Bladder Cancer

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The bladder is a hollow organ in the lower pelvis. It has flexible, muscular walls that can stretch to hold urine and squeeze to send it out of the body. The bladder's main job is to store urine.

Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the bladder muscle.

Bladder cancer is more common in men and in those who are older (the median age at diagnosis is 69 years).

The initial signs and symptoms of bladder cancer are often mistaken for those of a urinary tract infection or kidney stone.

The most common symptoms include the following:

• Blood in urine (hematuria)
• Painful urination
• Pelvic pain

If you have hematuria, your urine may appear bright red or cola colored. Sometimes, urine may not look any different, but blood in urine may be detected during a microscopic exam of the urine.

If you notice blood in your urine, even if it comes and goes, you should visit a doctor, so the cause can be investigated.

Although there's no guaranteed way to prevent bladder cancer, you can take steps to help reduce your risk. 

For instance:

• Don't smoke. Not smoking means that cancer-causing chemicals in smoke can't collect in your bladder. If you don't smoke, don't start. 
• Take caution around chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
• Choose a variety of fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.

The following factors may increase the risk of bladder cancer:

• Exposure to chemicals — Being exposed to certain chemicals or industrial compounds in the workplace or the environment may significantly increase the risk of bladder cancer. Of particular risk are a type of dyes that include "azo" compounds. In most cases, it takes many years after the chemical exposure for the person to develop bladder cancer, although in many cases, direct causation is difficult to establish.
• Cigarette smoke — People who smoke cigarettes have a two to fourfold increased risk of bladder cancer compared with never smokers.
• Family history — A family history of bladder cancer probably increases a person's risk of developing the cancer, especially in those who smoke cigarettes.

Anyone who has signs or symptoms of bladder cancer should have a complete evaluation of the kidneys, ureters, bladder, and urethra.

Tests and procedures used to diagnose bladder cancer may include:

• Cystoscopy. To perform cystoscopy, your doctor inserts a small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens that allows your doctor to see the inside of your urethra and bladder, to examine these structures for signs of disease.
• Biopsy. During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.
• Urine cytology. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
• Imaging tests. Imaging tests, such as computerized tomography (CT) urogram allow your doctor to examine the structures of your urinary tract.

During a CT urogram, a contrast dye injected into a vein in your hand eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.

After confirming that you have bladder cancer, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.

Tests may include:

• CT scan
• Magnetic resonance imaging (MRI)
• Bone scan

Treatment options for bladder cancer depend on a number of factors, including the type of cancer, grade of the cancer and stage of the cancer, which are taken into consideration along with your overall health and your treatment preferences.

Bladder cancer treatment may include:

• Surgery, to remove cancerous tissue.
• Chemotherapy in the bladder (intravesical chemotherapy), to treat tumors that are confined to the lining of the bladder but have a high risk of recurrence or progression to a higher stage.
• Reconstruction, to create a new way for urine to exit the body after bladder removal.
• Chemotherapy for the whole body (systemic chemotherapy), to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment in cases where surgery isn't an option.
• Radiation therapy, to destroy cancer cells, often as a primary treatment in cases where surgery isn't an option or isn't desired.
• Immunotherapy, to trigger the body's immune system to fight cancer cells, either in the bladder or throughout the body.

A combination of treatment approaches may be recommended by your doctor and members of your care team.

1. Is there any reliable test that can pick up bladder cancer early?
   
   It is important for a person to seek medical attention early if there is blood in the urine or unexplained or longstanding bladder infection. The confirmatory test for bladder cancer is cystoscopy and biopsy of abnormal areas. People who have high exposure to chemicals that cause bladder cancer may be routinely tested.