The bladder collects and stores urine, which is made by the kidneys. It is a muscular balloon-shaped organ.
Bladder cancer begins most often in the lining of the bladder. Cancer that is limited to the lining is called superficial bladder cancer. If the cancer spreads into the muscle wall of the bladder, it is called invasive bladder cancer. Bladder cancer has the ability to spread to other body parts including the lungs, bones, and liver.
Causes and Risk Factors
Cancer-causing agents (carcinogens) in the urine may lead to the development of bladder cancer. Cigarette smoking contributes to more than 50% of cases, and smoking cigars or pipes also increases the risk. Other risk factors include the following:
- Gender (male)
- Race (Caucasian)
- Family history of bladder cancer (several genetic risk factors identified)
- Diet high in saturated fat
- Exposure to second-hand smoke
- Chronic bladder inflammation (recurrent urinary tract infections, urinary stones)
- Consumption of Aristolochia fangchi (herb used in some weight-loss formulas)
- External beam radiation
- Infection with Schistosoma haematobium (parasite found in many developing countries)
- Treatment with certain drugs (e.g. cyclophosphamide – used to treat cancer)
Exposure to carcinogens in the workplace also increases the risk for bladder cancer. Occupational risk factors include recurrent exposure to antineoplastic drugs (used in chemotherapy), hair dye and aniline(a chemical used in medical and industrial dyes). Workers at increased risk include medical workers, hairdressers, machinists, printers, painters, truck drivers and workers in rubber, chemical, textile, metal, and leather industries.
Signs and Symptoms
The primary symptom of bladder cancer is blood in the urine (hematuria). Hematuria may be visible to the naked eye (gross) or visible only under a microscope (microscopic) . Hematuria is usually painless. Other symptoms include frequent urination and pain upon urination (dysuria).
A complete medical history is used to identify potential risk factors (e.g., smoking, exposure to dyes).
Laboratory tests may include the following:
- Urinalysis (to detect or confirm microscopic hematuria)
- Urine culture (to rule out Urinary Tract Infection)
- Urine cytology (to detect cancer cells by examining cells flushed from the bladder during urination)
- Cystoscopy – Local anesthesia is administered and a cystoscope (thin, telescope-like tube with a tiny camera attached) is inserted into the bladder through the urethra to allow the physician to detect abnormalities. Under cystoscopic examination, the bladder cancer appears like underwater corals. If tumour is detected, the patient goes for transurethral resection of bladder tumour (TURBT).
- IVU or intravenous urography is a series of X-rays taken of the kidney, ureter and bladder after injection of a dye into the bloodstream. The aim is to diagnose tumours that may arise from the internal mucosal lining of the whole urinary tract.
- CT Urography is a series of CT scan X-rays of the kidney, ureter and bladder taken after injection of a dye into the bloodstream. This very detailed study not only allows tumours arising from the internal mucosal lining to be diagnosed, it can also detect solid tumours in the kidney and bladder.
Tranurethral resection of bladder tumour (TURBT)