Topic Overview
What is bladder cancer?
Cancer is the growth of
abnormal cells in the body. These extra cells grow together and form masses,
called tumors. In bladder cancer, these growths happen in the bladder.
The bladder is the part of your
urinary tract
that stores your urine until you are
ready to let it out. See a picture of the
female urinary system
or
male urinary system
.
Bladder cancer can usually be successfully treated if it
is found and treated early. And most bladder cancer is found early.
What causes bladder cancer?
We don't know what
causes bladder cancer. But smoking cigarettes or being exposed to certain chemicals raises your risk. And like other cancers, changes in the DNA of your
cells seem to play a role.
What are the symptoms?
Blood in the urine is the
main symptom. Other symptoms may include having to urinate often or feeling
pain when you urinate.
These symptoms can be caused by other
problems, including a
urinary tract infection
. Always call your doctor if
you see blood in your urine.
How is bladder cancer diagnosed?
To diagnose
bladder cancer, your doctor will:
- Ask about your medical history and do a
physical exam, including a vaginal or rectal exam.
- Test your urine
to look for blood or abnormal cells.
- Do a
cystoscopy
, a test that lets your doctor look into
your bladder with a thin, lighted viewing tool. Small tissue samples (
biopsies
) are taken and looked at under a microscope
to find out if there are cancer cells.
How is it treated?
Treatment choices for bladder
cancer include:
- Surgery to remove any cancer. Sometimes
lasers or other methods can be used to get rid of tumors.
-
Chemotherapy
, which uses medicine to destroy cancer
cells.
-
Immunotherapy
, which causes your body's natural
defense system to attack bladder cancer cells.
-
Radiation therapy
, which uses high-dose X-rays to kill
cancer cells.
The treatment depends a lot on how much the cancer has
grown. Most bladder cancers are treated without having to remove the
bladder.
Sometimes doctors do have to remove the bladder. For some
people, this means having urine flow into a bag outside of the body. But in
many cases, doctors can make a new bladder—using other body tissue—that works
very much like the old one.
Bladder cancer often comes back. The
new tumors can often be treated successfully if they are caught early. So it's very
important to have regular checkups after your treatment is done.
It's common to feel scared, sad, or angry after finding out that you have
bladder cancer. Talking to others who have had the disease may help you feel
better. Ask your doctor about support groups in your area.
What increases your chances of getting bladder cancer?
Anything that increases your chances of getting a disease is called a
risk factor. The main risk factors for bladder cancer include:
- Smoking. Cigarette smokers are much more
likely than other people to get bladder cancer.
- Being older than
40, being male, or being white (Caucasian).
- Being exposed to
cancer-causing chemicals, such as those used in the wood, rubber, and textile
industries.
- What you eat. A diet high in fried meats and fats
increases your risk for bladder cancer.
- Parasites. There is a
parasite that causes schistosomiasis, which can increase your risk. This
condition is sometimes found in developing countries and rarely occurs in North
America.
Frequently Asked Questions
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Learning about bladder cancer:
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Being diagnosed:
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Getting treatment:
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Ongoing concerns:
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Living with bladder cancer:
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End-of-life issues:
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Cause
The cause of
bladder cancer is not known. Changes in the genetic
material (
DNA
) of bladder cells may play a role. Chemicals in
the environment and cigarette smoking also may play a role. And when the lining
of the bladder is irritated for a long time, cell changes that lead to cancer
may occur. Some things that cause this are radiation treatment, having
catheters in place for a long time, or having the parasite that causes
schistosomiasis.
Bladder cancer is twice as likely to develop in
smokers than in nonsmokers. Experts believe that smoking causes about half of
bladder cancer in men and more than one-fourth of bladder cancer in
women.
1
Exposure to chemicals and other
substances at work—including dyes, paints, leather dust, and others—may also
cause bladder cancer.
Symptoms
The most common symptoms of
bladder cancer include:
- Blood or blood clots in the urine (hematuria).
Hematuria occurs in 8 or 9 out of 10 people who have bladder cancer and is the
most common symptom. Usually it isn't painful.
- Pain during
urination (dysuria).
- Urinating small amounts frequently.
- Frequent
urinary tract infections
(UTIs).
Symptoms that may indicate more advanced bladder cancer
include:
- Pain in the lower back around the kidneys
(
flank pain
).
- Swelling in the lower legs.
- A growth in the pelvis
near the bladder (pelvic mass).
Other symptoms that may develop when bladder cancer has
spread include:
- Weight loss.
- Bone pain or pain in
the rectal, anal, or pelvic area.
-
Anemia
.
The symptoms of bladder cancer may be similar to symptoms
of other bladder conditions.
What Happens
Bladder cancer
is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer
usually begins in the lining of the bladder. The cancerous cells may spread
through the lining into the muscular wall of the bladder.
