BLADDER CANCER

What is it?

Bladder cancers are classified according to the type of cell that has become cancerous and the grade. Generally, low-grade tumors are slow-growing, while high-grade tumors grow more quickly and are more likely to spread. Knowing the cell type and grade of bladder cancer are important in planning the right treatment.

About 90% of cancers of the bladder involve transitional cells. Transitional cells are merely the name of the usual cell that lines the bladder wall and are not changing as the name would imply. Transitional cells are unique to the urinary tract and line the kidneys and ureters as well.

Other types of cells that cause bladder cancer include squamous cell cancers or adenocarcinomas.

Transitional-cell cancers of the bladder can be further divided into 'papillary' or 'solid' tumors.

Papillary, which means 'finger-like' are usually low grade which means that they grow slowly. Papillary tumors also usually grow towards the inside of the bladder, not towards the muscle lining. Sometimes, particularly if untreated, papillary tumors will invade into the bladder muscle and then spread into the body. Papillary tumors occur more than twice as often as solid tumors. There may be one papillary tumor or several. Patients with tumors in multiple areas are more likely to have the cancer come back, or recur, after treatment. In general, papillary cancers of the bladder have a recurrence rate of up to 50%. That means even if all the cancer is removed, new cancers will develop in other parts of the bladder in at least one-half of all patients at a later time. These recurrences can occur at any time within ten years, but usually within two years.

The solid tumors are usually high-grade and invade the bladder muscle very early. As mentioned earlier, cancers that have invaded the bladder wall are also more likely to spread beyond the bladder.

Who gets it?

Cancer of the bladder is the fourth most common cancer among men and the ninth most common cancer among women. About 38,500 men and 13,000 women will develop the disease each year. Cancer of the bladder may occur at any age, but it usually strikes those over 50 years old.

Smokers are three times as likely to develop bladder cancer as nonsmokers. This link between smoking and bladder cancer is especially strong among men.

Bladder cancer is more common in highly industrialized areas and among workers exposed to certain chemicals. Certain aniline derivatives, benzidine, 2-napthylamine, and other chemicals used in dye manufacturing increase the risk to workers involved in the process. Painters and workers in the rubber, metal, textile, and leather industries are also at high risk.

The artificial sweeteners saccharin and cyclamates have been shown to cause bladder cancer in animals when given in very large doses. The link between these sweeteners and bladder cancer in humans has not been shown.

In the Middle East and Africa, certain parasitic worm infections have been linked with bladder cancer.

What are the symptoms?

Blood in the urine is usually the first sign of bladder cancer. Many times, blood in the urine cannot be noticed by the individual, but is found by urinalysis done as part of a regular checkup or treatment for another medical condition. If blood can be seen in the urine, it may change the color of the urine from smoky to rusty to bright red. The blood may disappear for days or even weeks, only to reappear. Blood in the urine can be caused by a number of medical problems besides cancer. These include infection, benign tumors, and stones. If blood is noticed, a doctor should be consulted to determine its cause.

Early stage bladder cancer does not usually cause pain, but pain may sometimes occur along with the bleeding. The need to urinate may seem more urgent and frequent. Signs of late stage bladder cancer may include all of the above plus possible bowel problems, loss of appetite, and weight loss. Pain may be felt in the lower back and in the bones.

What tests will the Doctor want to do?

The diagnosis of bladder cancer begins with a complete medical history. The doctor will ask questions about the patient's overall health and bladder cancer risk factors, such as smoking and exposure to certain industrial chemicals.

To determine if cancer is present, some or all of the following tests may be done:

• Urinalysis
• Intravenous pyelogram (IVP)
• Cystoscopy
• Biopsy

What is the treatment?

Surgery, alone or combined with other therapies, is used to treat more than 90% of bladder cancer patients. Radiation and chemotherapy can increase the chances for a cure, help control metastatic disease, and prevent the disease from recurring, but are usually not used as the main or only treatment.

How can I stop it getting worse?

• Don't smoke. If you do, make plans to quit right away. If you need help in quitting, call the American Cancer Society.
• As part of your overall defense against cancer, have regular medical checkups.
• If you notice blood in your urine, or any other change in bladder habits, see your doctor.