What is Bladder Cancer?

Bladder cancer is cancer of the urinary bladder. Your bladder is where urine is stored. It is a hollow organ, the size of a small balloon, in the lower part of the abdomen. The bladder has a muscular wall that allows it to get larger and smaller. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through tubes called ureters. When you empty your bladder, the urine leaves the bladder through another tube called the urethra.

Like other organs in the body, the bladder is made up of many types of cells. Cells divide in an orderly, controlled way to produce more cells when more cells are needed in the body. When cells divide in an abnormal, uncontrolled way, they can form either a benign or malignant tumor.

Benign tumors are not cancerous and are generally not life-threatening. They can be removed surgically, and usually do not return.

Malignant tumors are cancerous. The lining inside the bladder is where most bladder cancers form. Cancer cells can spread to nearby healthy cells and destroy them. The cancerous cells can also invade other parts of the body. Cancerous cells in the bladder can spread to other parts of the body through the blood and lymph systems.

Like most diseases, cancer of the bladder is best treated when it is detected early. It can spread to other parts of the body through the blood or through the lymph system. Often, tumors in the bladder do not cause noticeable symptoms. You should see a urologist -- a physician who is a specialist in urology -- if you have any of the following symptoms:

• Blood in the urine (urine colored slightly rusty to deep red)
• Pain when you urinate
• Urinating too frequently
• Feeling like you need to urinate but cannot

These symptoms can also be caused by other conditions, such as infections or benign tumors. It is important to see a urologist to find out. The urologist may use several tests to see if you have bladder cancer.

The increase in survival rates for people with bladder cancer is partly due to greater success with early detection and treatment of the disease.

Urine samples can be checked using a microscope to see if there are any red blood cells. A test called NMP-22 may be used to detect a protein which can be an indicator of bladder cancer, although the protein it detects is not unique to bladder cancer. Newer, more specific tests are being developed.

The urologist may do an x-ray called an intravenous pyelogram (IVP) to make an image of the urinary system (the bladder, kidneys, and ureters). Before it is taken, the patient receives an injection that makes the urinary system easier to see on the x-ray.

By inserting a thin, flexible, lighted tube called a cytoscope through the urethra, the urologist can look for any abnormal areas and take some sample tissues from those areas. This is called a biopsy. A pathologist examines the samples under a microscope for the presence of cancer cells. The biopsy is the test that is used to make the diagnosis of bladder cancer.

Other tests that may be done include CT scans, radioactive bone scans, and ultrasound tests that use high-frequency sound waves to produce an image, called a sonogram, of the bladder.

Risk factors

The largest risk factor is smoking: smokers have twice the risk of bladder cancer as nonsmokers. Men are three times more likely to get bladder cancer than women. People who smoke heavily and use artificial sweeteners are more at risk than people who smoke heavily and do not use artificial sweeteners.

Other factors that may slightly increase risk include living in urban areas, drinking chlorinated water, and working with certain chemicals used in the rubber and textile industries. Another possible cause of bladder cancer is exposure to a parasite called Schistosoma haemotobium. Coffee has been studied as a potential risk factor, but the results of the studies have been inconsistent.

Women who have had radiation therapy for cervical cancer have a significantly increased risk of bladder cancer. Also, people who have had certain chemotherapy drugs, such as Cytoxan, may have an increased risk.

There are treatments for all patients with ancer of the bladder. Decisions about treatment of bladder cancer can be complex; the urologist is the best person to answer questions about it. Ask the urologist to explain anything that is not clear. Taking notes during the visit can help you remember what the urologist says. Bringing a spouse or another close friend or relative with you to the urologist's office can also help you ask questions and keep notes.

Decisions about treatment depend on the stage of the disease, that is, the location of the cancer and how much it has spread. Surgery is the most common treatment for this disease. Tumors in the early stage can be removed using a cytoscope in a treatment called transurethral resection. Part or all of the tumor can be removed, or it can be destroyed with electrical current.

If several tumors are removed, the doctor may also recommend a form of biological therapy called BCG. A BCG solution is placed in the bladder to kill cancer cells.

In Chemotherapy, one or more anti-cancer drugs can be placed in the bladder or in the bloodstream. Radiation therapy may be needed when tumors cannot be removed by transurethral resection. Sometimes, chemotherapy and/or radiation therapy is used prior to surgery to improve the results.

If much of the bladder is involved with the cancer, a radical cystectomy may be done. In this surgery, the doctor removes the entire bladder as well as other organs that are nearby. For women, these organs would include the uterus, ovaries, and fallopian tubes. For men, it would include the prostate and seminal vesicles. Various methods are used to construct a new bladder for the patient to store and pass urine. A new opening called an ostomy or stoma may be created through the abdominal wall.

General Questions

The bladder is a hollow organ in the lower abdomen that stores urine. The kidneys filter waste from the blood and produce urine, which enters the bladder through two tubes called ureters. Urine leaves the bladder through another tube, the urethra. In women, the urethra is a short tube that opens just in front of the vagina. In men, it is longer, passing through the prostate gland and then through the penis. 

1. What are the causes and risk factors of bladder cancer?

   ANSWER: While doctors can seldom explain why one person gets bladder cancer and another doesn't, we do know that the disease is not contagious; no one can "catch" bladder cancer from another person. Scientists do not know exactly what causes this disease, but research does show that some people are more likely to develop it than others. A number of factors contribute to this higher risk.

