- The Bladder
- Understanding Cancer
- Bladder Cancer: Who's at Risk?
- Recognizing Symptoms
- Treatment for Bladder Cancer
- Side Effects of Cancer Treatment
The bladder is a hollow organ in the lower abdomen. It stores
urine, the liquid waste produced by the kidneys. Urine passes
from each kidney into the bladder through a tube called a
An outer layer of muscle surrounds the inner lining of the
bladder. When the bladder is full, the muscles in the bladder
wall can tighten to allow urination. Urine leaves the bladder
through another tube, the urethra.
Cancer is a group of many related diseases. All cancers begin
in cells, the body's basic unit of life. Cells make up tissues,
and tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the
body needs them. When cells grow old and die, new cells take
Sometimes this orderly process goes wrong. New cells form
when the body does not need them, and old cells do not die
when they should. These extra cells can form a mass of tissue
called a growth or tumor.
Tumors can be benign or malignant:
Benign tumors are not cancer.
Usually, doctors can remove them. Cells from benign tumors
do not spread to other parts of the body. In most cases, benign
tumors do not come back after they are removed. Most important,
benign tumors are rarely a threat to life.
Malignant tumors are cancer. They
are generally more serious. Cancer cells can invade and damage
nearby tissues and organs. Also, cancer cells can break away
from a malignant tumor and enter the bloodstream or the lymphatic
system. That is how cancer cells spread from the original
(primary) tumor to form new tumors in other organs. The spread
of cancer is called metastasis.
The wall of the bladder is lined with cells called transitional
cells and squamous cells. More than 90 percent of bladder
cancers begin in the transitional cells. This type of bladder
cancer is called transitional cell carcinoma. About 8 percent
of bladder cancer patients have squamous cell carcinomas.
Cancer that is only in cells in the lining of the bladder
is called superficial bladder cancer. The doctor might call
it carcinoma in situ. This type of bladder cancer often comes
back after treatment. If this happens, the disease most often
recurs as another superficial cancer in the bladder.
Cancer that begins as a superficial tumor may grow through
the lining and into the muscular wall of the bladder. This
is known as invasive cancer. Invasive cancer may extend through
the bladder wall. It may grow into a nearby organ such as
the uterus or vagina (in women) or the prostate gland (in
men). It also may invade the wall of the abdomen.
When bladder cancer spreads outside the bladder, cancer cells
are often found in nearby lymph nodes. If the cancer has reached
these nodes, cancer cells may have spread to other lymph nodes
or other organs, such as the lungs, liver, or bones.
When cancer spreads (metastasizes) from its original place
to another part of the body, the new tumor has the same kind
of abnormal cells and the same name as the primary tumor.
For example, if bladder cancer spreads to the lungs, the cancer
cells in the lungs are actually bladder cancer cells. The
disease is metastatic bladder cancer, not lung cancer. It
is treated as bladder cancer, not as lung cancer. Doctors
sometimes call the new tumor "distant" disease.
Bladder Cancer: Who's at Risk?
No one knows the exact causes of bladder cancer. However,
it is clear that this disease is not contagious. No one can
"catch" cancer from another person.
People who get bladder cancer are more likely than other
people to have certain risk factors. A risk factor is something
that increases a person's chance of developing the disease.
Still, most people with known risk factors do not get bladder
cancer, and many who do get this disease have none of these
factors. Doctors can seldom explain why one person gets this
cancer and another does not.
Studies have found the following risk factors for bladder
Age. The chance of getting bladder
cancer goes up as people get older. People under 40 rarely
get this disease.
Tobacco. The use of tobacco is
a major risk factor. Cigarette smokers are two to three times
more likely than nonsmokers to get bladder cancer. Pipe and
cigar smokers are also at increased risk.
Occupation. Some workers have
a higher risk of getting bladder cancer because of carcinogens
in the workplace. Workers in the rubber, chemical, and leather
industries are at risk. So are hairdressers, machinists, metal
workers, printers, painters, textile workers, and truck drivers.
Infections. Being infected with
certain parasites increases the risk of bladder cancer. These
parasites are common in tropical areas but not in the United
Treatment with cyclophosphamide
or arsenic. These drugs are used to treat cancer and some
other conditions. They raise the risk 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. Researchers are studying changes in certain genes
that may increase the risk of bladder cancer.
Personal history of bladder cancer.
People who have had bladder cancer have an increased chance
of getting the disease again.
Chlorine is added to water to make it safe to drink. It kills
deadly bacteria. However, chlorine by-products sometimes can
form in chlorinated water. Researchers have been studying
chlorine by-products for more than 25 years. So far, there
is no proof that chlorinated water causes bladder cancer in
people. Studies continue to look at this question.
Some studies have found that saccharin, an artificial sweetener,
causes bladder cancer in animals. However, research does not
show that saccharin causes cancer in people.
People who think they may be at risk for bladder cancer should
discuss this concern with their doctor. The doctor may suggest
ways to reduce the risk and can plan an appropriate schedule
Common symptoms of bladder cancer include:
- Blood in the urine (making the urine slightly rusty to
- Pain during urination, and
- Frequent urination, or feeling the need to urinate without
These symptoms are not sure signs of bladder cancer. Infections,
benign tumors, bladder stones, or other problems also can
cause these symptoms. Anyone with these symptoms should see
a doctor so that the doctor can diagnose and treat any problem
as early as possible. People with symptoms like these may
see their family doctor or a urologist, a doctor who specializes
in diseases of the urinary system.
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
Urine tests -- The laboratory checks the urine for blood,
cancer cells, and other signs of disease.
Intravenous pyelogram -- The doctor injects dye into a blood
vessel. The dye collects in the urine, making the bladder
show up on x-rays.
Cystoscopy -- 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.
The removal of tissue to look for cancer cells is called a
biopsy. In many cases, a biopsy is the only sure way to tell
whether cancer is present. For a small number of patients,
the doctor removes the entire cancerous area during the biopsy.
For these patients, bladder cancer is diagnosed and treated
in a single procedure.
If bladder cancer is diagnosed, the doctor needs to know
the stage, or extent, of the disease to plan the best treatment.
Staging is a careful attempt to find out whether the cancer
has invaded the bladder wall, whether the disease has spread,
and if so, to what parts of the body.
The doctor may determine the stage of bladder cancer at the
time of diagnosis, or may need to give the patient more tests.
Such tests may include imaging tests -- CT scan, magnetic
resonance imaging (MRI), sonogram, intravenous pyelogram,
bone scan, or chest x-ray. Sometimes staging is not complete
until the patient has surgery.
These are the main features of each stage of the disease:
Stage 0 -- The cancer cells are found only on the surface
of the inner lining of the bladder. The doctor may call this
superficial cancer or carcinoma in situ.
Stage I -- The cancer cells are found deep in the inner lining
of the bladder. They have not spread to the muscle of the
Stage II -- The cancer cells have spread to the muscle of
Stage III -- The cancer cells have spread through the muscular
wall of the bladder to the layer of tissue surrounding the
bladder. The cancer cells may have spread to the prostate
(in men) or to the uterus or vagina (in women).
Stage IV -- The cancer extends to the wall of the abdomen
or to the wall of the pelvis. The cancer cells may have spread
to lymph nodes and other parts of the body far away from the
bladder, such as the lungs.