Bladder Cancer

Bladder cancer develops in the bladder, a balloon-shaped organ with elastic, muscular walls, which stores urine before it exits the body. The bladder is made up of four components: urothelial cells (the innermost lining cells, also known as the transitional epithelium), lamina propria (a thin layer of connective tissue, blood vessels and nerves), muscularis propria (a thick layer of muscle) and fatty connective tissue. Bladder cancer typically begins in the urothelial cells, and it spreads outward as it advances. About 9 out of 10 people with this cancer are over the age of 55. Also, men are about three to four times more likely than women to get bladder cancer during their lifetime1.

What different types of bladder cancer exist?

There are several types of bladder cancer that affect the different cells of the organ. Read more about the types of bladder cancer at:

http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-what-is-bladder-cancer

What are some symptoms of bladder cancer?

The most common bladder cancer symptom is the presence of blood in the urine (hematuria). However, hematuria cannot always be seen in the urine with the naked eye. Other symptoms include:

  • Changes in urination habits
  • Painful and/or frequent urination
  • Lower back pain 

How is bladder cancer diagnosed?

Physical exams for bladder cancer may include an examination of the bladder through the rectum and/or vagina (for women) to determine the size of the bladder tumor and if it has spread.

Cystoscopy is the insertion of a narrow lighted tube into the urethra to inspect the inside of the bladder for cancer.

Blood & urine tests for bladder cancer may include urine cystoscopy (examining a urine sample for the presence of (pre)cancerous cells); a urine culture (taking a urine sample and allowing any bacteria to grow on a dish in order to distinguish bladder cancer from a possible infection); and a urine tumor marker test (measuring the amount of specific urine substances released by bladder cancer cells).

Biopsy is the removal of a small amount of tissue from the bladder to microscopically examine its cells. Biopsies will determine the presence and type of bladder cancer.

Imaging tests use x-rays, magnets, sound waves or radioactive chemicals to create pictures of the inside of the body. For bladder cancer, these tests may include intravenous pyelograms, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, ultrasounds, chest x-rays and bone scans, all of which are particularly efficient at detecting if bladder cancer has spread to other organs.

What are the different stages of bladder cancer?

The staging system most often used for bladder cancer is the American Joint Committee on Cancer’s TNM system.

The TNM staging system is based on 3 key pieces of information:

  • T describes how far the main (primary) tumor has grown through the bladder wall and whether it has grown into nearby tissues.
  • N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.
  • M indicates whether or not the cancer has spread (metastasized) to distant sites, such as other organs or lymph nodes that are not near the bladder. 

What are the treatments for bladder cancer?

This bladder cancer treatment information does not outline the particular treatment(s) a patient will receive. Rather, it provides general information about the typical treatments used for this type of cancer.

Primary treatment options:

  • Surgery is most commonly used to remove bladder tumors, surrounding tissues and nearby lymph nodes to prevent the cancer from recurring. Types of surgery for bladder cancer include: Transurethral surgery (removal of a bladder tumor, used to treat early-stage or non-invasive bladder cancers) and Cystectomy (removal of all or part of the bladder, used to treat invasive bladder cancers).
  • Chemotherapy is the use of drugs to kill bladder cancer cells. Systemic chemotherapy is the injection of drugs into the blood that travel throughout the body to kill bladder cancer cells, as well as cancer cells found other places in the body. Chemotherapy is usually the main treatment for advanced cases of bladder cancers.
  • Radiation therapy uses high-energy rays or particles to kill cancer cells found in the bladder. Often, radiation therapy is combined with chemotherapy to make the radiation more effective.

Secondary treatment options:

  • Immunotherapy uses drugs that make the body’s immune system fight cancer cells. For non-invasive or minimally invasive bladder cancers, immunotherapy drugs are injected directly into the bladder; this type of immunotherapy is known as intravesical immunotherapy. 

What are the major risk factors of bladder cancer?

  • Smoking: Tobacco smoking remains the greatest risk factor of developing bladder cancer.
  • Age: The chance of developing bladder cancer increases in those age 40 and over.
  • Race: Caucasians are at the highest risk of developing bladder cancer.
  • Gender: Men are more likely than women to develop bladder cancer.
  • Personal history of bladder cancer: Bladder cancer has a 50 to 80% chance of recurring after treatment.
  • Chemical Exposure: Those exposed to chemicals in the rubber and leather industries are at higher risk for bladder cancer.
  • Infections: People infected by specific parasites (more commonly in the tropical climates) are at higher risk of bladder cancer.
  • Cyclophosphamide (chemotherapy drug) or arsenic exposure

How can I prevent getting bladder cancer?

  • Quitting or never starting to smoke
  • Avoiding exposure to industrial chemicals (including arsenic)
  • Eating a healthy diet
Creators: 
Mikayla D. Williams , BS student, Nursing , The University of Arizona
Michael Principe, MA, Information Resources and Library Science , The University of Arizona
Expert Reviewers: 
Cheryl Lacasse, MS, RN, OCN , Clinical Professor , College of Nursing, The University of Arizona
Works Cited: 
American Cancer Society (2014). Bladder Cancer. http://www.cancer.org/cancer/bladdercancer/detailedguide/index
Works Consulted: 
American Society of Clinical Oncology (2014). Bladder Cancer. http://www.cancer.net/cancer-types/bladder-cancer
Cancer Treatment Centers of America (2014). Bladder Cancer information. http://ww2.cancercenter.com/bladder-cancer/learning/
Bladder Cancer - Prevention (2014). In Bladder Cancer Health Center. http://www.webmd.com/cancer/bladder-cancer/bladder-cancer-prevention