   Smoking is a major risk factor. Cigarette smokers develop bladder cancer two to three times more often than do non-smokers. Quitting smoking reduces the risk of bladder ca, lung cancer, several other types of cancer, and a number of other diseases as well.

   People who smoke heavily and use artificial sweeteners are more at risk that people who smoke heavily and do not use artificial sweeteners.

   Other factors that may slightly increase risk include living in urban areas, drinking chlorinated water, and working with certain chemicals used in the rubber and textile industries, as well as hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.

   Another possible cause of bladder cancer is exposure to a parasite called Schistosoma haemotobium, found in South America, Africa, and Asia. Coffee has been studied as a potential risk factor, but the results of the studies have been inconsistent.

   Women who have radiation therapy for cervical cancer have a significantly increased risk of bladder cancer. Also, people who have had certain chemotherapy drugs, such as Cytoxan, may have an increased risk.

   The risk of bladder cancer increases with age, and it is rare among people younger that 40.  

2. How do I prevent developing bladder cancer? Decrease my risks?

• Stop smoking, or never start
• Follow safety rules when working with volatile chemicals
• Avoid excessive use of phenacetin - containing painkillers

      3.  What are the symptoms of bladder cancer?

• Blood in urine (urine colored slightly rusty to deep red)
• Pain when you urinate
• Urinating too frequently
• Feeling like you need to urinate but cannot

      4. How will my doctor know if I have bladder cancer? (Detection & Diagnosis)

     5. What about treatment for bladder cancer, what should I ask?

• What are the treatment options?
• What are the risks and benefits of each?
• Will I need to change my normal daily activities?
• Will I need an ostomy?
• Am I a candidate for a continent urinary diversion?
• Can I keep working during treatment?

6. What are some of the side effects of treatment?

   ANSWER: The methods used to treat bladder cancer are powerful. It is hard to limit the effects of treatment so that only cancer cells are destroyed; healthy tissue may also be damaged. That's why treatment may cause unpleasant side effects. Side effects depend on the type of treatment used and on the part of the body being treated.

   When the bladder is removed, the patient needs a new way to store and pass urine. Various methods are used (discussed above).

   Radical cystectomy (removal of bladder) causes infertility in both men and women. This operation can lead to sexual problems. In the past, nearly all men were impotent after the procedure, but improvements in surgery have made it possible to prevent this in many men. In women, the vagina may be narrower or shallower, and intercourse may be difficult.

   During radiation therapy, patients may become very tired as the treatment continues. Resting as much as possible is important. Radiation treatment to the lower abdomen may cause nausea, vomiting, or diarrhea. Usually, the doctor can suggest certain foods or medications to ease these problems.

   Radiation therapy can also cause problems with fertility and can make sexual intercourse uncomfortable.

   Chemotherapy causes side effects because it damages not only cancer cells but other rapidly growing cells as well. The side effects of chemotherapy depend on the specific drugs that are given. Each patient reacts differently.

   Patients may have side effects such as lowered resistance to infection, loss of appetite, nausea and vomiting, less energy, and mouth sores. They may lose their hair. These are short-term side effects that usually end after the treatment stops. When drugs are put directly into the bladder, these side effects may be limited. However, it is common for the bladder to be irritated.

   Doctors, nurses, dieticians can explain the side effects of cancer treatment and can suggest ways to deal with them. Doctors try to plan treatment to keep problems to a minimum.

7. Are follow-up visits important?

   ANSWER: Regular follow-up exams are very important after treatment for bladder cancer. The doctor will need to check the bladder with a cystoscope and remove any superficial tumors that may have recurred. The doctor also checks for cancer cells in the urine an may suggest a chest x-ray, an IVP, or other tests. You should continue be watched closely by your doctor for several years because bladder tumors can come back. If the cancer does recur, it is important for the doctor to detect it right away so additional treatment can be started.

8. Will I be able to adjust to this disease well?

   ANSWER: The diagnosis of bladder cancer can change your life and the lives of the people who care about you. These changes in daily life can be difficult to handle. It's natural for patients and their families and friends to have many different and sometimes confusing emotions.

   Patients and their loved ones may feel frightened, angry, or depressed. These are normal reactions that people have when diagnosed with a serious health problem. Others in the same situation have found that they cope with their emotions better if they can talk openly about their illness and their feelings with those who care about them.

   Sharing feelings with loved ones can help everyone feel more at ease, opening the way for others to show their concern and offer their support. Many patients feel that it helps to talk with others who are facing problems like theirs. Patients can meet other cancer patients through self-help and support groups.

   Living with any serious disease can be difficult and challenging. The public library is a good source of books and articles on living with cancer. Also, you may obtain literature from cancer information lines and the National Cancer Institute.

   Learning to live with the changes brought about by having cancer is easier for patients and those who care about them when they have helpful information and support services. Often, social workers at the hospital or clinic can suggest local and national groups that will help with emotional support, financial aid, transportation, home care, and rehabilitation.

9. Are there clinical trials available for bladder cancer?

   ANSWER: For some bladder cancer patients, one of the options may involve a clinical trial. Clinical trials are studies conducted with the consent of patients to evaluate a new treatment. Speak with your doctor.

10. What about a Second Opinion?