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Bladder cancer is a disease that affects the bladder, an elastic organ that is responsible for storing urine that is released by the kidneys. It is the fifth most common type of cancer in the U.S. and when diagnosed in the early stages, it is highly treatable.

There are several types of bladder cancer, some being more common then others. The most common type of bladder cancer is urothelial carcinoma, accounting for about 90% of bladder cancer cases. The remaining types of bladder cancer are considered rare. They include squamous cell carcinoma, adenocarcinoma, small cell carcinoma, leiomyosarcoma, lymphoma, and, melanoma.

What are the Causes and Risk Factors for Bladder Cancer?

Although researchers cannot pinpoint the exact causes of bladder cancer, several risk factors for the disease have been identified. The greatest risk factor for developing bladder cancer is smoking. When people smoke, the carcinogens are absorbed into the lungs and enter the bloodstream. Our blood is then filtered by the kidneys and the waste is then converted in urine, which is released to the bladder to exit our body. Unfortunately, the carcinogens from the tobacco remain in the urine and damage the cells in our bladder, potentially causing cancer.

We also know that occupational exposure to certain chemicals increases our risk of bladder cancer. Chemicals used in making dyes is strongly associated to the development of bladder cancer. Chemicals called aromatic amines at factories that produce leather, rubber, paint, and other products are also suspected.

We also know that hair stylists, painters, those who work at printing factories, and truck drives also develop bladder cancer more commonly than those who work in other industries. Other risk factors for bladder cancer include:

• being Caucasian
• being male
• increasing age
• personal or family history of bladder cancer
• bladder birth defects
• chronic bladder inflammation (cystitis)
• not consuming enough liquids

What are the symptoms of Bladder Cancer?

Bladder cancer symptoms include:

• Blood in the Urine (hematuria): When you can physically see blood in your urine, it is call gross hematuria. Blood can appear in the urine as a pink, brown or red hue. Blood clots can also be present. Many times, blood in the urine is not visible to the naked eye — a microscopic analysis of the blood can reveal hematuria when it cannot physically be seen.
• Painful Urination: Pain during urination is called dysuria. Pain can range from mild to severe.
• Frequent Urination: Having to urinate often and during the night is also a symptom of bladder cancer. People with bladder cancer may also have an intense physical sensation of needing to empty the bladder, despite just having urinating or not expelling urine when trying.

Diagnosing Bladder Cancer

If a doctor suspects that something may be wrong with the bladder, one of the first tests done will be a urine culture and urinalysis. Your doctor will want to see if an infection is the underlying cause of symptoms. A urine culture looks for the presence of bacteria in the urine, while urinalysis checks for the presence of blood. Note: If you are being treated for a urinary tract infection or cystitis and are not feeling better after taking all of your medication, it is important that you let your doctor know.

Your doctor may also want to check your urine for the presence of tumor markers, proteins that are increased in the urine of people with bladder cancer.

Another test used is diagnosing bladder cancer is urine cytology. In this test, a sample of your urine is screened for abnormal cells. These cells are then looked at under the microscope to screen for cancer. While it may sound like a non-invasive way to easily diagnose bladder cancer, it isn’t. The test is known for false-negatives and false positives.

If bladder cancer is suspected, then the doctor will want to get a better look at your bladder. This can be achieved through a cystoscopy, a procedure where the doctor inserts a thin, lighted tube equipped with a microscopic camera into the urethra to the bladder. The camera projects live feed to a monitor allowing the doctor to see see inside the bladder. If any suspicious areas are found, a biopsy can be done during a cystoscopy. A biopsy is the removal of small amount of bladder tissue to be examined further for the presence of cancer. It is the only way to confirm if cancer is present.

Staging

The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:

• Stage 0: Cancer cells are found only on the inner lining of the bladder (This stage is also often called Stage Ta).

• Stage I: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.

• Stage II: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.

• Stage III: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.

• Stage IV: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.

• Recurrent: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.

Bladder Cancer Treatment

The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be “shaved off” using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors.

BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy, such as valrubicin (Valstar) into the bladder can also be used to treat BCG-refractory CIS disease when cystectomy is not an option.

Patients whose tumors recurred after treatment with BCG are more difficult to treat. Many physicians recommend Cystectomy for these patients. This recommendation is in accordance with the official guidelines of the European Association of Urologists (EAU). and the American Urological Association (AUA) However, many patient refuse to undergo this life changing operation, and prefer to try novel conservative treatment options before opting to this last radical resort. Device assisted chemotherapy is such one group of novel technologies used to treat superficial bladder cancer. These technologies use different mechanisms to facilitate the absorption and action of a chemotherapy drug instilled directly into the bladder. Another technology uses an electrical current to enhance drug absorption. Another technology, Thermo-chemotherapy, uses radio-frequency energy to directly heat the bladder wall. The heat and chemotherapy show a synergistic effect, enhancing each other’s capacity to kill tumor cells. This technology was studied by different investigators.

Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder require more radical surgery where part or all of the bladder is removed (a cystectomy) and the urinary stream is diverted. In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon patient preference, age of patient, renal function, and the site of the disease.

A combination of radiation and chemotherapy can also be used to treat invasive disease. It has not yet been determined how the effectiveness of this form of treatment compares to that of radical ablative surgery.

There is weak observational evidence from one very small study (84) to suggest that the concurrent use of statins is associated with failure of BCG immunotherapy.

The hemocyanin found in the blood of the sea snail Concholepas concholepas has immunotherapeutic effects against bladder and prostate cancer. In a research made in 2006 mice were primed with C. concholepas before implantation of bladder tumor (MBT-2) cells. Mice treated with C. concholepas showed a significant antitumor effect as well. The effects included prolonged survival, decreased tumor growth and incidence and lack of toxic effects.

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Preventing Bladder Cancer

Unfortunately, there are no proven methods that guarantee prevention of bladder cancer. By avoiding what risk factors we can for bladder cancer, we may be able to reduce our chances of developing it.

• Quit Smoking or Don’t Start. Smoking is the number one risk factor for bladder cancer. As soon as you quit (it’s never too late!), your body reaps the benefits of being tobacco free. Quitting smoking is one of your best defenses against bladder cancer.
• Be Aware of Your Workplace Chemical Exposure. If you are exposed to fumes, dust and chemicals in the workplace, you have a right to know what you are being exposed to. Talk to your employer about limiting your exposure.
• Drink Plenty of Fluids. Some studies suggest that keeping well hydrated may reduce your risk of developing bladder cancer. The more liquids you intake, the less time toxic substance remain in the system, potentially causing damage.