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Bladder cancer Information*******************************************
The Bladder
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 ureter.
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.
Bladder Cancer
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 cancer:
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 States.
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 for
checkups.
Symptoms
Common symptoms of bladder cancer include:
Blood in the urine (making the urine slightly rusty to deep
red),
Pain during urination, and
Frequent urination, or feeling the need to urinate without
results.
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.
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.
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.
A patient who needs a biopsy may want to ask the doctor
some of the following questions:
Why do I need to have a biopsy?
How long will it take? Will I be awake? Will it hurt?
How soon will I know the results?
Are there any risks? What are the chances of infection or
bleeding after the biopsy?
If I do have cancer, who will talk with me about
treatment? When?
Staging
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 bladder.
Stage II -- The cancer cells have spread to the muscle of
the bladder.
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.
Information obtained from The National Cancer Institute.
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