three times more often in men than women.

Genetics and family medical history. Family members may be exposed to the same cancer-causing chemicals, such as those in tobacco smoke. They may also share certain genetic traits that make bladder cancer more likely to develop, such as in the case of Cowden disease or Lynch syndrome.

Previous chemotherapy or radiotherapy. In particular, the chemotherapy drug cyclophosphamide can irritate the bladder, increasing the risk of bladder cancer if taken for a long time. People treated with this drug are often advised to drink plenty of fluid to avoid bladder irritation.

Risk factors which can be controlled and may therefore be helpful to know in order to lessen the risk of bladder cancer, include: 2 6

Using tobacco products. People who smoke tobacco are at least three times more likely to get bladder cancer. Smoking is known to cause about half of all bladder cancers in both men and women.

Certain chemical exposures. Industries using chemicals that can cause bladder cancer include dye, rubber, leather, textiles, paint and printing.

Chronic bladder irritation and infections. Chronic bladder irritation, such as can be caused by bladder catheters left in place a long time, urinary tract infections, bladder and kidney stones are all linked with bladder cancer.

Not drinking enough. This may be because drinking plenty of fluid causes a person to empty their bladder more often, which could keep cancer-associated chemicals from lingering in the bladder.

Certain medicines or herbal supplements. The diabetes medicine pioglitazone has been linked with bladder cancer. Aristolochic acid, contained in some dietary supplements, has also been linked with bladder cancer.

• Arsenic in drinking water. However, drinking water is not likely to be a major source of arsenic in the developed world.

If a person has blood in their urine, they should go to a doctor. A sample of urine from the affected person may be analysed in a laboratory to look for the presence of blood, bacteria or cancer cells. It can also rule out other, more likely causes of blood in the urine, such as a urinary tract infection.

The doctor may also carry out a physical examination of the rectum – the final section of the large intestine, terminating at the anus – and/or vagina. This is because bladder cancer may cause a lump that can be felt by pressing against the walls of the rectum and/or vagina.

If bladder cancer is suspected, a person may be referred to hospital for further tests. These tests may include: 7 8

Blood tests normally include:

• A Complete Blood Count (CBC)
• A Comprehensive Metabolic Panel (CMP)

Read more about Blood Test Results »

This is a procedure to look at the inside of the bladder. It involves passing a thin tube with a camera and light at one end through the urethra, the tube through which a person urinates. A local or general anesthetic may be used so that the procedure is painless.

An ultrasound will usually be done to create a picture of the bladder and surrounding area to look for tumors. It involves a transducer being passed over the skin of the abdomen, which sends sound waves to create a picture of the internal organs. A person will be asked to have a full bladder for a first scan, then to empty their bladder before a second scan.

An ultrasound can’t always find small tumors, so an MRI or CT scan may also be used to get a more detailed image of the bladder.

An intravenous (IV) urogram may also be used to look at the whole urinary tract. This involves injecting dye into the bloodstream and then using X-rays to study the dye as it moves through the urinary system.

If abnormal tissue is found during a cystoscopy, a transurethral resection of a bladder tumor (TURBT) will be done. This is a type of biopsy in which any tumor, a sample of the bladder muscle near the tumor and possibly from other parts of the bladder are removed and examined under a microscope.

A TURBT may also be used as a treatment method for a non-muscle invasive tumor (see treatment).

Once bladder cancer is diagnosed, doctors will try to find out whether it has spread and, if so, how far, in a process known as staging.

The staging system most often used for bladder cancer is the TNM system, developed by the American Joint Committee on Cancer (AJCC).

The treatment required depends on the exact type of bladder cancer and the extent to which it has spread. Treatments usually differ significantly between non-muscle-invasive bladder cancer and muscle-invasive bladder cancer.

Treatment options for bladder cancer also depend on the overall health of the affected person. The treating doctor can give the best advice as to treatment.

Cases of non-muscle-invasive bladder cancer are normally treated by surgery. It’s usually possible to do this with a TURBT, i.e. removing the cancerous cells while leaving the rest of the bladder intact (see transurethral resection of a bladder tumor.

TURBT is usually followed by one dose of chemotherapy to reduce the risk of the cancer returning. The chemotherapy medication is administered directly into the bladder using a catheter that is inserted through the urethra, i.e. the thin tube that carries urine out of the bladder. This method of administration reduces the chemotherapy side effects. 3

In cases of higher recurrence risk, Bacillus Calmette-Guerin (BCG) therapy may be used. This is a type of immunotherapy for bladder cancer. BCG is a germ that doesn’t usually cause serious disease, but attracts the body’s immune system to the bladder, so that it may fight against bladder cancer cells.

BCG therapy is intravesical, meaning a liquid drug is put directly into the bladder, rather than being taken by mouth or injected into a vein. This means that the drug acts on the bladder lining, with little or even no effects on other parts of the body. 9

Good to know: BCG therapy can cause flu-like symptoms. Rarely, BCG can spread to other parts of the body, where it can cause serious infection. A high fever may be a sign of serious infection; if this is experienced, medical attention should be sought as soon as possible.

Treatment for muscle-invasive bladder cancer or high-risk non-muscle invasive bladder cancer, may involve removing the bladder in an operation known as a cystectomy.

If the bladder is removed, another way of collecting urine will be created at the same time as the cystectomy. This may involve one of the following: 3

• Creating a new bladder out of a section of the bowel
• Making an opening in the abdomen so urine can be passed out into an external bag

If it is possible to avoid removing the bladder or if surgery is not advisable, a course of chemotherapy may be recommended, sometimes combined with radiotherapy. Chemotherapy may sometimes be used before surgery on its own or combined with radiotherapy. 3

In many cases, bladder cancer can be cured. However, the likelihood of this depends upon the type of bladder cancer and what stage it is at (see bladder cancer staging).

People who have non-muscle-invasive bladder cancer have a fairly high chance of recovery. People with muscle-invasive bladder cancer can sometimes make a full recovery. Bladder cancer that has spread to other parts of the body tends to be much more difficult to cure, but some people do have long-term positive responses to treatment. 10

The prognosis of cancer is calculated by looking at survival rates. Survival rates show what percentage of people live for a certain length of time after being diagnosed with cancer. Not everyone who is diagnosed with a cancer wants to know this information. They are based on averages taken from huge numbers of people and do not predict what will happen to an individual.

Non-muscle invasive bladder cancer has a good prognosis, with 5-year survival rates of 82 to 100 percent. 11 The 5-year survival rate decreases with increasing stage.

Q: Is bladder cancer curable?
A: This depends on the individual case of bladder cancer. Superficial or non-muscle invasive tumors tend to be curable as they normally do not metastasize, i.e. spread from where they originally develop to other parts of the body. However, if left untreated, in some cases they can develop into muscle-invasive tumors. Muscle-invasive tumors have a high chance of metastasis, so they are harder to cure.

• Bladder carcinoma
• Bladder tumor
• Transitional cell carcinoma