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Bladder cancer is a cancer that starts in the bladder. The bladder is the body part that holds and releases urine. It is in the center of the lower belly area.
Transitional cell carcinoma of the bladder; Urothelial cancer
Causes, incidence, and risk factors
In the United States, bladder cancers usually start from the cells lining the bladder (called transitional cells).
These tumors are classified based on the way they grow:
The exact cause of bladder cancer is uncertain. However, several things may make you more likely to develop it:
Some research has suggested a link between artificial sweeteners and bladder cancer. The evidence is weak.
Symptoms of bladder cancer can include:
Note: Other diseases and conditions can cause similar symptoms. It is important to see a doctor to rule out all other possible causes.
Signs and tests
The health care provider will perform a physical examination, including a rectal and pelvic exam.
Tests that may be done include:
If tests confirm you have bladder cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.
The TNM (tumor, nodes, metastatis) staging system is used to stage bladder cancer:
Tumors are also grouped based on how they appear under a microscope. This is called grading the tumor. A high-grade tumor is fast growing and more likely to spread. Bladder cancer can spread into nearby areas, including the:
Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.
Stage 0 and I treatments:
Stage II and III treatments:
Most patients with stage IV tumors cannot be cured and surgery is not appropriate. In these patients, chemotherapy is often considered.
Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
A Foley catheter can be used to deliver the medication into the bladder. Common side effects include bladder wall irritation and pain when urinating. For more advanced stages (II-IV), chemotherapy is usually given by vein (intravenously).
Bladder cancers are often treated with immunotherapy. In this treatment, a medication triggers your immune system to attack and kill the cancer cells. Immunotherapy for bladder cancer is usually performed using the Bacille Calmette-Guerin vaccine (commonly known as BCG). A medicine called Interferon is sometimes used. It is given through a Foley catheter directly into the bladder. If BCG does not work, patients may receive interferon.
As with all treatments, side effects are possible. Ask your doctor what side effects you might expect, and what to do if they occur.
Surgery for bladder cancer includes:
Surgery may also be done to help your body drain urine after the bladder is removed. This may include:
After treatment for bladder cancer, you will be closely monitored by a doctor. This may include:
How well a patient with bladder cancer does depends on the initial stage and response to treatment of the bladder cancer.
The outlook for stage 0 or I cancers is fairly good. Although the risk of the cancer returning is high, most bladder cancers that return can be surgically removed and cured.
The cure rates for people with stage III tumors are less than 50%. Patients with stage IV bladder cancer are rarely cured.
Bladder cancers may spread into the nearby organs. They may also travel through the pelvic lymph nodes and spread to the liver, lungs, and bones. Additional complications of bladder cancer include:
Calling your health care provider
Call your health care provider if you have blood in your urine or other symptoms of bladder cancer, including:
If you smoke, quit. Smoking can increase your risk of bladder cancer. Avoid exposure to chemicals linked to bladder cancer.
Bajorin D. Tumors of the kidney, bladder, ureters, and renal pelvis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia , Pa : Saunders Elsevier; 2011: chap 203.
National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Bladder Cancer, Including Upper Tract Tumors and Urothelial Carcinoma of the Prostate. 2012.
Reviewed by:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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