Bladder Cancer

The bladder is part of the urinary system. (Read about "The Urinary System") Bladder cancer strikes an estimated 55 thousand people each year. It is the sixth most common cancer. (Read about "Cancer: What It Is") Over 12,000 people die from the disease each year, according to the American Cancer Society (ACS). It is three times more common in men than in women, according to the National Cancer Institute (NCI). Bladder cancer is also much more prevalent after age 55 according to NCI, and it strikes whites twice as often as African-Americans.

Types of bladder cancer

There are three main types of bladder cancer according to NCI and ACS. They are:

• Transitional cell carcinoma is the most common, accounting for 90 percent of all bladder cancers. This cancer starts in the lining of the bladder but can spread into the walls of the bladder and beyond.
• Squamous cell carcinomas tend to be more aggressive, almost always spreading into the deeper layers of the bladder. Squamous cell carcinomas account for some 8 percent of bladder cancers.
• Adenocarcinomas account for one to 2 percent of bladder cancers. They are likely to invade the deep tissues as well.

There are other types of bladder cancer, but ACS says they are very rare.

Survival

The survival rate for bladder cancer is considered very good. ACS says if it's discovered early, before it spreads, the five year survival rate is 94 percent. When the cancer has spread to the organs in the pelvic region, the rate drops to 49 percent and once it has spread to other organs the survival rate falls to 6 percent. The five year survival rate is used to compare survival rates for cancers and treatments. Many people live long beyond the five years. It is also important to remember that NCI says that a superficial bladder cancer often returns, so follow-up with your doctor is important.

Risk factors and symptoms

There are other risk factors (Read about "Cancer Risk") for bladder cancer beyond the ones already mentioned such as age, race and sex. ACS and NCI list them as follows:

• Smoking is considered a huge risk factor for bladder cancer. Two to three times as many smokers get bladder cancer as non-smokers. (Read about "Quit Smoking")
• Chemicals in the workplace are linked to increases in bladder cancer. People who work in the rubber, chemical and leather industry show an increased risk. Other workers at risk include printers, painters, textile workers, truck drivers and hairdressers. Appropriate safety precautions and chemical handling procedures are important for these workers.
• Chronic bladder infections have also been linked as a risk factor. (Read about "Urinary Tract Infections")

If you fall into the risk factor categories, it is important that you talk to your doctor about potential warning signs. (Read about "Cancer Check-ups") Potential symptoms include:

• blood in the urine
• pain during urination
• changes in bladder habits, such as needing to go more often or feeling the need but not being able to

These can also be symptoms of other problems, but should not be ignored. Talk with your doctor.

Diagnosis and treatments

If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. NCI says the person may have one or more of the following procedures:

• Physical exam - The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
• Urine tests - The laboratory checks the urine for blood, cancer cells and other signs of disease.
• Intravenous pyelogram - The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays. (Read about "X-rays")
• Cystoscopy - The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure. (Read about "Anesthesia")

The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. (Read about "Biopsy")

If bladder cancer has been found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for bladder cancer, according to NCI:

• Stage 0 - In stage 0, the cancer is found on tissue lining the inside of the bladder only. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:
  • Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
  • Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.
• Stage I - In stage I, the cancer has spread to the layer below the inner lining of the bladder.
• Stage II - In stage II, cancer cells have spread to either the inner half or outer half of the muscle wall of the bladder.
• Stage III - In stage III, cancer cells have spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).
• Stage IV - In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body. (Read about "The Lymph System")

Treatments for bladder cancer are based on a number of factors, according to ACS. It depends on the type of the cancer, how far it has progressed or the stage it is in, and other factors such as your age, general health and personal preferences. There are four basic treatments:

• Surgery, of which there are a number of difference kinds. Some will remove the entire bladder; others will not. If the cancer has spread in any way, other organs could be partially or entirely removed. Once again, the decision on the type of surgery should be discussed carefully with your doctor and will depend on many issues.
• Radiation is often used in conjunction with surgery to get the rest of the cancer cells that might be missed by the operation.
• Chemotherapy can be used in many ways. In early stage bladder cancer, ACS says the drugs can be placed directly into the bladder and might be the only treatment needed. Later stages require more aggressive chemotherapy.
• Biological or immunotherapy uses the bodies own immune system (Read about "The Immune System") to attack the cancer cells. Once again, it is used on early stage cancers.

Each treatment has its own set of side effects that should be discussed with your doctor. (Read about chemo, radiation and other cancer therapies in "Cancer Treatments")

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is