Whether you’re facing a diagnosis of bladder cancer or supporting a loved one who may be at risk for this disease, learning about the cancer is the first step in understanding its mechanisms, potential causes, and current treatment options.
Risk factors and symptoms
Your bladder is a small, balloon-shaped organ in your lower abdomen that has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body Its primary role is to collect urine and then expel it on a regular basis. Because it’s part of the body’s toxin-filtering system, those who are exposed to chemical substances — often as part of a job — are at highest risk for developing bladder cancer, says Jennifer Linehan, M.D., urologist and associate professor of urology and urologic oncology at the John Wayne Cancer Institute, Santa Monica, California.
People who work in professions like furniture making, painting, manufacturing, even hair salons can be at higher risk, she says. That’s because dyes and solvents often contain certain carcinogenic chemicals that have been linked to bladder cancer. Another major factor, she adds, is long-term smoking.
Bladder cancer doesn’t have a family connection, Dr. Linehan notes, so just because your parent might have developed this cancer doesn’t mean you have more risk — unless you both work in a field where regular chemical exposure is a factor, or if you’re both smokers.
In terms of symptoms, bladder cancer is often painless, but does cause blood to appear in the urine. That’s because as cancer cells are growing on the bladder, they break into the bladder tissue and cause blood cell leaks, Dr. Linehan says. The blood can be a microscopic amount, and may get detected only through a urine sample provided at an annual physical.
Other symptoms could be frequent urinary tract infections (UTI), and increased urgency and frequency of urination, especially over a long period of time.
“Any symptoms that seem to persist for a number of months should be checked out,” says Dr. Linehan. “For example, if your usual urination rate is to go every hour, but now you’re urinating every 20 minutes and getting up six times a night, talk to your doctor.”
But keep in mind that blood in the urine or a recurring UTI doesn’t automatically point to bladder cancer, adds Arjun Balar, M.D., director of the genitourinary medical oncology program at NYU Langone’s Perlmutter Cancer Center, New York. For example, you may have kidney stones or another benign issue.
Types of bladder cancer
There are three main types of bladder cancer. Urothelial carcinoma represents about 90 percent of all bladder cancer, and begins in the urothelial cells that line the urinary tract. This cancer type is sometimes called transitional cell carcinoma.
The second type, squamous cell carcinoma, involves cancer cells that develop in the bladder lining, often as a result of irritation or frequent inflammation, and occurs in about 4 percent of all bladder cancer cases.
The third type, adenocarcinoma, represents about 2 percent of all bladder cancers and starts in glandular cells, which make and release mucus and other fluids.
The remaining 4 percent of bladder cancers are comprised of much rarer cancer types like sarcoma — a cancer that starts in the fat or muscle layer of the bladder — and small cell anaplastic cancer.
No matter which kind you might have, the cancer will be further categorized in terms of whether it’s spreading to other areas. Some cancers are non-invasive, while others might be expanding into the bladder’s wall muscle or the fatty tissue that lines the outside of the bladder.
Much like other cancers, bladder cancer is staged according to its spread. In stage 1, cancer has formed and spread to the layer of connective tissue next to the inner lining of the bladder. Stage 2 is a tumor that has spread to the muscle of the bladder wall, and stage 3 is a tumor that’s now in the fatty tissue. For stage 4 designation, the tumor must be present in some form in the abdominal wall, the pelvic wall, the prostate, or the uterus.
Treatment and outlook
If you’re diagnosed with a form of bladder cancer, your treatment will depend on what stage you’re in and which type of cancer you have, says Dr. Balar. The most common first-line treatment is chemotherapy, and your doctor may suggest removal of the bladder as well, called a cystectomy.
One thing to keep in mind is that bladder cancer can recur even if you no longer have the organ, Dr. Balar adds, because the cells may have migrated to another part of the body.
In addition to chemo and surgery, there’s been a great deal of promise with immunotherapies for bladder cancer, he says. These drugs stimulate the immune system, and there have been five specific drugs for bladder cancer immunotherapy approved by the Food and Drug Administration within the past few years.
“We are seeing an exciting amount of research into new treatment options in the area of bladder cancer,” Dr. Balar says. “The pace of progress for this condition is unprecedented. We’re understanding bladder cancer biology in a way we haven’t before, so that makes us optimistic about potentially new options even just a few years from now.”