Invasive bladder
cancer may spread to
lymph nodes
, other organs in the pelvis (causing
problems with kidney and bowel function), or other organs in the body, such as
the liver and lungs.
Your treatment will depend on how far the cancer has spread.
Most bladder cancer is found early, before it has spread into the bladder wall. Surgery can usually remove these tumors. But bladder cancer often comes back, so you may also get other treatments, such as
chemotherapy
or
immunotherapy
, to lower the chances of that happening.
What Increases Your Risk
The main risk factors for
bladder cancer include:
-
Smoking.
Smokers are twice as likely to get bladder cancer as nonsmokers.
1
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Chemical exposure. Bladder cancer has been linked to chemicals
called aromatic amines. These chemicals are found in many products, including dyes, paints,
solvents, inks, and the dust from leather. This risk may also depend on how
much and how often a person was exposed to these chemicals.
-
Being older. Your risk goes up as you get older. Most people
who get bladder cancer are close to their 70s.
-
Being a white male. Men are 4 times more likely to get bladder cancer than women. And white men are twice as likely to get it as African-American men.
1
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A diet that
is high in nitrates or rich in meat and fatty foods.
-
Schistosomiasis, which is an infection caused by a parasite. It's sometimes
found in developing countries and rarely occurs in North America.
When To Call a Doctor
If you have been diagnosed with
bladder cancer, be sure to follow your doctor's
instructions about calling when you have problems, new symptoms, or symptoms
that get worse.
Call your doctor if you:
- Have blood in your urine.
- Feel pain
when you urinate.
- Are urinating small amounts
frequently.
- Have
back or flank pain
.
Watchful waiting
If you are concerned about your symptoms or about your risk for bladder cancer, make an appointment with your
doctor.
Watchful waiting
is not appropriate if you have
symptoms that do not go away.
Who to see
Health professionals who can evaluate your symptoms and your risk
for bladder cancer include:
Doctors who can manage your
cancer treatment include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
To find out whether
bladder cancer may be the cause of your urinary
symptoms, your doctor will:
- Do a physical exam. This may include
a
rectal exam, a
prostate
exam for men, or a
pelvic exam for women.
- Ask questions about your medical history,
including:
- Your smoking history.
- Your possible exposure to cancer-causing chemicals.
- Your family history of cancer.
- Order a urine test and
urine culture to check for the presence of blood,
infection, and other abnormal cells.
Cystoscopy
You will have a cystoscopy, a test that allows your doctor to look at your bladder with a thin, lighted tube. The doctor can use the same tube to take small tissue samples (
biopsies
) of any abnormal areas. The samples will be looked at under a microscope to find out whether cancer cells are present and what the cells look like.
Tests to determine stage and grade
Bladder cancer is classified by
stage and grade
. The stage is determined by the
cancer growth in the bladder wall and how far it has spread to nearby tissues
and other organs, such as the lungs, the liver, or the bones. The grade of
bladder cancer is determined by how the cancer cells look in comparison with
normal bladder cells.
Your doctor finds out the stage and grade of
your bladder cancer by gathering information from several tests, including:
The stage and grade of your cancer are important in choosing the right treatments.
Other tests
Other diagnostic tests that may be done include:
Early detection of returning cancer
Bladder cancer often comes back, so it's important to have regular checkups. Then, if the cancer does come back, you have a better chance of finding it early enough for successful treatment.
Treatment Overview
The choice of treatment and the
long-term outcome (prognosis) for people who have
bladder cancer depend on the
stage and grade
of cancer. When deciding about your treatment, your doctor also considers your age, overall
health, and quality of life.
Bladder cancer has a better chance of being treated successfully if it is found early.
Treatment choices for bladder cancer may include:
-
Surgery to remove the cancer. Surgery,
either alone or along with other treatments, is used in more than 9 out of 10 cases.
1
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Chemotherapy to
destroy cancer cells using medicines. Chemotherapy may be given before or after
surgery.
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Radiation therapy to destroy cancer cells using
high-dose X-rays or other high-energy rays. Radiation therapy may also be given
before or after surgery and may be given at the same time as
chemotherapy. For more information, see Other Treatment.
-
Immunotherapy
. This treatment causes your body's natural
defenses, known as your
immune system, to attack bladder cancer cells. For more information, see Medications.
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.
Additional information about bladder cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/bladder.
Side effects of treatment
Most treatments for bladder
cancer cause side effects. Side effects may differ, depending on the type of
treatment used and your age and overall health.
-
Side effects of chemotherapy may
include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair
loss. There is also an increased chance of getting a serious infection during
chemotherapy treatment.
Mitomycin may cause skin peeling or a
rash.
