Bladder cancer, which is much more common in men than in women, afflicts tens of thousands in the United States each year. That is the bad news. The good news is, the most frequent bladder cancer is not particularly virulent and most types of bladder cancer respond well to a variety of treatments if the disease is detected in an early stage.
“Bladder cancer is a common genitourinary cancer,” says Dr. Christopher Tardif, a urologist at Indian River Medical Center. There are about 75,000 new cases of bladder cancer diagnosed in the U.S. each year. The incidence is about twice as high in Caucasians as in African-Americans and Hispanics. The reasons for the ethnic and gender differences are not clearly understood.
There are three types of bladder cancer; by far the most common is transitional cell carcinoma, which affects the cells that line the inside of the bladder. This type of cancer is either contained in the lining of the bladder (this is most commonly the case) or has invaded the muscle walls. It’s rare for this form of bladdere cancer to spread to other parts of the body.
The two other types of bladder cancer are rare in the United States, and this has been borne out in Dr. Tardif’s experience. In squamous cell carcinoma, cancerous cells appear in response to infection or irritation. In adenocarcinoma, the cancer begins in cells that make up the mucus-secreting glands in the bladder.
The most common early sign of bladder cancer is blood in the urine, according to Dr. Tardif. “There are many reasons other than bladder cancer for blood in the urine, but it’s important to see your doctor and get a work-up. There’s a good long-term survival rate if the cancer is caught early.” Sometimes, the blood is not visible and is only seen microscopically as a result of a routine urine test.
Other symptoms of bladder cancer may include frequent urination, painful urination, back pain, and pelvic pain.
When bladder cancer is suspected, it is often diagnosed via a cystoscopy, a minimally invasive procedure in which a narrow tube is inserted into the urethra, allowing the doctor to see the inside of the bladder. This procedure is sometimes combined with a biopsy, where a sample of cells is removed for further testing. Imaging tests (X-ray, CT scan) can also be used as diagnostic tools.
Biopsies are also used to determine the stage of the cancer – how invasive it is. Dr. Tardif says that it’s also important to determine the “grade” of the cancer, which is an assessment of how fast-growing the cancer is. This is done by examining a sample of the cancer cells under a microscope.
A recent 2-year study by UCLA researchers on biopsy as a diagnostic tool published in Science Daily concluded “the quality of diagnostic staging using biopsy in patients with bladder cancer is directly linked to survival.”
Researchers found that for half of the patients who were biopsied, there was no bladder muscle wall retrieval; tissues were taken only from the inner lining of the bladder. Ignoring the underlying muscle wall may lead to incorrect staging, and the appropriate treatment may not be prescribed.
If the staging and grading show that the cancer is small and has not invaded the muscle wall, treatment options include:
- Transurethral resection (TUR). A small wire loop is passed through a cytoscope into the bladder. An electric current is then used to burn away cancer cells. The cells are then biopsied. As with biopsy as a diagnostic tool, there must be muscle wall retrieval. “If there’s no muscle in the specimen, I’ll perform another TUR in a few weeks and go deeper into the bladder,” says Dr. Tardif.
- Partial cystectomy. The portion of the bladder that contains cancer cells is removed.
- Biological therapy. Drugs are used to send signals to the body’s immune system to help fight cancer cells; they are typically administered directly into the bladder through the urethra. Dr Tardif says that this can be a very effective treatment. “If the cancer recurs later after this form of treatment, it often recurs at a lower grade.”
- Chemotherapy. Two or more cancer-killing drugs are usually used in combination; they can be given through a vein in the arm, or directly into the bladder. If chemo is the chosen treatment, “there is a partial or complete response about 70 percent of the time,” according to Dr. Tardif.
Radiation is sometimes used in conjunction with chemotherapy, but it is seldom used as a standalone treatment for bladder cancer.
While bladder cancer can occur at any age, it is rarely found in someone under the age of 40, and most of those diagnosed are 55 or older.
Smoking is the key risk factor for bladder cancer, with smokers at least 3 times as likely as non-smokers to get the disease. The cancer-causing chemicals (carcinogens) in tobacco smoke are absorbed into the blood, filtered by the kidneys, and accumulated in the urine. These chemicals can then damage the cells that line the inside of the bladder.
Bladder cancer is likely to recur, so having been diagnosed and treated for it in the past is a very significant risk factor, even if the treatment was fully successful. It’s essential to get follow-up tests every 3-6 months for the first few years, then annually thereafter. Tests include those used in the initial diagnosis; there is also a urine test that looks for a certain DNA marker, and has been shown to be accurate in predicting future recurrence.
Other risk factors include:
- Exposure to certain chemicals used in the manufacture of dyes, rubber, leather, textiles, and print products.
- Family history of bladder cancer.
- Radiation treatments to the pelvis.
- Long-term use of the chemotherapy drug Cytoxan, as it causes irritation to the bladder.
- Use of the diabetes medicine Actos.
If the cancer has invaded the bladder wall, a surgical procedure called radical cystectomy is often performed, in which the entire bladder and surrounding lymph nodes are removed. This surgery also includes the removal of the prostate in men and certain reproductive organs in women.
With the removal of the bladder, the surgeon will also create new ways for the patient for the patient to expel urine; several options exist. Which option is best depends on the patient’s individual circumstances and preferences.
Dr. Tardif says chemotherapy is sometimes used in conjunction with a radical cystectomy. “It’s still controversial, but chemo may be indicated after the removal of the bladder, especially if the surgeon feels that not all of the cancer was removed.”
The fortunate news for those diagnosed with bladder cancer is that the diagnosis is usually made at an early stage, and if so, the disease is highly treatable.
