Bladder Cancer

What is bladder cancer?

Bladder cancer is abnormal growth of the cells that line the inside of the bladder. The growth is called a bladder tumor.

A tumor may be either invasive or noninvasive. A noninvasive tumor is usually a small, wart-like growth that has not yet grown into the bladder wall. If a tumor is invasive, the cancer cells may spread into the bladder wall and then to other organs through the bloodstream and lymphatic system.

Bladder cancer affects men 4 times more often than women. Bladder tumors are most likely to develop in white men over the age of 50.

How does it occur?

In most cases, bladder tumors occur when the cells lining the urinary tract are exposed to cancer-causing chemicals in the urine. Chemicals in the urine can come from:

• Cigarette smoking (the most common cause)
• The workplace, such as from rubber, aniline dye, some textiles, and, rarely, hairdressing supplies. Leather workers, rubber workers, painters, dry cleaners, truck drivers, and aluminum workers are at risk.
• Overuse of pain medicines that contain phenacetin. These medicines are no longer available in the US.

You have a higher risk of bladder cancer if members of your family have had it.

What are the symptoms?

Symptoms of bladder cancer are:

• blood in the urine
• pain when you urinate
• frequent need to urinate
• trouble starting to urinate
• lower back pain.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. Your urine will be tested for the presence of blood or infection. Your provider may also look for abnormal cells in the urine.

You will probably have an exam called a cystoscopy. During this exam your provider passes a slim, flexible, lighted tube called a cystoscope through the urethra and into the bladder to look inside your bladder. The urethra is the passageway that carries urine from your bladder to outside the body.

During this test your provider will probably do a biopsy. This involves removing a small piece of tissue from the bladder that looks abnormal. The tissue is examined in the lab to see if it is cancerous.

You may also have the following types of X-rays or scans:

• intravenous pyelogram (an X-ray study of the whole urinary tract using X-rays and a dye injected into a vein in your arm)
• CT scan of your abdomen
• an ultrasound of the kidneys.

If cancer is found, you may have more tests to see if cancer cells have spread into the bladder wall, to nearby lymph nodes, or to other parts of the body. For example, you may have a chest X-ray or a bone scan.

How is it treated?

Treatment of a bladder tumor depends first on whether it is invasive. For an early, noninvasive tumor, your healthcare provider will try to destroy the tumor by burning it off with a high-frequency electrical current passed through a cystoscope. This procedure is called fulguration. For small tumors this may be the only treatment that is needed. Another possible procedure involves putting chemicals or other medicines, such chemotherapy, into the bladder to destroy the cancer cells. These treatments should not cause any problems for you.

Large tumors that have grown into the muscle of the bladder wall must be surgically removed. Sometimes all or part of the bladder is removed. This type of surgery is called a cystectomy. It is performed under general anesthesia. If all of the bladder is removed, the ureters (tubes draining urine from the kidney to the bladder) will be connected to a reservoir surgically created from a part of the end of your small intestine, the ileum, and then to an opening made on your abdominal wall. A bag is attached to this opening.

Other treatments for invasive tumors include radiation therapy to the bladder or chemotherapy to help destroy cancer cells that may have spread beyond the bladder. You may have a combination of treatments.

How long will the effects last?

As with other forms of cancer, the treatments for bladder cancer that are most successful are those that begin before the disease has spread. This is why it is important to find the cancer as early as possible. See your healthcare provider as soon as you detect any symptoms of bladder cancer.

If you have a noninvasive tumor (superficial bladder cancer), your chances of cure are very good. You should, however, have regular cystoscopic exams because small tumors often come back or new ones may develop.

The removal of a large invasive tumor by partial bladder resection reduces the size of the bladder. This means the bladder holds less urine than before the surgery and you will need to urinate more often.

How can I take care of myself?

• Follow your healthcare provider's instructions and take the full course of your prescribed medicines.
• If your entire bladder is removed, keep the external opening clean to prevent infection. Empty the external bladder bag before it gets too full.
• Early in your treatment, consider talking with a counselor about the changes in your body and your body image. Some people become depressed over these changes. Talking with someone early can help you avoid more involved problems later.
• Maintain a positive outlook. If necessary, make lifestyle changes that include a healthy diet, lots of liquids, regular exercise and rest, reduction of stress, and time for activities that you enjoy.
• Do not smoke.

For more information on cancer, contact national and local organizations such as:

• American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org
• National Cancer Institute
  Phone: 1-800-4CANCER, or 1-800-422-6237 (TTY: 1-800-332-8615)
  Web site: http://www.cancer.gov

How can I help prevent bladder cancer?

• If you smoke, stop smoking.
• Use protective measures when you are likely to be exposed to industrial chemicals.
• Drink lots of fluids