-
Side effects of surgery depend on how extensive your
surgery was to treat the stage of your cancer. Men may have erection problems
after surgery if the bladder is removed (cystectomy). If you choose a surgeon
who does many of these procedures, you will have fewer side effects and you
will recover faster.
-
Side effects of radiation may include
nausea, vomiting, diarrhea, pain or discomfort when urinating, and bladder
inflammation and scarring (radiation cystitis). You may also have an increased
risk of infection.
-
Side effects of immunotherapy
vary
depending on the medicine.
Bacillus Calmette-Guerin (BCG) is a tuberculosis
vaccine used in countries outside the United States. With BCG, the side effects
may include fever, joint pain, inflammation of the prostate, or disseminated
tuberculosis.
Home treatment measures may help you manage the side
effects.
Body image and sexual problems
Sexual problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.
- Women who have the bladder removed (radical
cystectomy) will also have the
ovaries
and
uterus
removed. They cannot become pregnant and may
experience
menopause
soon after having the cystectomy.
- Men who have their prostate glands and seminal vesicles removed
may have erection problems and will no longer produce semen.
Your feelings about your body may change following
treatment for cancer. Managing body image issues may involve talking openly
about your concerns with your partner and discussing your feelings with your
doctor. Your doctor may also be able to refer you to groups that can offer
support and information.
Bladder cancer that comes back
After initial treatment for
bladder cancer, it is important to receive follow-up
care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.
Bladder cancer may recur in the bladder, or it may spread (metastasize) to other parts of
the body. Recurrent bladder cancer may be treated with surgery or
chemotherapy to slow cancer growth and relieve
symptoms.
Participation in a
clinical trial may be recommended if you have been
diagnosed with recurrent bladder cancer.
Palliative care
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible.
Palliative care
can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief.
But this isn't the end of treatment. It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. You and your doctor can decide when you may be ready for
hospice care
.
For more information, see:
Prevention
Bladder cancer cannot be prevented, but you may be
able to reduce some of your risk for getting it.
- Stop smoking. Cigarette smokers are much more likely to get bladder cancer
than nonsmokers. For help on how to quit smoking, see the topic
Quitting Smoking.
-
Avoid exposure to
industrial chemicals, such as benzene substances and arylamines. Occupational
exposure from working with dyes, rubbers, textiles, paints, leathers, and
chemicals raises your risk for bladder cancer.
-
Avoid
exposure to arsenic. Have your drinking water tested. Drink bottled
water if you think that your water is contaminated with
arsenic.
-
Eat healthy foods. Experts believe that what you eat and
drink may help prevent bladder cancer.
- Choose a
low-fat, low-cholesterol diet that includes plenty of
fruits and vegetables. For more information, see the topic
Weight Management. - Avoid
dehydration
. Increase your fluid intake, particularly
water. Water dilutes cancer-causing chemicals.
Home Treatment
The side effects of bladder cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.
You can try home treatments:
Other issues that can be treated at home include:
-
Sleep problems. If you have trouble sleeping, try having
a regular bedtime and getting exercise daily.
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Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.
-
Hair loss. Hair loss may be unavoidable. But using
mild shampoos and avoiding damaging hair products will reduce irritation of
your scalp.
-
Pain. Home treatment can help you manage pain. Be sure to talk with your doctor about any home treatment you use.
Handling the stress of having cancer
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
-
Get the support you need. Spend time with people who care about you, and let them help you.
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Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about your feelings. Find a support group where you can share your experience.
-
Try new ways to relax. And do things each day that help you stay calm and relaxed. Stress reduction techniques may help.
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
Medications
Medicines may be used to control the growth
of
bladder cancer cells and to relieve symptoms.
These medicines may be taken by mouth, injected
into a vein (
intravenous, or IV
), or delivered directly into the bladder using a catheter.
-
Chemotherapy
uses medicines to destroy cancer cells.
-
Immunotherapy
, also called biological therapy, uses medicines
that cause your body's
immune system
to attack cancer cells in your bladder.
It is most often used for early-stage bladder cancer. It may also be used after a transurethral resection (TUR) to help keep cancer from coming back.
Most chemotherapy causes some
side effects. Home treatment may be all that is needed to manage your
symptoms. But some people may need
medicines to control nausea and vomiting.
Medication choices
Chemotherapy medicines
Immunotherapy medicines
Surgery
Surgery is used to treat most
stages of
bladder cancer.
-
Transurethral resection (TUR)
is surgery done through the urethra. A thin, lighted tube called a cystoscope is used to remove or destroy tumors in the bladder.
-
Cystectomy
is surgery to remove the bladder.
- Partial cystectomy removes only part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area.
- Simple cystectomy removes all of the bladder.
- Radical cystectomy removes all of the bladder as well as nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer.
