There will be nearly 70,000 new cases of bladder cancer in the United States this year. Bladder cancer is more common in men than in women and more common in whites than blacks. The chance of a man developing bladder cancer during his lifetime is approximately 1 in 26. The corresponding risk for women is approximately 1 in 84.
Bladder cancer involves the cells that comprise the urinary bladder and is divided into several subtypes: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma and small cell carcinoma. There are a few other subtypes, but these are extremely rare. Transitional cell carcinoma is by far the most common subtype of bladder cancer. Transitional cell carcinoma develops in the cells that line the bladder (urothelial cells).
Symptoms of Bladder Cancer
Frequently, blood in the urine is the first sign of bladder cancer. Blood in the urine can be caused by a number of different conditions, both benign and malignant. There may be enough blood in the urine to change the color of urine or the blood might be picked up by urine tests. Additionally, increased urinary frequency or other changes in normal urination can be signs of bladder cancer.
Risk Factors of Bladder Cancer
· Like many other cancers, the risk of bladder cancer increases with age. Approximately 90% of patients with bladder cancer are over the age of 55. And 70% are over the age of 65 years.
· Cigarette smoking is the greatest risk factor for bladder cancer. Smokers are twice as likely as non-smokers to develop bladder cancer.
· Chemicals used in the process of making dyes have been linked to bladder cancer. The areas of industry with the highest risk included makes of rubber, leather, textiles, paints and printing companies.
· Other occupations have been linked with bladder cancer: hairdressers, machinists, printers and truck drivers.
· Chronic infections of the urinary tract, kidney stones or bladder stones all create ongoing inflammation of the bladder, which increases an individual’s risk of developing bladder cancer.
· History of pelvic radiation and the use of certain medications, such as phenacetin and cyclophosamide, have been associated with an increase risk of developing bladder cancer.
· Individuals with congenital bladder defects (i.e. bladder exstrophy) are also at an increased risk of developing bladder cancer.
How Bladder Cancer Is Diagnosed
· If there is a reason to suspect bladder cancer, your physician will use a combination of modalities to look for cancer, starting with a careful history and physical exam. The urine is examined for the presence of infection, which can sometimes mimic the signs and symptoms of bladder cancer.
· A cystoscopy can be performed so that your physician can look inside the bladder. If there is any abnormality, a small piece of tissue (biopsy) can be obtained in order to determine if this is cancer. A washing of the bladder can be obtained during this procedure and examined for cancer cells.
· Imaging studies can also be used to look at the bladder and surrounding organs. An intravenous pyelogram (IVP) is an x-ray of the kidneys, ureters, and bladder that is taken after a special dye has been injected into the patient. Similarly, a retrograde pyelogram and cystogram can be performed by placing a small catheter into the ureters and bladder and injecting a dye, which makes the lining of the urinary tract easier to see on x-rays.
· Just like in many other cancers, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound can all be used to visualize the bladder and the surrounding organs.
Treatment Options for Bladder Cancer at Tufts Medical Center
The treatment of bladder cancer is based upon stage. Staging ranges from I to IV, with I being the earliest and IV being the most advanced.
Options for treatment of bladder cancer include surgery, intravesical therapy (where treatment is introduced directly into the bladder), chemotherapy and radiation, or a combination of the above.
For bladder cancer that has not invaded the muscle, the most common first treatment is surgery to remove any abnormal cells from inside the bladder. This is called transurethral resection of bladder tumor (TURBT). Sometimes two procedures are required to be sure that no tumor cells were missed and confirm the cancer has not invaded into the muscle. Intravesical chemotherapy can be used immediately after TURBT to aid in destruction of the cancer cells.
Depending on the stage and grade of the tumor up to 70% of all patients who have their tumor removed with TURBT can have a recurrence of their cancer within 12 months. Additional intravesical chemotherapy or immunotherapy with an agent called BCG is often recommended in order to decrease the risk of recurrence and progression.
For bladder cancer invading into the muscle of the bladder and/or fat surrounding the bladder the treatment options would include surgery to remove the entire bladder (radical cystectomy), surgery to remove only part of the bladder (partial cystectomy), followed by radiation and/or chemotherapy, chemotherapy to shrink the tumor before surgery (neoadjuvant chemotherapy), or combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery).
When bladder cancer has spread beyond the bladder to other organs, most patients cannot be cured and surgery is not an option, unless it is done for palliation (relief) of symptoms. In these patients, chemotherapy is often considered.
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