How common is it?
Over the past several decades there has been a steady rise in the
incidence of bladder cancer. Currently, it is the 6th most common
cancer in the U.S., with over 53, 000 Americans diagnosed with bladder
cancer each year, and about 12,000 die annually of this disease.
What causes bladder cancer?
Our understanding of the ways in which bladder cancers develop
and progress is incomplete. However, there is a link to a number
of substances. Among the numerous toxins, cigarette smoke and various
industrial chemicals have the strongest association to the development
of this disease. Cigarette smoking has been associated in at least
50 percent of cases. Chemical compounds such as paints and solvents
are involved in another 20 to 25 percent of bladder cancer cases.
Chronic or long-term exposure to these substances increases your
What are the signs and symptoms of bladder cancer?
Unfortunately there may not be any pain or bothersome symptoms
in the early stages of this cancer. Painless blood in the urine
(hematuria) is a common reason for referral to a urologist, with
many patients having only microscopic amount of blood in the urine.
It is important to note that hematuria, particularly microscopic,
has many possible causes and is a common finding in people without
The most important task of your initial urological consultation
is to define your risk for bladder cancer. Patients with higher
risk include older patients, smokers, those with chemical exposures,
those with bothersome symptoms (frequent, urgent, painful urination),
and those with persistent signs of infection.
How is bladder cancer diagnosed?
Since blood in the urine is a non-specific sign of bladder cancer,
a look of the entire urinary tract is mandatory including radiological
imaging of the kidneys. Another commonly used test is the urine
cytology, looking for any cancer cells that may have shed into the
urine from the bladder lining. Urine can also be tested for substances
(markers) known to be closely associated with cancer cells.
For many patients, the most important test is cystoscopy, which
is a procedure that allows direct viewing of the inside of the bladder.
This is most commonly performed as an office procedure using a cystoscope
under local anesthesia.
If tumors are seen or if the lining of the bladder looks suspicious,
the patient is then scheduled to have a surgical procedure to remove
the tumors or to biopsy any suspicious areas of the bladder under
general anesthesia. This procedure is also done through the urethra,
using slightly larger instruments to perform the resection (cut
and remove tumors) or the biopsy (sampling of bladder lining). The
removed tissue is sent to a pathologist for examination and diagnosis.
The pathologist's report contains important information regarding
the grading of the tumors (low to high grade) and the depth of involvement.
Superficial tumors are contained within the innermost lining of
the bladder wall. Invasive tumors have penetrated the inner lining
into the muscle layer or possibly through the entire wall of the
How is bladder cancer treated?
Patients with superficial tumors will require close follow-ups
with regular cystoscopy examinations (usually every 3 months for
the first several years). High-grade superficial tumors tend to
recur and may progress to invasive disease. In these cases, additional
treatment with medication placed into the bladder is usually recommended
to minimize the risk of recurrence and progression. Patients who
have multiple and/or large tumor size can also benefit from such
Radical surgery to remove the entire bladder (Cystectomy) is the
standard treatment for muscle-invasive bladder cancer. Patients
with high-grade superficial cancers or carcinoma in situ cancers
that have persisted or recurred are also candidates for radical
surgery. Partial removal of the bladder is an option for well selected
cases. Our ability to create a "new bladder" using a segment
of your intestine has helped patients accept the need for radical
Frequently Asked Questions:
Is there a screening test for early detection of bladder cancer?
Not at this time.
What are some risk factors for bladder cancer?
Smokers develop bladder cancer at two to three times the rate of
non-smokers. People who work with dyes, metal, paints, leather,
textile and organic chemicals may be at a higher risk. People who
have chronic bladder infections may also be at higher risk.
People in these high-risk group, especially those with evidence
of blood in the urine (even if it is only trace or microscopic),
are encouraged to go through a complete urological evaluation.
Anesthesia: induced loss of sensitivity to pain in all or
a part of the body for medical reasons or procedures.
Biopsy(-ies): small tissue sampling obtained for examination
under a microscope.
Cancer: an abnormal growth that can invade nearby structures
or spread to other parts of the body.
Carcinoma: cancer that begins from the skin or from other
tissue lining an organ or its cavity.
Carcinoma in situ: also known as CIS. It is a high grade
form of a cancer (e.g. bladder cancer).
Cystectomy: surgical removal of the bladder, either complete
(radical) or partial.
Cystoscopy: an examination to look at the inner lining of
the bladder, using a lighted telescope.
Hematuria: blood in the urine.
Invasive: having or showing a tendency to spread from the
point of origin to adjacent tissue, as some cancers do.
Pathologist: a physician with specialization in tissue examination
for diagnosis of disease.
Muscle-invasive: cancer (e.g. bladder cancer) has spread
into the outer muscle layer of the bladder wall.
Resection: surgical removal of a specific mass or tumor
or a portion of a body part or organ.
Superficial: involving the surface or inner lining (of the
Transurethral resection: surgical removal of tumors using
special instruments passed through the urethra.
Urethra: in males, this long tube travels through the center
of the prostate, carrying urine from the bladder to the outside,
and also serves as the channel through which semen is ejaculated.
In females, this tube is shorter and carries urine from the bladder
to the outside.
Ureter(s): narrow tube carrying urine from each kidney to
Urinary tract: includes the kidneys, ureters, bladder and
urethra (in males, the prostate too).
Urologist: a physician and surgeon who specializes in diseases
or conditions of the male and female urinary tract, and the male
Download: Bladder Cancer Basics for the Newly Diagnosed in PDF format
*  This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information.