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 risk.

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 bladder cancer.

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 bladder.

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 treatments.

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 surgery.

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.

Glossary Terms

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 bladder).
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 the bladder.
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 reproductive system.

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.

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