Bladder Cancer Treatment (PDQ®)–Patient Version

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BLADDER CANCER

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General Information About Bladder Cancer

KEY POINTS

Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.
Smoking can affect the risk of bladder cancer.
Signs and symptoms of bladder cancer include blood in the urine and pain during urination.
Tests that examine the urine and bladder are used to help detect (find) and diagnose bladder cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.

Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller to store urine made by the kidneys. There are two kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

Anatomy of the male urinary system (left panel) and female urinary system (right panel); two-panel drawing showing the right and left kidneys, the ureters, the bladder filled with urine, and the urethra. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine. Also shown are the prostate and penis (left panel) and the uterus (right panel). — Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade:
- Low-grade transitional cell carcinoma often recurs (comes back) after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body.
- High-grade transitional cell carcinoma often recurs (comes back) after treatment and often spreads into the muscle layer of the bladder, to other parts of the body, and to lymph nodes. Almost all deaths from bladder cancer are due to high-grade disease.
Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
Adenocarcinoma: Cancer that begins in glandular cells that are found in the lining of the bladder. This is a very rare type of bladder cancer.

Cancer that is in the lining of the bladder is called superficial bladder cancer. Cancer that has spread through the lining of the bladder and invades the muscle wall of the bladder or has spread to nearby organs and lymph nodes is called invasive bladder cancer.

See the following PDQ summaries for more information:

Smoking can affect the risk of bladder cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer.

Risk factors for bladder cancer include the following:

Using tobacco, especially smoking cigarettes.
Having a family history of bladder cancer.
Having certain changes in the genes that are linked to bladder cancer.
Being exposed to paints, dyes, metals, or petroleum products in the workplace.
Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
Taking Aristolochia fangchi, a Chinese herb.
Drinking water from a well that has high levels of arsenic.
Drinking water that has been treated with chlorine.
Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
Using urinary catheters for a long time.

Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.

Signs and symptoms of bladder cancer include blood in the urine and pain during urination.

These and other signs and symptoms may be caused by bladder cancer or by other conditions. Check with your doctor if you have any of the following:

Blood in the urine (slightly rusty to bright red in color).
Frequent urination.
Pain during urination.
Lower back pain.

Tests that examine the urine and bladder are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:

Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Internal exam : An exam of the vagina and/or rectum. The doctor inserts lubricated, gloved fingers into the vagina and/or rectum to feel for lumps.
Urinalysis : A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
Urine cytology : A laboratory test in which a sample of urine is checked under a microscope for abnormal cells.
Cystoscopy : A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
ENLARGE
Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor.
Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
The type of bladder cancer cells and how they look under a microscope.
Whether there is carcinoma in situ in other parts of the bladder.
The patient’s age and general health.

If the cancer is superficial, prognosis also depends on the following: