Bladder cancer


Definition

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 abdomen.

Alternative Names

Transitional cell carcinoma of the bladder; Urothelial cancer

Causes

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In the United States, bladder cancer often starts from the cells lining the bladder. These cells are called transitional cells.

These tumors are classified by the way they grow:

The exact cause of bladder cancer is not known. But several things may make you more likely to develop it:

Research has not shown clear evidence that using artificial sweeteners leads to bladder cancer.

Symptoms

Symptoms of bladder cancer can include:

Other diseases and conditions can cause similar symptoms. It is important to see a doctor to rule out all other possible causes.

Exams 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

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 people with stage IV tumors cannot be cured and surgery is not appropriate. In these people, chemotherapy is often considered.

CHEMOTHERAPY

Chemotherapy may be given to people 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 medicine 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).

IMMUNOTHERAPY

Bladder cancers are often treated with immunotherapy. In this treatment, a medicine triggers your immune system to attack and kill the cancer cells. Immunotherapy for bladder cancer is often performed using the Bacille Calmette-Guerin vaccine (commonly known as BCG).

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

Surgery for bladder cancer includes:

Surgery may also be done to help your body drain urine after the bladder is removed. This may include:

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

After treatment for bladder cancer, you will be closely monitored by a doctor. This may include:

How well a person 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 for 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%. People with stage IV bladder cancer are rarely cured.

Possible Complications

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:

When to Contact a Medical Professional

Call your health care provider if you have blood in your urine or other symptoms of bladder cancer, including:

Prevention

If you smoke, quit. Smoking can increase your risk for bladder cancer. Avoid exposure to chemicals linked to bladder cancer.

References

National Cancer Institute: PDQ bladder cancer treatment. Bethesda, MD: National Cancer Institute. Updated February 18, 2016. www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional. Accessed April 4, 2016.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): Bladder cancer. Version 2.2015. www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. Accessed April 4, 2016.

Smith A, Balar AV, Milowsky MI, Chen RC. Bladder cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier; 2014:chap 83.

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