BLADDER CANCER

The bladder is an organ made of muscle; it stores urine before excretion. The inner lining of the bladder is made of cells called transitional cells. Nearly 95% of all bladder cancers originate from these transitional cells. Approximately 53,000 new cases of bladder cancer were diagnosed in 1996. No specific cause is known, but certain exposures place people at risk. The two main risk factors for bladder cancer are cigarette smoking and work exposure to certain chemicals. Additional risks are radiation therapy to the pelvic area and infestation by Schistosoma parasites.

The only sure way to diagnose bladder cancer is with a tissue biopsy. This procedure usually is performed with a lighted scope placed into the bladder (cystoscopy). The bladder is examined for any abnormal areas. If abnormal areas are found, a biopsy specimen is obtained and examined with a microscope. Sometimes the diagnosis can be made by means of examination of three consecutive morning urine samples for cancerous cells (urine cytology). Bladder cancer detected early has an excellent prognosis.

Blood in the urine is generally the first sign of bladder cancer. Whether the blood is grossly visible or seen with routine microscopic analysis, further evaluation is needed. Other symptoms are frequency, urgency, hesitancy, and pain with urination. Bladder cancer tends to spread locally. The cancer starts off superficially and invades the bladder wall to local structures. This may lead to pain in the pelvic area, obstruction of the ureters (tubes connecting the kidney with bladder), and leg swelling from affected veins and lymph glands.

Treatment depends on the extent or stage of the cancer. When cystoscopy is performed to detect and diagnose bladder cancer, tissue that extends beyond the superficial layer to the muscle layer is removed. This tells you the depth of invasion of the cancer. A cystoscope can be used to examine the structures that enter the bladder (ureters) and leave the bladder (urethra) for spread of cancer. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) of the abdomen and pelvis is performed to look for spread beyond the bladder. This staging tells whether the bladder cancer is superficial, invasive, or metastatic (has spread).

Superficial bladder cancer is treated by means of removal of the cancer with a cystoscope and placement of an agent called bacille Calmette-Guérin (BCG) or chemotherapeutic drug directly into the bladder. Side effects are burning with urination, bladder irritation, and urinary frequency.

Invasive bladder cancer (cancer that has invaded beyond the superficial layer to the muscle layer) is managed by means of removal of the entire bladder and surrounding organs (radical cystectomy). Removal of the bladder makes it necessary to form an artificial bladder. In this procedure a piece of small intestine called the ileum is attached to the ureters (tubes that connect the kidney to the bladder). The other end of the ileum is attached to an opening in the abdominal wall near the navel where the urine can drain into a pouch. Side effects and complications are infection, kidney stones, blockage or narrowing at the connecting sites, metabolic problems, and impotence.

Metastatic bladder cancer is managed with chemotherapy. Various combinations of drugs are available and are recommended by an oncologist (cancer physician). Side effects of chemotherapy are easy bruising, bleeding, infection, hair loss, nausea, and vomiting.

• Remember that industries in leather, paint, and rubber may expose you to chemicals that can put you at risk for bladder cancer. Take precautions by wearing protective clothing.
• Ask about environmental safety.
• Remember that other occupations such as chimney sweep and dry cleaner also can expose you to chemicals that place you at risk.

• Do not smoke.
• Do not be frustrated if superficial cancer returns. This happens often, but the cancer can be controlled with close follow-up care and removal of the lesion with a cystoscope.
• Do not miss follow-up appointments. After superficial cancer is diagnosed, you undergo cystoscopy every 3 months for the first year to see if the cancer returned. Patients who undergo surgical treatment undergo examinations every 3 months to look for recurrence of cancer.

• If you have blood in your urine or urinary symptoms of frequency, urgency, hesitancy, or pain.
• If you have pain after your operation.
• If you have excess bleeding, fever, and chills after cystoscopy.
• If you have pain after your operation.
• If you have an abnormal amount of drainage around the urinary diversion site.
• If you have trouble with erections after your operation.
• If you need emotional support.

National Cancer Institute (NCI)
9000 Rockville Pike
Bethesda, MD 20892

Cancer Information Service
1-800-422-6237 (1-800-4-CANCER)





Bladder fulguration. (From Meeker MH, Rothrock JC: Alexander's care of the patient in surgery, ed 9, 1991, St Louis, Mosby. Used by permission.)

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