Understanding Bladder Cancer

What does your bladder do?
The bladder is part of your urinary system. An important job of the urinary system is to filter waste products from your blood and then, once produced, transport the waste products or urine out of your body. The diagram below shows the organs of the urinary system. Most of the urinary tract is lined with a special layer of cells called transitional cells.The primary “machines” in the human filtering system are the two kidneys located close to the backbone and protected by the ribs. The kidneys, working independently, have the significant task of filtering approximately 20% of total blood volume each minute and removing the by-products of digestion and of other body functions. Once produced, the urine (the filtered waste product) is stored in the central part of the kidney called the renal pelvis. At regular intervals, the renal pelvis contracts and propels the urine through the ureters, narrow, thin-walled tubes that extend from inside the renal pelvis to the bladder.The bladder is a thick-walled structure, consisting of a relatively thin inner layer with a thick muscle covering. This inner layer or epithelium consists of several layers of cells. The epithelial layer is also called the transitional cell layer. The main function of the bladder is to store urine. For most people, the bladder can hold as much as 1 pint (16 ounces) of urine at a time and contracts or expands depending on how much fluid is in it. When the bladder contracts following a series of neurological “messages” to the brain and spinal cord, the urine moves through the urethra outside the body.

Diagram of Urinary Tract - cropped

What is bladder cancer?
Bladder cancer occurs when cells in the bladder start to grow out of control. Most bladder cancers develop on the inner layer of the bladder. Some can grow into the deeper bladder layers. As cancer grows through these layers into the wall of the bladder, it becomes harder to treat. The lining of the bladder, where tumors initiate, is also found in the inner layers of the kidneys, ureters and urethra. So, similar cancers can occur in these areas, though much less frequently.

What are the different types of bladder cancer?
The vast majority (~90%) of patients diagnosed with bladder cancer have urothelial carcinoma, also referred to as transitional cell cancer. Another 10% of bladder cancer patients have other types including squamous cell carcinoma, adenocarcinoma, or small cell cancer.

What are the risk factors for bladder cancer?

  • Smoking: Smoking is the greatest risk factor. Smokers get bladder cancer twice as often as people who don’t smoke.
  • Chemical Exposure: Some chemicals used in the making of dye have been linked to bladder cancer. People who work with chemicals called aromatic amines may have higher risk. These chemicals are used in making rubber, leather, printing materials, textiles and paint products.
  • Race: Caucasians are twice as likely to develop bladder cancer as are African Americans or Hispanics. Asians have the lowest rate of bladder cancer.
  • Age: The risk of bladder cancer increases as you get older.
  • Gender: While men get bladder cancer more often than women, recent statistics show an increase in the number of women being diagnosed with the disease. Unfortunately, because the symptoms of bladder cancer are similar to those of other gynecologic and urinary diseases affecting women, women may be diagnosed when their disease is at a more advanced stage.
  • Chronic bladder inflammation: Urinary infections, kidney stones and bladder stones don’t cause bladder cancer, but they have been linked to it.
  • Personal history of bladder cancer: People who have had bladder cancer have a higher chance of getting another tumor in their urinary system. People whose family members have had bladder cancer may also have a higher risk.
  • Birth defects of the bladder: Very rarely, a connection between the belly button and the bladder doesn’t disappear as it should before birth and can become cancerous.
  • Arsenic: Arsenic in drinking water has been linked to a higher risk of bladder cancer.
  • Earlier Treatment: Some drugs (in particular Cytoxan/cyclophosphamide) or radiation used to treat other cancers can increase the risk of bladder cancer.
  • Some drugs (in particular Cytoxan/cyclophosphamide) or radiation used to treat other cancers can increase the risk of bladder cancer.”

What are the signs and symptoms of bladder cancer?
The most common clinical sign of bladder cancer is painless gross hematuria, blood in the urine that can easily be seen. Two features that tend to mask the severity of the gross hematuria and may influence patients to postpone seeking immediate medical care are 1) the bleeding may be occasional and short-lived; and 2) there is likely to be no pain associated with the bleeding. In addition, it may be that the tumors do not produce enough blood for a patient to see (microscopic hematuria) and are only detected with the help of special chemicals and/or a microscope after a urine test is done by a physician.

However, blood in the urine does not necessarily mean a diagnosis of bladder cancer. Infections, kidney stones as well as aspirin and other blood-thinning medications may cause bleeding. In fact, the overwhelming majority of patients who have microscopic hematuria do not have cancer.

