Bladder Cancer

What is Bladder Cancer?

Bladder cancer is the second most common cancer of the urinary system after prostate cancer. About 67,200 people are diagnosed with bladder cancer in the US each year.

The bladder is a holding tank for urine after it passes through the kidneys and before it leaves the body.

Most bladder cancers start in the innermost layer of your bladder. It probably hasn’t grown into the muscle layer when it’s diagnosed. This noninvasive cancer can usually be removed using a lighted fiberoptic tube called a cystoscope.

When bladder cancer is caught early, it is treatable and may be curable. But because bladder cancer can come back (recur), continuous surveillance after treatment is necessary.

When the cancer spreads into the deep muscular wall—called invasive cancer—removing it requires more extensive surgery, chemotherap,y and radiation treatment. Invasive cancer is more likely to spread to other organs.

Diagnosis, Symptoms, and Risk Factors

Diagnosis

Your doctor may conduct the following tests for bladder cancer:

• Urine cytology. A pathologist examines a sample of your urine under a microscope to check for any cancerous or precancerous cells. They may also order a urine culture to rule out an infection, which can cause similar symptoms to bladder cancer.
• Cystoscopy and retrograde pyelography. If your doctor suspects you have a tumor growing in the ureters (tubes that carry urine from the kidney to the bladder) or collecting system, they may do a procedure with a cystoscope. A cystoscope is a slender tube with a lens in it that lets them look inside your body. During this procedure, they may inject a dye into the ureters and take an X-ray to help them see the area better, called retrograde pyelography. These tools give your doctor a better picture to check for tumors.
• CT (computerized tomography) scan. A CT scan creates a 3D image of your body using a series of cross-sectional images. A scan of your abdomen and pelvis can show if your urinary system is normal. If cancer is present, a CT can show how far it has spread outside your bladder.
• MRI (magnetic resonance imaging) scan. MRI uses magnetic fields to create a detailed image of your abdomen and pelvis. This test can show if your urinary system is normal, and if cancer is present, how far it has spread outside the bladder. MRI is preferred over CT for some people with reduced kidney function. The doctors at Columbia Cancer are increasingly using MRI to image the bladder in order to improve our ability to stage bladder cancer, assess treatment response, and impact treatment decision-making.
• Ultrasound. This procedure uses sound waves to find out if you have tumors in your bladder.

Symptoms

Early-stage bladder cancer may not have any symptoms at all, but the most common symptom is blood in the urine. Some symptoms are similar to those for bladder stones, an enlarged prostate, or even a urinary tract infection. You should see your doctor if you experience:

• Blood in your urine (this might be visible or only seen in a urine test)
• More frequent urination, an urgent need to urinate, or burning upon elimination
• Difficulty or inability to urinate
• Painful urination
• Abdominal pain
• Unexpected weight loss
• Lack of appetite
• Persistent pain in your lower back, upper thigh, or pelvic area

Risk Factors

If you are diagnosed with bladder cancer, it is not your fault. Most bladder cancer risks are out of your control. There are several risk factors for bladder cancer, including:

• Tobacco use: Smoking cigarettes is the most common risk factor for bladder cancer. Smokers are four to seven times more likely to develop bladder cancer than nonsmokers.
• Gender: About four times more men than women get bladder cancer, but women are more likely to die from the disease.
• Age: Nearly 90% of people with bladder cancer are over age 55.
• Race and ethnicity: White people develop bladder cancer twice as often as African American people. African American people are more likely to die from the disease. Hispanic, Asian American, and Native American people have slightly lower rates of bladder cancer.
• Chemical exposure: Painters, printers, machinists, hair stylists, truck drivers, and other people who work in jobs where they are exposed to chemicals have a higher risk of contracting bladder cancer.
• Arsenic exposure: Arsenic is a naturally occurring substance that can be found in drinking water, particularly in unfiltered well water. It can increase your chance of developing bladder cancer if consumed in large amounts.
• Chronic bladder irritation: Chronic bladder inflammation from bladder stones, infections, and indwelling catheters have been linked to bladder cancer.
• History of other urinary tract cancer:  If you’ve had cancer in your kidneys or ureters, which also have urothelial cells, you are at an increased risk of bladder cancer.
• Rare birth defects: Two birth defects increase your risk of bladder cancer: exstrophy and failure of the urachus (the canal connecting your belly button to your bladder) to close.
• Genetics and family history: A mutation of the retinoblastoma gene (RB1), Cowden disease, and Lynch syndrome are all associated with a higher risk of bladder cancer.