Matthew H.T. Bui, MD, PhD

Bladder cancer is the fourth leading cause of cancer in men and the eight case of cancer in women in the United States. In 2008, there will be 68,000 new cases of bladder cancer. During this year alone, over 14,000 American will die of bladder cancer.

What is Bladder Cancer?  The bladder is the organ within the pelvis whose sole purpose is to store urine. Cancer may occur in the cells that line the inside of the bladder. Cancer occurs when cells develop mutations and grow out of control to develop in to a tumor. There are several forms of bladder cancer with the most common form called transitional cell carcinoma. Other less common variants of bladder cancer include squamous cell carcinoma and adenocaricoma.

There are many known risk factors that contribute to bladder cancer formation. The most common risk factor is cigarette smoking. Smoking may increase your risk of bladder cancer by causing harmful chemicals to accumulate in your urine which may damage the lining of the bladder. Other chemical exposures linked to bladder cancers include arsenic and chemicals used in the manufacture of dyes, rubber, textiles and paint products.Furthermore, certain chemotherapy drugs and radiation exposure have shown increase risks of bladder cancer. In addition, you are at increased risk of bladder cancer if you are male, are over the age o f40 and have had relatives who themselves have had bladder cancer.

Symptoms of Bladder Cancer may present as blood in the urine, called hematuria. Often, there is little pain associated with hematuria. However, bladder cancer can be a source of irritation that may cause painful and frequent urination. The blood in the urine may be easily visible as a red discoloration or the blood may only be visible under a microscope. Bladder cancer may also present with urinary frequency and a possible urinary tract infection. See your urologist if you are having any urinary symptoms. However, it is important to be aware that having these symptoms can have other causes besides bladder cancer. Only your urologist can determine if bladder caner is causing your symptoms or if it is from some other urological condition.

Diagnosis of Bladder Cancer If your urologist suspects possible bladder cancer, he or she may perform several tests to confirm the presence of bladder cancer. One important test is a cystoscopy. During cystoscopy, the doctor inserts a narrow fiber optic camera through the urethra to examine the inside of the urethra and bladder. Usually local anesthesia applied to the urethra makes the procedure more comfortable. Additional studies called urine cytology is performed on urine sample to examine for the presence of cancer cells. Further imaging tests are needed to examine the upper urinary system related to the kidney and ureter. The most common upper tract imaging study is a computerized tomography (CT) scan with intravenouscontrast to better see the urinary tract and surrounding tissues. If you have an allergy to iodine or contrast dye, you cannot receive the intravenous contrast. Instead, the urologist may elect to perform aretrograde pyelogram study where the dye is delivered cystoscopically up through the ureterand kidney. Alternatively, an MRI of the abdomen and pelvis can alsobe performed.

If an abnormality is detected in any ofthe above studies, the urologist will need to collect a small cellsample (biopsy) for testing. This biopsy is normally done undergeneral anesthesia by a procedure called transurethral resection ofbladder tumor (TURBT).

Treatment of Bladder Cancer

The extent of spread of the cancer is referred as the staging. The staging of bladder cancer determines the options of treatment.

In Stage 1, also known as superficial bladder cancer, the cancer occurs in the bladder’s inner lining and has not invaded the muscle layer. If the cancer is small in size and number,often the TURBT will be able to eradicate the cancer completely.Patients are then re-examined periodically by cystoscopy for any recurrence. However, if the superficial cancer is extensive, the patient may receive additional medication into the bladder called Bacille-Calmette-Guerin (BCG) to prevent cancer recurrence.

In Stage 2, the bladder cancer has invaded the muscle layer. To prevent further spread of the cancer,the entire bladder will need to be surgically removed including the surrounding lymph node tissue in a procedure called a radical cystectomy. In men, a cystectomy also involves removal of the prostate and seminal vesicles. In women, a cystectomy also involves removal of the uterus, ovaries and part of the vagina. A new bladder will need to be constructed from a segment of the intestine.

In Stage 3, the cancer has invaded through the bladder wall and into surrounding tissues. They cancer may have spread to the prostate in men and into the uterus in women.In stage 3 bladder cancer, the patient may require both surgery and chemotherapy to effectively treat the disease.

In Stage 4, the cancer has spread or metastasized to distant organs such as the lung or liver. Chemotherapy is the primary treatment modality. Surgery and/or radiation therapy may provide some temporary relief of painful symptoms.

Prevention

Although there is no guaranteed way to prevent bladder cancer, you can take measure to reduce your risks.Avoid cigarette smoke. Even second-hand exposure to cigarette smoke carries cancer risks. If you smoke, talk to your primary doctor about plans to help quit smoking. If you work with chemicals, take safety precautions to avoid exposure. Furthermore, drink plenty of water to dilute the toxic substances that may concentrate in the urine and flushes them out quickly.

Early detection is key. If you have any of the symptoms mentioned above or if you see any blood in the urine,please consult a urologist.