Bladder Cancer

The bladder is a hollow organ in your lower abdomen that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age. It is the sixth most common type of cancer in the United States.

The most common type of bladder cancer is transitional cell carcinoma, which begins in urothelial cells that line the inside of the bladder. Urothelial cells are transitional cells, which are able to change shape and stretch when the bladder is full. This type of cancer is also called urothelial carcinoma. Other types of bladder cancer include squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Symptoms of bladder cancer include blood in your urine, a frequent urge to urinate, pain when you urinate, and low back pain.

Risk factors for developing bladder cancer include smoking and exposure to certain chemicals in the workplace. People with a family history of bladder cancer or who are older, white, or male also have a higher risk of developing bladder cancer.

Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and biologic therapy.

Most bladder cancers are diagnosed at an early stage when bladder cancer is easy to treat. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests for years after treatment to look for bladder cancer recurrence.

The cause of bladder cancer is not always clear. Bladder cancer has been linked to smoking, a parasitic infection, radiation and chemical exposure.

Bladder cancer develops when cells in the bladder begin to grow abnormally. Instead of growing and dividing in an orderly way, cells develop mutations that cause them to grow out of control and not die. These abnormal cells form a tumor.

Several risk factors make a person more likely to develop bladder cancer:

• Smoking. Smoking is the most important risk factor for bladder cancer. Smokers are at least 3 times as likely to get bladder cancer as non-smokers.
• Chemical exposures. Certain industrial chemicals have been linked with bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, which are sometimes used in the dye industry, can cause bladder cancer.
• Race and ethnicity. Caucasians are approximately twice as likely to develop bladder cancer as African Americans. Hispanics, Asian Americans, and American Indians have slightly lower rates of bladder cancer. The reasons for these differences are not well understood.
• Advanced age. The risk of bladder cancer increases with age, and most people with bladder cancer are older than 55.
• Gender. Bladder cancer is more common in men than in women.
• Chronic bladder irritation and infections. Urinary tract infections, kidney and bladder stones, bladder catheters left in place for a long time, and other causes of chronic bladder irritation have been linked with bladder cancer , but it is not clear if they actually cause bladder cancer.
• Personal history of bladder or other urothelial cancer. Urothelial carcinomas can form in many areas in the bladder as well as in the lining of the kidney, the ureters, and urethra. Having a cancer in the lining of any part of the urinary tract puts you at higher risk of having another tumor.
• Bladder birth defects. Rarely, defects in the bladder and abdominal wall can cause bladder cancer. Surgery soon after birth can repair defects, but these people will have a higher risk for urinary infections and bladder cancer.
• Genetics and family history. People who have family members with bladder cancer have an increased risk of getting it themselves. A small number of people inherit a gene syndrome that increases their risk for bladder cancer.
• Chemotherapy and radiation therapy. Long-term use of the chemotherapy drug cyclophosphamide(Cytoxan) can irritate the bladder and increase the risk of bladder cancer. People taking this drug are often told to drink plenty of fluids to help protect the bladder from irritation and decrease the risk of bladder cancer. People who are treated with radiation to the pelvis are more likely to develop bladder cancer.
• Certain medicines or herbal supplements. According to the US Food and Drug Administration (FDA), use of the diabetes medicine pioglitazone (Actos) for more than 1 year may be linked with an increased risk of bladder cancer. Dietary supplements containing aristolochic acid (mainly in herbs from the Aristolochia family) have been linked with an increased risk of urothelial cancers, including bladder cancer.
• Arsenic in drinking water. Arsenic in drinking water has been linked with an increased risk of bladder cancer in some parts of the world. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a public water system that meets the standards for arsenic content. For most Americans, drinking water is not a major source of arsenic.
• Low fluid consumption. Not drinking enough fluids may increase the risk of bladder cancer. People who drink a lot of fluids each day have a lower rate of bladder cancer. This is thought to be because they empty their bladders often. By doing this, they keep chemicals from lingering in their bodies.

See your doctor promptly for blood in your urine, painful or very frequent urination, or pelvic pain. Early evaluation greatly improves outcomes.