Bladder Cancer

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Bladder Cancer

Topic Overview

What is bladder cancer?

Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumors. In bladder cancer, these growths happen in the bladder.

The bladder is the part of your urinary tract that stores your urine until you are ready to let it out. See a picture of the female urinary system or male urinary system.

Bladder cancer can often be successfully treated if it is found and treated early. And most bladder cancer is found early.

This topic is about the most common type of bladder cancer, called transitional cell cancer. This is cancer that starts in the inner layer of the bladder. It happens most often in people who are in their 60s or older.

What causes bladder cancer?

Experts don't know what causes bladder cancer. But smoking cigarettes or being exposed to certain chemicals raises your risk. And like other cancers, changes in the DNA of your cells seem to play a role.

What are the symptoms?

Blood in the urine is the main symptom. Other symptoms may include having to urinate often or feeling pain when you urinate.

These symptoms can be caused by other problems, including a urinary tract infection. Always call your doctor if you see blood in your urine.

How is bladder cancer diagnosed?

To diagnose bladder cancer, your doctor will:

  • Ask about your medical history and do a physical exam, including a vaginal or rectal exam.
  • Test your urine to look for blood or abnormal cells.
  • Do a cystoscopy, a test that lets your doctor look into your bladder with a thin, lighted viewing tool. Small tissue samples (biopsies) are taken and looked at under a microscope to find out if there are cancer cells.

How is it treated?

Treatment choices for bladder cancer include:

  • Surgery to remove any cancer. Sometimes lasers or other methods can be used to get rid of tumors.
  • Chemotherapy, which uses medicine to destroy cancer cells.
  • Immunotherapy, which causes your body's natural defense system to attack bladder cancer cells.
  • Radiation therapy, which uses high-dose X-rays to kill cancer cells.

The treatment depends a lot on how much the cancer has grown. Most bladder cancers are treated without having to remove the bladder.

Sometimes doctors do have to remove the bladder. For some people, this means having urine flow into a bag outside of the body. But in many cases, doctors can make a new bladder—using other body tissue—that works very much like the old one.

Bladder cancer often comes back. The new tumors can often be treated successfully if they are caught early. So it's very important to have regular checkups after your treatment is done.

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.

What increases your chances of getting bladder cancer?

Anything that increases your chances of getting a disease is called a risk factor. The main risk factors for bladder cancer include:

  • Smoking. Cigarette smokers are much more likely than other people to get bladder cancer.
  • Being older than 40, being male, or being white (Caucasian).
  • Being exposed to cancer-causing chemicals, such as those used in the wood, rubber, and textile industries.
  • What you eat. A diet high in fried meats and fats increases your risk for bladder cancer.
  • Parasites. There is a parasite that causes schistosomiasis, which can increase your risk. This condition is sometimes found in developing countries and rarely occurs in North America.

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Cause

The cause of bladder cancer is not known. Changes in the genetic material (DNA) of bladder cells may play a role. Chemicals in the environment and cigarette smoking also may play a role. And when the lining of the bladder is irritated for a long time, cell changes that lead to cancer may occur. Some things that cause this are radiation treatment, having catheters in place for a long time, or having the parasite that causes schistosomiasis.

Bladder cancer is twice as likely to develop in smokers than in nonsmokers. Experts believe that smoking causes about half of all bladder cancers in men and women.footnote 1

Exposure to chemicals and other substances at work—including dyes, paints, leather dust, and others—may also cause bladder cancer.

Symptoms

The most common symptoms of bladder cancer include:

  • Blood or blood clots in the urine (hematuria). Hematuria occurs in 8 or 9 out of 10 people who have bladder cancer and is the most common symptom. Usually it isn't painful.
  • Pain during urination (dysuria).
  • Urinating small amounts frequently.
  • Frequent urinary tract infections (UTIs).

Symptoms that may indicate more advanced bladder cancer include:

  • Pain in the lower back around the kidneys (flank pain).
  • Swelling in the lower legs.
  • A growth in the pelvis near the bladder (pelvic mass).

Other symptoms that may develop when bladder cancer has spread include:

  • Weight loss.
  • Bone pain or pain in the rectal, anal, or pelvic area.
  • Anemia.

The symptoms of bladder cancer may be similar to symptoms of other bladder conditions.

What Happens

Bladder cancer is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer usually begins in the lining of the bladder. The cancerous cells may spread through the lining into the muscular wall of the bladder.

