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What Is Bladder Cancer?
The bladder is a hollow organ with a muscular wall that stores urine until it is passed from the body. Bladder cancer refers to the out of control growth of cells within the lining of the urinary bladder. It is the sixth most common cancer among adults in the U.S.
Initial symptoms include blood in the urine, increased urinary frequency, and pain during urination, although these symptoms are nonspecific and can be due to other problems. Later symptoms may include back pain, difficulty urinating, bone pain, and foot swelling.
Treatment often involves a combination of surgery, immunotherapy, chemotherapy, radiation, and supportive care.
You should visit your primary care physician who will coordinate your care with a cancer specialist (oncologist). Early bladder cancer is usually confined to the superficial lining, and treatment is for the most part easy and curative.
Bladder Cancer Symptoms
The diagnosis of bladder cancer is made through patient history, physical examination, urinalysis, imaging such as ultrasound, and biopsy. Main symptoms are described below as well as indicators of advanced disease.
The main symptoms of bladder cancer include bloody urine as well as urinary irritation and urinary outflow obstruction that can be described by the following details.
- Bloody urine (hematuria): This is typically painless.
- Pain with urination (dysuria)
- Increased urinary frequency: You will have a need to urinate many times during the day but in less than normal volumes.
- Increased urinary urgency: This is a sudden need to urinate.
- Need to urinate at night (nocturia)
- Decreased force of the urine stream
- Incomplete voiding of the bladder
- Straining while urinating
Signs of advanced disease
The following signal that bladder cancer is at an advanced stage .
- Low red blood cell counts (anemia): This is associated with fatigue and pallor from chronic blood loss.
- Pelvic pain: This is from the effects of any mass.
- Back pain
- Lower extremity swelling (edema)
Bladder Cancer Causes
Certain risk factors can more likely lead to the development of bladder cancer, including those that are general, environmental, and medical. Types of bladder cancer have also been described in this section.
General risk factors for bladder cancer include the following.
- A family history of bladder cancer
- Certain gene mutations: Such as HRAS, Rb1, PTEN, NAT2, and GSTM1 .
- Male sex: Men are affected three times as often as women .
- White people: This group has a greater risk of bladder cancer than people of other races.
- Age: Ninety percent of people affected people are over 55, with the average age of 73 when diagnosed .
Environmental risks can be related to lifestyle habits or certain exposures.
- Smoking: This is the most common risk factor, attributed in more than half of new cases, due to damage from urinary excretion of harmful chemicals in tobacco [3,4].
- Chemical exposure: You may be at risk if you work with dyes (e.g., naphthylamine), petroleum products, and chemicals used in the rubber, leather, electric, cable, paint, and textile industries [3,5].
- Arsenic: This is a natural element in rocks and soil that can contaminate drinking water, particularly from wells .
- Chronic bladder irritation: Chronic infections, such as the parasite schistosomiasis (common in some countries outside the U.S.), bladder stones, and long-term catheterization can put you at risk.
Risks for bladder cancer related to medical procedures or medications include, but are not limited to the following. Talk to your physician if you are on any medications to learn about possible risks of bladder cancer and other malignancies.
- Pelvic radiation: This can be from the treatment of other malignancies.
- Cyclophosphamide: This a medication used to treat cancers and suppress the immune system, such as following an organ transplant.
- Phenacetin: This is a pain and fever-relieving medication that was previously widely used until its ban in the 1980s .
- Aristolochia fangchi: This a Chinese herb .
Types of bladder cancer
The types of bladder cancer include the following.
- Transitional cell carcinoma (urothelial carcinoma): This is the most common type, accounting for more than 90 percent of bladder cancers. Most are superficial and well-differentiated papillary carcinomas, while others, sessile tumors, tend to invade more aggressively and metastasize .
- Squamous cell carcinoma: This is a less common form in the U.S. that is often associated with chronic irritation. Squamous cell carcinoma is a more common cause of bladder cancer in countries with a high prevalence of the parasite schistosomiasis .
