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Learn About Bladder Cancer, What is bladder cancer?

Bladder cancer occurs when there are abnormal, cancerous cells growing in the bladder. According to the American Cancer Society, it is the sixth most common cancer in men and women in the US, excluding skin cancers. Each year, approximately 54,000 people are newly diagnosed with bladder cancer.

Bladder cancer affects men two to three times more often than women, and it occurs in Caucasians twice as often as in African-Americans. Most bladder cancer occurs after age 55, but it can occur at younger ages.

The bladder is a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder’s walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.

What are the different types of bladder cancer?
There are several types of bladder cancers, including the following:

• transitional cell carcinoma
  Transitional cell carcinoma is cancer that begins in the cells lining the bladder. Transitional cells also line the other parts of the urinary tract including the kidneys, ureters, and urethra. Transitional cell carcinoma is the most common kind of bladder cancer, occurring in about 90 percent of cases. This type of cancer is also called urothelial carcinoma.
• squamous cell carcinoma
  Squamous cell carcinoma is cancer that begins in squamous cells - thin, flat cells found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. About 6 to 8 percent of bladder cancers are squamous cell carcinomas.

• adenocarcinoma
  Adenocarcinoma is cancer that begins in the cells of glandular structures lining certain organs in the body and then spreads to the bladder. Common primary sites for adenocarcinomas include the lung, pancreas, breast, prostate, stomach, liver, and colon. Adenocarcinomas account for only about 2 percent of bladder cancers.

What causes bladder cancer?

While the exact causes of bladder cancer are not known, there are well-established risk factors for developing the disease. Risk factors for bladder cancer include the following:

• cigarette smoking
  Cigarette smoking is a major risk factor for developing bladder cancer. Smoking causes about half of the deaths from bladder cancer among men, and over one-third of bladder cancer deaths in women. The disease occurs in smokers twice as often as nonsmokers. Quitting smoking reduces the risk of bladder cancer, as well as several other types of cancer and diseases.

• occupational exposure
  Certain occupations and work environments that expose workers to dyes and some organic chemicals appear to increase the risk for bladder cancer. Workers in the rubber, chemical, leather, textile, metal, and printing industries are exposed to substances such as aniline dye and aromatic amines that may increase their risk for bladder cancer. Other at-risk occupations include hairdressers, machinists, painters, and truck drivers.

• chronic bladder irritation
  Chronic bladder infections or bladder stones may be linked to certain types of bladder cancer.
• age
  The risk for bladder cancer increases with age. Bladder cancer is rare in individuals under age 40.
• gender
  Bladder cancer occurs about two to three times more often in men than in women.
• race
  Caucasians are two times more likely to develop bladder cancer than African-Americans and Hispanics. Asians have the lowest bladder cancer rates.
• personal history of bladder cancer
  Individuals who have previously had bladder cancer have an increased risk of developing the disease again.
• family history
  Individuals with family members who have had bladder cancer are more likely to develop the disease. Research is ongoing to determine specific genetic risks for bladder cancer.
• parasite infections
  Infection with certain parasites found in tropical regions of the world, but not in the US, increases the risk of bladder cancer.

What are the symptoms of bladder cancer?

The following are the most common symptoms of bladder cancer. However, each individual may experience symptoms differently. Symptoms may include:

• visible blood in the urine
• hematuria - the presence of microscopic red blood cells (RBCs) in the urine.
• painful urination
• urgency - frequently feeling the need to urinate without results.
• frequent urination
• pelvic or flank pain

The symptoms of bladder cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is bladder cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for bladder cancer may include the following:

• rectal or vaginal examination - the physician can check for the presence of tumors large enough to be felt.
• cystoscopy (Also called cystourethroscopy.) - an examination in which a scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones. Samples of the bladder tissue (called a biopsy) may be removed through the cystoscope for examination under a microscope in the laboratory.

• intravenous pyelogram (IVP) - a series of x-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein. This test is used to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow. It may also be used to rule out other diseases or check for spread (metastasis) of the bladder cancer to other areas of the urinary tract.

• laboratory tests - tests may be performed on the urine to check for blood, chemicals, bacteria, and cells. The urine may be examined microscopically or grown in culture to check for infection. Cancerous cells may be detected using the microscope.

• bladder tumor marker studies - tests to determine cellular characteristics and markers or substances released by bladder cancer cells into the urine.

Once bladder cancer is diagnosed, your physician will determine the grade and stage of the cancer:

• grade - differentiates the cells from normal tissue and estimates the rate of cancer growth.

• stage - indicates the extent the cancer has spread and if other body parts or organs are affected. Additional tests may be needed to determine if bladder cancer is limited to the bladder or if it has spread.

The American Joint Committee on Cancer (AJCC) provides guidelines for staging of bladder cancer. The stages range from Stage 0 to Stage IV and have detailed criteria for tumor size, invasiveness, presence in lymph nodes, and whether or not the cancer has metastasized (spread) to other organs. A general description of each stage of bladder cancer follows:

• Stage 0 - cancer cells are found only on the inner lining of the bladder. This is also called superficial cancer or carcinoma in situ.
• Stage I - cancer cells are found deep in the lining of the bladder, but have not invaded the bladder muscle.
• Stage II - cancer cells are present in the muscle of the bladder.
• Stage III - cancer cells have spread through the bladder muscle into the tissues around the bladder, such as the prostate in men or the uterus in women.
• Stage IV - cancer has progressed further into the abdominal cavity, and may have spread to lymph nodes and other organs in the body.