Irritation when urinating, urgency, frequency and a constant need to urinate may be symptoms a bladder cancer patient initially experiences. Oftentimes, though, these are merely symptoms of a urinary tract infection and antibiotics become the first line of treatment. To make the necessary distinction between an infection and something more serious, it is critical that a urinalysis and/or culture are done to detect any bacteria in the urine. If the culture is negative for bacteria, patients should be referred to a urologist for further testing.


What types of tests will the doctor conduct to determine if I have bladder cancer?
Ultrasound, CT scans (computed tomography), MRI scans (magnetic resonance imaging), and IVPs (intravenous pylogram) can detect irregularities in the bladder wall, which would suggest a possible cancer. The urologist will also look inside the bladder with a cystoscope to visually examine your bladder and remove samples of any suspicious areas for biopsy. Urine cytology will be performed to detect cancer cells in the urine. A number of other tests are also available. These urine-based markers detect cells or substances in voided urine that are relatively specific to bladder cancer. Patients should check with their urologists to learn whether such tests are being offered.


What is a cystoscopy?
Although the radiological tests provide important information about the kidneys and the ureters, cystoscopy is still the best method of evaluating the bladder and the urethra. The cystoscope is inserted through the urethra. Today, with the widespread use of the flexible cystoscope, most of the diagnostic cystoscopies are done in the outpatient setting with little or no discomfort.

Newer technology known as “blue light” cystoscopy uses an optical imaging agent to view tumors and is available at major medical centers.

Narrow band imaging is a technology that utilizes light of specific blue and green wavelengths which enhance visibility of vascular structures on the mucosa surface which can help in identification of suspicious lesions.

As the urologist looks through the cystoscope, the locations where there appears to be abnormal features are noted and recorded. During the cystoscopy, the urologist may choose to take a small piece of what appears to be abnormal tissue (biopsy) and send it to the pathologist to read and analyze. In addition, a sample of the urine from the bladder is frequently sent for analysis (cytology) to determine if there are any cancer cells. The biopsy specimen as well as the urine sample will help the doctor make recommendations about the patient’s future care.

Patients will go home after the cystoscopy if it is done in the doctor’s office. Patients should expect that there may be some minor bleeding and possible irritative bladder symptoms following the cystoscopy. Although seeing blood in the urine may be very troubling for the patient, the urologist, understanding that even small amounts of blood can affect the color of the urine dramatically, may not be concerned.


What are the types of bladder cancer tumors that may form?
Three types of bladder cancer may form, and each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time:

  • Papillary tumors stick out from the bladder lining on a stalk. They tend to grow into the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall.
  • Sessile tumors lie flat against the bladder lining. Sessile tumors are much more likely than papillary tumors to grow deeper into the layers of the bladder wall.
  • Carcinoma in situ (CIS) is a cancerous patch of bladder lining, often referred to as a “flat tumor”. The patch may look almost normal or may look red and inflamed.


What is meant by “staging and grading” a tumor?

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. Grade refers to what the cancer cells look like, and how many cells are multiplying. The higher the grade, the more uneven the cells are and the more cells are multiplying. Knowing the grade can help your doctor predict how fast the cancer will grow and spread.


Urologists typically send a sample of the cancer tissue to a pathologist, a doctor who specializes in examining tissue to determine the stage and grade of the cancer.  The pathologist writes a report with a diagnosis, and then sends it to your urologist.


What are the different “stages” for a bladder cancer tumor?

Stage suggests the location of the tumor in relation to the inner lining of the bladder. The higher the stage the further the tumor has grown away from its original site on the surface. The following are the stages for bladder tumors:

T0: No tumor

Ta: Papillary tumor without invading the bladder wall

TIS (CIS): Carcinoma in situ (non-invasive flat high-grade (G3) cancer)

T1: Tumor invades the connective tissue under the surface lining

T2: Tumor invades the muscle layer

T3: Tumor penetrates the bladder wall and invades the surrounding fat layer

T4 Tumor invades other organs (i.e., prostate, uterus, vagina, pelvic wall)


What are the different “grades” for a bladder cancer tumor?

Grade is expressed as a number between 1 (low) and 3 (high, i.e. G3); the higher the number the less the tumor resembles a normal cell. In lieu of numbers to grade a bladder cancer tumor, your doctor may refer to the tumor simply as low or high grade.


The information and services provides by the Bladder Cancer Advocacy Network (BCAN) are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures or products even though they may be mentioned on this site

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