- Adenocarcinoma: This is a rare cause that begins in the cells that form mucus-secreting glands in the bladder .
Bladder Cancer Symptom Checker
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Treatment Options and Prevention for Bladder Cancer
The best treatment plan for you can be determined by your medical provider. Methods of preventing bladder cancer as well as the prognosis are also described in this section.
After a likely diagnosis of bladder cancer has been made via urinalysis, visualization of the inside of the bladder with a camera (cystoscopy), and imaging, such as CT scan, a variety of further interventions follow.
- Transurethral resection of the bladder tumor (TURBT): By inserting an instrument into the urethra, this procedure enables removal of the visible tumor, allowing for definitive diagnosis, grading, and staging of the tumor.
- Immunotherapy in the bladder (intravesical): For non-muscle invasive disease, Bacille Calmette-Guerin (BCG), a drug based on a bacteria related to tuberculosis, is injected into the bladder, causing a local immune response that affects the cancer cells. BCG therapy is the main immunotherapy for early-stage bladder cancer. It is typically repeated weekly for six weeks following TURBT .
- Chemotherapy in the bladder (intravesical): For tumors with a higher risk of progression, chemotherapy medications can be injected into the bladder. By containing the medications to the bladder, individuals are spared some of the negative side effects of chemotherapy when it is given throughout the whole body.
- Surgical removal of the bladder: Tumors that invade the muscle are typically treated via radical cystectomy and lymphadenectomy, a resection of the entire bladder and related lymph nodes. Chemotherapy is often given prior to the surgery (neoadjuvant) to reduce cancer and improve the likelihood of successful surgery. Partial cystectomy, removal of part of the bladder, may be an option for certain people . A variety of methods can be used to reconstruct the bladder .
- Radiation therapy: This may be used in addition to certain treatments above in efforts to preserve the bladder or as palliation for people for whom surgical removal of the bladder is not a desirable option .
In order to reduce your risk of bladder cancer, you should practice the following.
- Avoid tobacco products: Quitting smoking can be difficult, but is possible, thanks in part to a variety of supports .
- Use caution around chemicals: If your job involves exposure to chemicals, carefully follow all safety precautions to protect your health.
Superficial cancer, in early stages, rarely causes death. However, for people whose cancer invades the bladder muscles, the five-year survival rate is about 50 percent. Prognosis for progressive or recurrent invasive bladder cancer is often poor .
When to Seek Further Consultation for Bladder Cancer
If you notice blood in your urine
Blood in your urine can be a sign of a number of different diseases. It is never normal and should always be reported to a physician so that the underlying cause can be identified and treated to prevent further complications.
If you have difficulty urinating or find yourself urinating more frequently than usual
Any changes from prior urination patterns can be signs of an infection, obstruction, or other disease processes. Report these symptoms to your physician as soon as possible to ensure proper treatment.
Questions Your Doctor May Ask to Determine Bladder Cancer
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Any fever today or during the last week?
- Have you lost your appetite recently?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Is your abdominal pain constant or come-and-go?
- Is your abdominal pain getting better or worse?
If you've answered yes to one or more of these questions
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- DeGeorge K, Holt HR, Hodges S. Bladder cancer: Diagnosis and treatment. Am Fam Physician. 2017;96(8):507-4. AAFP Link
- Bladder cancer treatment (PDQ) health professional version. National Cancer Institute. Updated November 16, 2018. NCI Link
- Mark JR. Bladder cancer. Merck Manual Professional Version. Updated October 2017. Merck Manuals Professional Version Link
- Bladder cancer symptoms & causes. Mayo Clinic. Published December 22, 2017. Mayo Clinic Link
- Bladder cancer. Centers for Disease Control and Prevention. Updated June 12, 2018. CDC Link
- Quitting is a journey. Smokefree.gov. Smoke Free Link
- Intravesical therapy for bladder cancer. American Cancer Society. Updated May 23, 2016. American Cancer Society Link