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.
• 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.
• 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.

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.

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.

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.

Other diagnostic tests that may be done include:

• A complete blood count (CBC) to find out if you have anemia.
• A chemistry screen to evaluate kidney, liver, and bone functions.

Treatment for bladder cancer is based on the stage of the cancer and other things, such as your overall health. Most people have surgery to remove or destroy the cancer. Other treatments may include medicines, like chemotherapy, or radiation therapy.

Your doctor will talk with you about your options and then make a treatment plan.

Surgery is used to treat most stages of bladder cancer. It may be used alone or with other treatments. Types of surgery include:

Transurethral resection (TUR).

A thin, lighted tool is used to remove or destroy tumors in the bladder. This surgery is done through the urethra.

Cystectomy.

This is surgery to remove the bladder. There are two types:

• Partial cystectomy. This removes only part of the bladder. It's used for slow-growing cancer that is in just one area of the bladder.
• Radical cystectomy. This removes the whole bladder and part of the urethra. The doctor also removes nearby organs and lymph nodes that may have cancer cells.

In most cases, the bladder doesn’t need to be removed. If it is removed, the doctor will make a new way for urine to leave your body. This is called urinary diversion. For example, a piece of your intestine may be used to make a new bladder. Or the doctor may make a small opening in your belly. Then urine can flow into a bag attached to your body.