Bladder Cancer

Overview

Urinary bladder is a hollow muscular organ that stores urine. Bladder cancer is the fifth most common cancer seen in the US, and one of the leading cancers in many other countries. Age more than 50 years and a history of smoking are the most important risk factors for developing bladder cancer. Localized bladder cancer can be treated with excellent outcome in more than 90% cases. Hence, early diagnosis of bladder cancer is of utmost importance.

Symptoms of Bladder Cancer

  • The most common symptom is blood in urine that makes it appear rusty or deep red in color (gross hematuria)
  • There is no associated pain
  • The blood is seen throughout urination
  • Sometimes blood in urine is not visible to the naked eye but it can be seen under a microscope (microscopic hematuria)
  • Other les common symptoms are:
  • Pain during urination
  • Frequent urination
  • Urge to urinate, but no urination on trying
  • Advanced stage bladder cancer may cause:
  • Pain in flanks
  • Swelling in the lower legs
  • Bone pain in the pelvic area
  • An obvious growth (lump or mass) in the pelvis

Risk Factors for Bladder Cancer

The most important risk factors for bladder cancer are:

 

  • Age: Risk of bladder cancer increases with age. Less than 1% of cases occur in people under the age of 40.
  • Smoking: Smokers are two to three times more likely than nonsmokers to get bladder cancer. Second hand smoke also increases the risk.
  • Being Male: Men are two to three times more likely to have bladder cancer than women.
  • Being a Caucasian: Caucasians are at higher risk than African Americans and Hispanics. Asians are at the lowest risk.
  • Certain Occupations: Workers in the rubber, leather, textile and chemical industries, hairdressers, machinists, printers, and painters are at increased risk because of long-term exposure to carcinogens.
  • Family history: People with a family history of bladder cancer are more likely to get it.
  • Tropical parasite infection: People infected with Schistosoma hematobium, a parasite common in tropical climates are at increased risk of bladder cancer.
  • Chronic bladder inflammation:     Chronic bladder inflammation caused by repeated infections or stones has been linked to bladder cancer.
  • Cyclophosphamide: Taking cyclophosphamide for some other cancer or other condition increases the risk of bladder cancer.
  • Arsenic: A high level of arsenic in drinking water has been linked to bladder cancer.

Diagnosis of Bladder Cancer

Patients in whom blood in urine is confirmed on urine microscopy and risk factors for bladder cancer are present, or other diseases causing it are ruled out, a work-up   
for bladder cancer becomes necessary. Tests done in patients suspected to have bladder cancer are:

 

  • Cystoscopy and biopsy: This is the most important procedure for diagnosis. The inside of the bladder is visualized through a thin tube with a camera (cystoscope) inserted through the urethra. If a suspicious lesion is seen, a tissue sample is taken for biopsy. Since some flat or very small lesions may be missed on cystoscopy, your urologist might recommend additional tests to be surer of the results.
  • Imaging tests: An intravenous pyelogram (IVP), ultrasound and CT scan may be done to corroborate the cystoscopy findings.
  • Urine cytology: Urine sample is examined to look for cancer cells.
  • NMP-22 or BTA: Urine is tested for the presence of special substances called “tumor markers” that may be found in patients with a bladder cancer.

Treatment of Bladder Cancer

  • Superficial Cancers: A large number of bladder cancers are limited to the inner lining of the bladder. They are treated by a minimally invasive procedure called transurethral resection (TUR) using a cystoscope. TUR may be done at the same time as the cystoscopy done for diagnosis of the cancer. A resectoscope (a thin instrument with a loop) is inserted through the urethra to scrape or burn the tumor. Since bladder cancers have a strong tendency to come back, TUR is mostly followed by additional treatment to prevent recurrence. The most commonly used process is instillation of bacillus calmette-Guerin (BCG) in the bladder. It instigates the body’s immune system to kill any remaining cancer cells.
  • Invasive Cancers: Bladder cancers that spread or beyond the muscle layer, usually necessitate complete removal of the bladder along with lymph nodes, prostate and seminal vesicles in men and the uterus and anterior vaginal wall in women (radical cystectomy). Partial removal of the bladder is successful in some selected cases. Radical cystectomy is followed by a surgery to make an alternative way to store and eliminate urine (urinary diversion surgery). Sexual function after radical cystectomy may be preserved with some advanced surgical techniques.
  • Chemotherapy: Cancer drugs may be used before or after surgery to produce better results. They help kill cancer cells that may have spread to other organs before surgery. Chemotherapy is the main treatment available for patients whose cancer has spread to other organs at the time of diagnosis.
  • Radiation: Radiation therapy or the destruction of cancer cells through high-energy x-rays may be used as an adjunct to surgery. Sometimes it may be used along with chemotherapy to avoid removal of the bladder, but long term success rates are lower than radical cystectomy.  
  • Follow-Up: Careful follow-up is necessary because bladder cancer has high recurrence rate. Most urologists recommend urine cytology and cytoscopy every three months for the first two years following treatment. The tests are then performed every six months for the next two years and then performed yearly.
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