Invasive bladder cancer may spread to lymph nodes, other organs in the pelvis (causing problems with kidney and bowel function), or other organs in the body, such as the liver and lungs.

Your treatment will depend on how far the cancer has spread.

Most bladder cancer is found early, before it has spread into the bladder wall. Surgery can usually remove these tumors. But bladder cancer often comes back, so you may also get other treatments, such as chemotherapy or immunotherapy, to lower the chances of that happening.

What Increases Your Risk

The main risk factors for bladder cancer include:

  • Smoking. Cigarette smokers are much more likely than other people to get bladder cancer.
  • Chemical exposure. Bladder cancer has been linked to chemicals called aromatic amines. These chemicals are found in many products, including dyes, paints, solvents, inks, and the dust from leather. This risk may also depend on how much and how often a person was exposed to these chemicals.
  • Being older. Your risk goes up as you get older. Most people who get bladder cancer are close to their 70s.
  • Being a white male. Men are 4 times more likely to get bladder cancer than women. And white men are twice as likely to get it as African-American men.footnote 1
  • Some cancer treatments, such as radiation therapy to the belly or pelvis.
  • Some chemotherapy medicines, such as cyclophosphamide.
  • A diet that is high in nitrates or rich in meat and fatty foods.
  • Schistosomiasis, which is an infection caused by a parasite. It's sometimes found in developing countries and rarely occurs in North America.

When To Call a Doctor

If you have been diagnosed with bladder cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Call your doctor if you:

  • Have blood in your urine.
  • Feel pain when you urinate.
  • Are urinating small amounts frequently.
  • Have back or flank pain.

Watchful waiting

If you are concerned about your symptoms or about your risk for bladder cancer, make an appointment with your doctor. Watchful waiting is not appropriate if you have symptoms that do not go away.

Who to see

Health professionals who can evaluate your symptoms and your risk for bladder cancer include:

Doctors who can manage your cancer treatment include:

Exams and Tests

To find out whether bladder cancer may be the cause of your urinary symptoms, your doctor will:

  • Do a physical exam. This may include a rectal exam, a prostate exam for men, or a pelvic exam for women.
  • Ask questions about your medical history, including:
    • Your smoking history.
    • Your possible exposure to cancer-causing chemicals.
    • Your family history of cancer.
  • Order a urine test and urine culture to check for the presence of blood, infection, and other abnormal cells. A urine test may also be done to look for tumor markers, which can be signs of cancer.

Cystoscopy

You will have a cystoscopy, a test that allows your doctor to look at your bladder with a thin, lighted tube. The doctor can use the same tube to take small tissue samples (biopsies) of any abnormal areas. The samples will be looked at under a microscope to find out whether cancer cells are present and what the cells look like.

Tests to determine stage and grade

Bladder cancer is classified by stage and grade. The stage is determined by the cancer growth in the bladder wall and how far it has spread to nearby tissues and other organs, such as the lungs, the liver, or the bones. The grade of bladder cancer is determined by how the cancer cells look in comparison with normal bladder cells.

Your doctor finds out the stage and grade of your bladder cancer by gathering information from several tests, including:

  • Biopsies from the cystoscopy.
  • An intravenous pyelogram or CT urogram to look for a mass near the kidneys, ureters, or bladder.
  • Ultrasound or magnetic resonance imaging (MRI). These help find out if the cancer has spread to lymph nodes, the lungs, the liver, or other abdominal organs.
  • CT scan. This finds out if the cancer has spread to other parts of the body.
  • Chest X-ray. This finds out if the cancer has spread to the lungs.
  • Bone scan. This finds out if the cancer has spread to the bones.

Knowing the stage and grade of your cancer is important in choosing the right treatments.

Other tests

Other diagnostic tests that may be done include:

Early detection of returning cancer

Bladder cancer often comes back, so it's important to have regular checkups. Then, if the cancer does come back, you have a better chance of finding it early enough for successful treatment.

Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for people who have bladder cancer depend on the stage and grade of cancer. When deciding about your treatment, your doctor also considers your age, overall health, and quality of life.

Bladder cancer has a better chance of being treated successfully if it is found early.

Treatment choices for bladder cancer may include:

  • Surgery to remove the cancer. Surgery, either alone or along with other treatments, is used in most cases.
  • Chemotherapy to destroy cancer cells using medicines. Chemotherapy may be given before or after surgery.
  • Radiation therapy to destroy cancer cells using high-dose X-rays or other high-energy rays. Radiation therapy may also be given before or after surgery and may be given at the same time as chemotherapy. For more information, see Other Treatment.