-
Urinary diversion is surgery that makes a new way for your body to store urine. This can be done with a pouch created inside your body from part of your intestines, called a continent reservoir. Or the surgeon may make an artificial opening, called an ileal conduit, and you will wear a flat bag to store urine outside your body.
What to think about
Side effects from your surgery
can include bowel problems such as constipation or diarrhea.
Your ability to have or enjoy sexual intercourse may also be affected.
Adhesions
may develop after surgery. And a
bowel obstruction
may occur as a complication if
surgery was extensive.
Other Treatment
Radiation treatment
Radiation treatment for
bladder cancer uses high-energy X-rays to kill cancer
cells and shrink tumors. It may be given after surgery. It may be used along with chemotherapy. Sometimes it is used instead of surgery or chemotherapy.
-
External beam radiation comes from a machine outside
the body. The machine aims radiation at the area where the cancer cells are
found.
-
Internal radiation uses needles, seeds, wires, or catheters that contain
radioactive materials placed close to or directly into the bladder.
Which
treatment you receive will depend on the type and stage of your cancer.
Clinical trials
Your doctor may talk to you about joining a research study called
a clinical trial if one is available in your area. Clinical trials are research studies to look for ways
to improve treatments for bladder cancer. Experts are doing studies on:
-
Chemoprevention for early-stage bladder cancer. This is the
use of medicines or vitamins to reduce the risk of getting cancer or having
cancer come back.
-
Photodynamic therapy. This uses medicine and a
special light to treat the cancer.
For some people with bladder cancer, clinical trials may offer the best treatment available.
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
Other Places To Get Help
Organizations
|
American Cancer Society (ACS)
|
| Phone: | 1-800-ACS-2345 (1-800-227-2345) |
| Web Address: | www.cancer.org |
| |
|
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
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AUA Foundation: The Official Foundation of the American Urological
Association
|
| 1000 Corporate Boulevard |
| Linthicum, MD 21090 |
| Phone: | 1-800-828-7866 |
| Phone: | (410) 689-3700 |
| Fax: | (410) 689-3998 |
| Email: | auafoundation@auafoundation.org |
| Web Address: | www.urologyhealth.org |
| |
|
UrologyHealth.org is a website written by urologists
for patients. Visitors can find specific topics by using the "search"
option. The website provides information about adult and
pediatric urologic topics, including kidney, bladder, and prostate conditions.
You can find a urologist, sign up for a free quarterly newsletter, or click on
the Urology A–Z page to find materials about urologic problems.
|
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National Cancer Institute (NCI)
|
| 6116 Executive Boulevard |
| Suite 300 |
| Bethesda, MD 20892-8322 |
| Phone: | 1-800-4-CANCER (1-800-422-6237) |
| Web Address: | www.cancer.gov (or
https://livehelp.cancer.gov/app/chat/chat_launch for live help
online) |
| |
|
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
|
|
|
National Kidney and Urologic Diseases Information
Clearinghouse
|
| 3 Information Way |
| Bethesda, MD 20892-3580 |
| Phone: | 1-800-891-5390 |
| TDD: | 1-866-569-1162 |
| Fax: | (703) 738-4929 |
| Email: | nkudic@info.niddk.nih.gov |
| Web Address: | www.kidney.niddk.nih.gov |
| |
|
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases. NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
Human Services.
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References
Citations
-
American Cancer Society (2010). Cancer Facts and Figures 2010
. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010.
Other Works Consulted
- National Cancer Institute (2010). Bladder Cancer PDQ: Treatment—Health Professional Version
. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional/allpages.
- National Comprehensive Cancer Network (2010). Bladder Cancer. NCCN Clinical Practice Guidelines in Oncology
, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf.
- American Cancer Society (2010). Bladder Cancer
. Available online: http://documents.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf.
-
American Cancer Society (2010). Lasers in cancer treatment. Available online: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/lasers-in-cancer-treatment.
- American Joint Committee on Cancer (2010). Urinary bladder. In AJCC Cancer Staging Manual, 7th ed., pp. 497–505. New York: Springer-Verlag.
- Cancer of the bladder (2007). In Cancer Stat Fact Sheets based on SF Altekruse et al., eds., SEER Cancer Statistics Review, 1975–2007
. Bethesda, MD: National
Cancer Institute. Available online: http://seer.cancer.gov/statfacts/html/urinb.html.
- National Cancer Institute (2010). Bladder Cancer PDQ: Treatment—Patient Version
. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/patient/allpages.
- U.S. Preventive Services Task Force (2010). Screening adults for bladder cancer: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153(7): 461–468.
Credits
|
By
| Healthwise Staff |
|
Primary Medical Reviewer
| E. Gregory Thompson, MD - Internal Medicine |
|
Specialist Medical Reviewer
| Christopher G. Wood, MD, FACS - Urology, Oncology |
|
Last Revised
| October 22, 2012 |
