Bladder Cancer

Definition

Bladder cancer is a disease in which certain cells in the bladder become abnormal and multiply without control or order. The bladder is a hollow, muscular organ in the lower abdomen that stores urine until it is ready to be excreted from the body. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (TCC).

Bladder cancer may cause blood in the urine, pain during urination, frequent urination, or the feeling that one needs to urinate without results. These signs and symptoms are not specific to bladder cancer, however. They also can be caused by noncancerous conditions such as infections.

If you smoke, quit. Smoking can increase your risk for bladder cancer. Avoid exposure to chemicals linked to bladder cancer.

Alternative Names

Also called: Malignant tumor of the urinary bladder, Malignant tumor of the urinary bladder, Malignant neoplasm of the urinary bladder, Carcinoma of the bladder, Carcinoma of the urinary bladder, Urinary bladder carcinoma

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Causes

In the United States, bladder cancer often starts from the cells lining the bladder. These cells are called transitional cells.

These tumors are classified by the way they grow:

  • Papillary tumors look like warts and are attached to a stalk.
  • Nonpapillary (sessile) tumors are flat. They are much less common. But they are more invasive and have a worse outcome.

The exact cause of bladder cancer is not known. But several things may make you more likely to develop it:

  • Cigarette smoking: Smoking greatly increases the risk of developing bladder cancer. Up to half of all bladder cancers in men and several in women may be caused by cigarette smoke.
  • Chemical exposure at work: About 1 in 4 cases of bladder cancer is caused by coming into contact with cancer-causing chemicals at work. These chemicals are called carcinogens. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk.
  • Chemotherapy: The chemotherapy drug cyclophosphamide may increase the risk for bladder cancer. Your doctor may prescribe a medicine to reduce this risk.
  • Radiation treatment: Women who had radiation therapy to treat cervical cancer have an increased risk of developing bladder cancer.
  • Bladder infection: A long-term (chronic) bladder infection or irritation may lead to a certain type of bladder cancer.

Research has not shown clear evidence that using artificial sweeteners leads to bladder cancer.

Symptoms

Symptoms of bladder cancer can include:

Exams and Tests

The health care provider will perform a physical examination, including a rectal and pelvic exam.

Tests that may be done include:

If tests confirm you have bladder cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

The TNM (tumor, nodes, metastatis) staging system is used to stage bladder cancer:

  • Ta: The cancer is in the lining of the bladder only and has not spread.
  • T1: The cancer goes through the bladder lining, but does not reach the bladder muscle.
  • T2: The cancer spreads to the bladder muscle.
  • T3: The cancer spreads past the bladder into the fatty tissue surrounding it.
  • T4: The cancer has spread to nearby structures such as the prostate gland, uterus, vagina, rectum, abdominal wall, or pelvic wall.

Tumors are also grouped based on how they appear under a microscope. This is called grading the tumor. A high-grade tumor is fast growing and more likely to spread. Bladder cancer can spread into nearby areas, including the:

  • Lymph nodes in the pelvis
  • Bones
  • Liver
  • Lungs

Treatments

Different types of treatment are available for patients with bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Four types of standard treatment are used:

Surgery

One of the following types of surgery may be done:

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapyafter surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat bladder cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). For bladder cancer, regional chemotherapy may be intravesical (put into the bladder through a tube inserted into the urethra). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment using more than one anticancer drug.

See Drugs Approved for Bladder Cancer for more information.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

PD-1 inhibitors are a type of immunotherapy used in the treatment of bladder cancer. PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells.

Atezolizumab and nivolumab are types of PD-1 inhibitors.

Bladder cancer may be treated with an intravesical immunotherapy called BCG (bacillus Calmette-Guérin). The BCG is given in a solution that is placed directly into the bladder using a catheter (thin tube).

See Drugs Approved for Bladder Cancer for more information.

Possible Complications

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer. 

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When to Contact a Medical Professional

These and other signs and symptoms may be caused by bladder cancer or by other conditions. Check with your doctor if you have any of the following:

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Preventions

If you smoke, quit. Smoking can increase your risk for bladder cancer. Avoid exposure to chemicals linked to bladder cancer.