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Bladder Cancer

By

Thenappan Chandrasekar

, MD, Thomas Jefferson University

Last full review/revision Feb 2022
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Most bladder cancers are of a type called transitional cell because they affect the same kinds of cells (transitional cells) that are usually the cancerous cells responsible for cancers of the renal pelvis and ureters Renal Pelvis and Ureter Cancer Cancer can occur in the cells lining the central collecting area of the kidney (the renal pelvis—usually a type called urothelial carcinoma of the renal pelvis) and in the slender tubes that... read more .

  • Bladder cancer most often causes blood in the urine.

  • To make the diagnosis, doctors insert a thin, flexible tube with a camera (cystoscope) through the urethra into the bladder.

  • Many cancers are treated with removal, using a cystoscope (for surface cancers) or by removing the bladder (for deeper cancers).

About 83,730 new cases of bladder cancer are diagnosed every year in the United States. According to 2021 estimates, more than 17,200 people die of bladder cancer every year. About 3 times as many men as women develop bladder cancer.

Smoking is the greatest single risk factor and seems to be one of the causes in at least half of all new cases. Certain chemicals that are used in industry can become concentrated in the urine and cause cancer, although exposure to these chemicals is decreasing. These chemicals include hydrocarbons, aniline dyes (such as naphthylamine used in the dye industry) and chemicals used in the rubber, electric, cable, paint, and textile industries. Long-term exposure to some drugs, especially cyclophosphamide, increases the risk of bladder cancer. The chronic irritation that occurs with a parasitic infection called schistosomiasis Schistosomiasis Schistosomiasis is infection caused by certain flatworms (flukes), called schistosomes. People acquire schistosomiasis by swimming or bathing in fresh water that is contaminated with the flukes... read more or with bladder stones Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more Stones in the Urinary Tract , urinary tract infections, or chronic catheter use also predisposes people to bladder cancer, although irritation accounts for only a small number of all cases.

Symptoms of Bladder Cancer

Bladder cancer most often causes blood in the urine. Other symptoms may include pain and burning during urination and an urgent, frequent need to urinate. The symptoms of bladder cancer may be identical to those of a bladder infection ( cystitis Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more Bladder Infection ), and the two problems may occur together. A low blood count ( anemia Overview of Anemia Anemia is a condition in which the number of red blood cells is low. Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts... read more ) may cause fatigue, paleness, or both.

Diagnosis of Bladder Cancer

  • Blood in urine

  • Cytology (examination of urine under the microscope)

  • Cystoscopy (visualization of the inside of the bladder) and biopsy (examination of bladder tissue under the microscope)

The diagnosis is often first suspected when blood is found in the urine. Blood may be detected when a routine microscopic examination of a urine specimen detects red blood cells, or sometimes the urine may be visibly red. Bladder cancer may be suspected if the symptoms of cystitis do not disappear with treatment. Special microscopic evaluation of urine (such as cytology Diagnosis ) may detect cancer cells. Sometimes bladder cancer is detected when an imaging study such as computed tomography Computed tomography There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. (See also Overview of the Urinary Tract.) X-rays are usually not helpful in evaluating... read more (CT) or ultrasonography Ultrasonography There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. (See also Overview of the Urinary Tract.) X-rays are usually not helpful in evaluating... read more is done for another reason.

If the cancer has invaded the bladder muscle, additional testing, including abdominal CT and chest x-ray, is needed to determine whether a cancer has spread. Magnetic resonance imaging (MRI) can now be used to determine the extent of spread in the area around the bladder cancer.

Improvements in detecting and staging bladder cancer are expected to improve outcomes by finding the cancer earlier.

Prognosis for Bladder Cancer

For cancers that remain on the bladder’s inner surface (superficial tumors) and grow and divide slowly, the risk of death from bladder cancer is less than 5% in the 5 years after diagnosis. The 5-year death rate for tumors that invade the bladder muscle is significantly higher (about 50%), but chemotherapy may improve survival. Cancers that have spread beyond the bladder wall (such as to the lymph nodes or other abdominal or pelvic organs) have a much poorer prognosis.

Treatment of Bladder Cancer

  • Removal during cystoscopy

  • Intravesical immunotherapy or chemotherapy (for superficial, or surface, cancers)

  • Partial or total removal of the bladder, radiation, chemotherapy or immunotherapy (for deeper, more invasive cancers)

Cancers that are on only the bladder’s inner surface may be removed completely during cystoscopy. However, people commonly develop new cancers later within the bladder. Doctors may be able to prevent the recurrence of these cancers by repeatedly putting anticancer drugs (such as gemcitabine, docetaxel or mitomycin C) or bacille Calmette-Guérin (BCG—a substance that stimulates the body’s immune system) into the bladder after all of the cancer has been removed.

Cancers that have grown into the bladder wall cannot be completely removed through a cystoscope. They are usually treated by total or partial removal of the bladder (cystectomy). Chemotherapy is usually given before removing the bladder as this has been shown to improve survival compared to cystectomy alone. Radiation therapy alone or in combination with chemotherapy is used in an attempt to cure the cancer in selected people.

If the entire bladder needs to be removed, doctors must devise a method for the person to be able to drain urine. The usual way has been to route the urine to an opening (stoma) made in the abdominal wall through a passageway made of intestine, called an ileal loop (conduit). The urine is then collected in a bag worn on the outside of the body.

Several alternative methods of diverting urine are becoming increasingly common and are appropriate for many people. These methods can be grouped into two categories: an orthotopic neobladder and a continent urinary diversion. In both, an internal reservoir for urine is constructed from the intestine.

For an orthotopic neobladder, the reservoir is connected to the urethra. The person learns to empty this reservoir by relaxing the pelvic floor muscles and increasing pressure within the abdomen, so that urine passes through the urethra very much as it would naturally. Most people are dry during the day, but some urine leakage may occur at night.

For a continent urinary diversion, the reservoir is connected to a stoma in the abdominal wall. A collecting bag is not needed, because the urine remains in the reservoir until the person empties it by inserting a catheter through the stoma into the reservoir, which is done at regular intervals throughout the day. The most common of these is known as an Indiana pouch and is made from a part of the colon.

Cancer that has spread beyond the bladder to the lymph nodes or other organs is treated with chemotherapy. Several different combinations of drugs are active against this type of cancer, particularly when the spread is confined to the lymph nodes. Cystectomy or radiation therapy Radiation Therapy for Cancer Radiation is a form of intense energy generated by a radioactive substance, such as cobalt, or by specialized equipment, such as an atomic particle (linear) accelerator. Radiation preferentially... read more , including external beam radiation, may be offered to people who respond well to chemotherapy. However, a relatively small number of people are cured. For people who are not cured, efforts are directed at pain relief (see Symptoms During a Fatal Illness Symptoms During a Fatal Illness Many fatal illnesses cause similar symptoms, including pain, shortness of breath, digestive problems, incontinence, skin breakdown, and fatigue. Depression and anxiety, confusion and unconsciousness... read more ) and end-of-life issues.

Drugs Mentioned In This Article

Generic Name Select Brand Names
No US brand name
GEMZAR
TAXOTERE
MITOSOL
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