  • Immunotherapy
    . This treatment causes your body's natural defenses, known as your immune system, to attack bladder cancer cells. For more information, see Medications.

Stages and grades of bladder cancer

There are five stages of bladder cancer, stages 0 to IV:footnote 2

  • Stage 0: Cancer cells are only on the surface of the inner layer of the bladder. This may be called carcinoma in situ.
  • Stage I: Cancer has grown deeper into the inner layer but not into the muscle layer.
  • Stage II: Cancer has grown into the muscle layer of the bladder.
  • Stage III: Cancer has grown through the muscle layer and into nearby organs, such as the prostate, uterus, or vagina.
  • Stage IV: Cancer has grown into the wall of the pelvis or the belly but not into any lymph nodes. Or the cancer has spread into at least one lymph node or to another part of the body, such as the liver, lungs, or bones.

The grade of bladder cancer is usually either low-grade (LG) or high-grade (HG). High-grade tumors tend to grow faster. They are also more likely to spread than low-grade tumors. When your doctor knows the grade of your cancer, this information will help him or her choose the best treatment plan for you.

More information about bladder cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/bladder.

Bladder cancer that comes back

After initial treatment for bladder cancer, it is important to receive follow-up care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.

Bladder cancer may recur in the bladder, or it may spread (metastasize) to other parts of the body. Recurrent bladder cancer may be treated with surgery or chemotherapy to slow cancer growth and relieve symptoms.

Participation in a clinical trial may be recommended if you have been diagnosed with recurrent bladder cancer.

Body image and sexual problems

Sexual problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.

  • Women who have their bladder removed (radical cystectomy) will also have their ovaries and uterus removed. They cannot become pregnant and may experience menopause soon after having this surgery.
  • Men who have their prostate glands and seminal vesicles removed may have erection problems and will no longer produce semen.

Your feelings about your body may change after treatment for cancer. Managing your feelings about your body may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

If you're interested in palliative care, talk to your doctor.

For more information, see the topic Palliative Care.

End-of-life care

For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

For more information, see the topics:

Prevention

Bladder cancer cannot be prevented, but you may be able to reduce some of your risk for getting it.

  • Stop smoking. Cigarette smokers are much more likely to get bladder cancer than nonsmokers. For help on how to quit smoking, see the topic Quitting Smoking.
  • Avoid exposure to industrial chemicals, such as benzene substances and arylamines. Occupational exposure from working with dyes, rubbers, textiles, paints, leathers, and chemicals raises your risk for bladder cancer.
  • Avoid exposure to arsenic. Have your drinking water tested. Drink bottled water if you think that your water is contaminated with arsenic.
  • Eat healthy foods. Experts believe that what you eat and drink may help prevent bladder cancer.

    • Choose a low-fat, low-cholesterol diet that includes plenty of fruits and vegetables. For more information, see the topic Weight Management.
    • Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.

Home Treatment

The side effects of bladder cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.

You can try home treatments:

Other issues that can be treated at home include:

  • Sleep problems. If you have trouble sleeping, try having a regular bedtime and getting exercise daily.
  • Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.
  • Hair loss. Hair loss may be unavoidable. But using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.
  • Pain. Home treatment can help you manage pain. Be sure to talk with your doctor about any home treatment you use.

Handling the stress of having cancer

Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.

These ideas may help:

  • Get the support you need. Spend time with people who care about you, and let them help you.
  • Take good care of yourself. Get plenty of rest, and eat nourishing foods.
  • Talk about your feelings. Find a support group where you can share your experience.
  • Try new ways to relax. And do things each day that help you stay calm and relaxed. Stress reduction techniques may help.

Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.

Medications

Medicines may be used to control the growth of bladder cancer cells and to relieve symptoms. These medicines may be taken by mouth, injected into a vein (intravenous, or IV), or delivered directly into the bladder using a catheter.


  • Chemotherapy
     uses medicines to destroy cancer cells.

  • Immunotherapy
    , also called biological therapy, uses medicines that cause your body's immune system to attack cancer cells in your bladder. It is most often used for early-stage bladder cancer. It may also be used after a transurethral resection (TUR) to help keep cancer from coming back.

Medicine choices

Examples of chemotherapy medicines used for bladder cancer include gemcitabine, mitomycin, and cisplatin.

