Bladder cancer (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Meagan E. Doherty , Associate Editor-In-Chief: Ujjwal Rastogi, MBBS.
Overview
The bladder is a hollow organ in your lower abdomen that stores urine. Bladder cancer occurs in the lining of the bladder. It is the sixth most common type of cancer in the United States.
What are the symptoms of Bladder cancer?
Common symptoms of bladder cancer include:
- Blood in the urine (making the urine slightly rusty to deep red)
- Pain during urination
- Frequent urination, or feeling the need to urinate without results
What causes Bladder cancer?
Common causes of bladder cancer include:
- The chemotherapy drug cyclophosphamide may increase the risk of bladder cancer.
- Women who had radiation therapy to treat cervical cancer have an increased risk of developing bladder cancer.
- A long-term (chronic) bladder infection or irritation may lead to a certain type of bladder cancer.
Who is at highest risk?
Common risk factors of bladder cancer include:
- Age
- The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.
- 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
- About one in four cases of bladder cancer is caused by coming into contact with to 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.
- The chemotherapy drug cyclophosphamide (Cytoxan) may increase the risk of bladder cancer.
- Women who had radiation therapy to treat cervical cancer have an increased risk of developing bladder cancer.
- A long-term (chronic) bladder infection or irritation may lead to a certain type of bladder cancer.
- Race
- Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.
- Being a man
- Men are two to three times more likely than women to get bladder cancer.
- Family history
- People with family members who have bladder cancer are more likely to get the disease.
When to seek urgent medical care?
See your doctor immediately if you experience any of the above symptoms associated with bladder cancer
Diagnosis
If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:
- Physical exam
- The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
- Urine tests
- The laboratory checks the urine for blood, cancer cells, and other signs of disease.
- The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
- The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure.
- The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope.
Treatment options
Surgery
- Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor.
- Common types of surgery of bladder cancer include:
- Transurethral resection: The doctor may treat early (superficial) bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and to burn away any remaining cancer cells with an electric current. (This is called fulguration.) The patient may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy.
- Radical cystectomy: For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra, and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed.
- Segmental cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.
Radiation therapy
- Radiotherapy uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.
- A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.
- Common types of radiation therapy include:
- External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.
- Internal radiation: The doctor places a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during this treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.
Chemotherapy
- For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.
- If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.
- The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.
Biological therapy
- Biological therapy uses the body's immune system to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back.
Where to find medical care for Bladder cancer?
Directions to Hospitals Treating Bladder Cancer
Prevention
There is no standard or routine screening test for bladder cancer.
What to expect (Outlook/Prognosis)?
The prognosis of bladder cancer depends on location and stage of the disease. When diagnosed early there is a better chance of recovery than when it is diagnosed during advanced stages.
Possible complications
- Bladder cancers may spread into the nearby organs. They may also travel through the pelvic lymph nodes and spread to the liver, lungs, and bones.
- Additional complications of bladder cancer include:
- Anemia
- Swelling of the ureters (hydronephrosis)
- Urethral stricture
- Urinary incontinence