Side effects of chemotherapy may include:

  • Loss of appetite, nausea, or vomiting.
  • Diarrhea.
  • Hair loss.
  • Mouth sores.
  • An increased risk of infection.
  • Skin peeling or a rash from mitomycin.

Some people may need medicines to control nausea and vomiting.

Examples of immunotherapy medicines used for bladder cancer include Bacillus Calmette-Guerin (BCG), nivolumab, and atezolizumab.

Side effects of immunotherapy medicines may include:

  • Fatigue.
  • Fever.
  • Joint pain.
  • Decreased appetite or nausea.
  • Constipation.
  • Disseminated tuberculosis from BCG.
  • Immune-related problems (such as infections or skin reactions) from nivolumab and atezolizumab.

Surgery

Surgery is used to treat most stages of bladder cancer.


  • Transurethral resection (TUR)
     is surgery done through the urethra. A thin, lighted tube called a cystoscope is used to remove or destroy tumors in the bladder.

  • Cystectomy
     is surgery to remove the bladder.

    • Partial cystectomy removes only part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area.
    • Radical cystectomy removes all of the bladder as well as nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells.
  • Urinary diversion is surgery that makes a new way for your body to store urine. This can be done with a pouch created inside your body from part of your intestines, called a continent reservoir. Or the surgeon may make an artificial opening, called an ileal conduit, and you will wear a flat bag to store urine outside your body.

The side effects of surgery may include:

  • Bowel problems, such as constipation or diarrhea.
  • Scar tissue that forms inside your body from having surgery (adhesions).
  • A blockage in the intestines (bowel obstruction).
  • In men, erection problems if the bladder was removed.

Other Treatment

Radiation treatment

Radiation treatment for bladder cancer uses high-energy X-rays to kill cancer cells and shrink tumors. It may be given after surgery. It may be used along with chemotherapy. Sometimes it is used instead of surgery or chemotherapy.

  • External beam radiation comes from a machine outside the body. The machine aims radiation at the area where the cancer cells are found.
  • Internal radiation uses needles, seeds, wires, or catheters that contain radioactive materials placed close to or directly into the bladder.

Which treatment you receive will depend on the type and stage of your cancer.

Side effects of radiation may include:

  • Nausea, vomiting, or diarrhea.
  • Pain or discomfort when you urinate.
  • An increased risk for infection.
  • In women, changes to the cells lining the vagina. These changes can make intercourse difficult or painful.
  • In men, erection problems if the nerves that control erection were affected by radiation.

Clinical trials

Your doctor may talk to you about joining a research study called a clinical trial if one is available in your area. Clinical trials are research studies to look for ways to improve treatments for bladder cancer. Experts are doing studies on:

  • Chemoprevention for early-stage bladder cancer. This is the use of medicines or vitamins to reduce the risk of getting cancer or having cancer come back.
  • Photodynamic therapy. This uses medicine and a special light to treat the cancer.

For some people with bladder cancer, clinical trials may offer the best treatment available.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.

References

Citations

  1. American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
  2. National Cancer Institute (2010). What You Need To Know About Bladder Cancer (NIH Publication No. 10-1559). Available online: http://www.cancer.gov/cancertopics/wyntk/bladder.

Other Works Consulted

  • American Cancer Society (2011). Lasers in cancer treatment. Available online: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/lasers-in-cancer-treatment.
  • American Cancer Society (2012). Bladder cancer. Available online: http://www.cancer.org/cancer/bladdercancer/detailedguide/index.
  • American Joint Committee on Cancer (2010). Urinary bladder. In AJCC Cancer Staging Manual, 7th ed., pp. 497–505. New York: Springer-Verlag.
  • National Cancer Institute (2012). Bladder Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional.
  • National Cancer Institute (2012). Bladder Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/patient.
  • National Cancer Institute (2012). SEER Fact Sheets: Bladder. Bethesda, MD: National Cancer Institute. Available online: http://seer.cancer.gov/statfacts/html/urinb.html.
  • National Comprehensive Cancer Network (2013). Bladder Cancer. NCCN Clinical Practice Guidelines in Oncology, version 1.2013. Available online: http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf.
  • U.S. Preventive Services Task Force (2011). Screening for bladder cancer: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf11/bladdercancer/bladcanrs.htm.

Credits

ByHealthwise StaffPrimary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Christopher G. Wood, MD, FACS - Urology

Current as ofMarch 28, 2018

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