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Definition of bladder cancer:

Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation. 

Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through two tubes called ureters. When the bladder is emptied during urination, the urine goes from the bladder to the outside of the body through another tube called the urethra.

Anatomy of the male urinary system; shows the right and left kidneys, the ureters, the bladder filled with urine, and the urethra passing through the penis. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine.  Also shown is the prostate.

Anatomy of the male urinary system (above) and female urinary system (below) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.

Anatomy of the female urinary system; shows the right and left kidneys, the ureters, the bladder filled with urine, and the urethra. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine. The uterus is also shown.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

  • Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
    • Plasmacytoid Urothelial Carcinoma: Plasmacytoid carcinoma of the urinary bladder or plasmacytoid urothelial carcinoma (PUC) is a rare and only recently described histological variant of transitional cell carcinoma (TCC). PUC is a rare tumor associated with poor prognosis due to its advanced clinical stage upon its diagnosis.
  • Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
  • Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Squamous Cell Carcinoma with variants of Bladder

Squamous cells are flat cells that make up the moist, skin like, tissues lining the body organs. About 5 out of every 100 (5%) bladder cancers in the UK are squamous cell cancers. They are more common in developing countries where a worm infection called bilharzia or schistosomiasis is widespread.

Most squamous cell carcinomas produce no symptoms until they reach an advanced stage. Patients are typically in their sixth or seventh decades when the disease manifests, although patients with obstructive and irritative symptoms are usually diagnosed earlier.

The most common symptom is gross hematuria. Bacteriuria occurs in about 50% of patients. Less commonly, patients may experience nocturia, dysuria, frequency, and pain.

Radical surgery appears to result in an improved survival rate as compared to radiation therapy and/or chemotherapy, whereas neoadjuvant radiation improves the outcome in locally advanced tumours. 

Adenocarcinoma with variants of Bladder

This is a very rare type of bladder cancer. Between 1 and 2 out of every 100 people diagnosed with bladder cancer have this type (1 to 2%). It is a cancer that develops from the cells in the lining of the bladder that produce mucus. All the moist, skin like, tissues lining the body have some gland cells that produce mucus.

There are 3 type of adenocarcinoma that affect the bladder:

  • Primary bladder adenocarcinoma.
  • Adenocarcinoma arising from the urachus (an embrologic remnant that drains the foetal bladder before closing).
  • Metastatic adenocarcinoma - the most common primary sites for metastatic adenocarcinomas come from prostate, ovary and colon cancer.

Urachal cancer

A type of bladder cancer, making up less than 1% of all bladder cancers. The urachus is a structure normally only present during development in the womb that connects the bellybutton and the bladder. This connection normally disappears before birth, but in some people remains. Urachal cancers are usually diagnosed in adults in their 50's and 60's and may develop at the dome or anterior wall of the bladder, along the midline of the body (including the belly button), and between the pubis symphasis and the bladder.

Most urachal cancers are adenocarcinomas (cancers that develop from gland cells). Others may be sarcomas (which develop from connective tissue - such as leiomyosarcoma, rhabdomyosarcoma, and malignant fibrous histiocytoma), small cell carcinomas, transitional cell cancer, and mixed neoplasias. Most individuals with urachal cancer have symptoms of with hematuria (blood in urine). Other symptoms may include abdominal pain, a palpable abdominal mass, mucinuria, and bacteriuria. Treatment usually involved surgery to remove the cancer.

Risk Factors 

Smoking can affect the risk of bladder cancer. Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer. Risk factors for bladder cancer include:

  • Using tobacco, especially smoking cigarettes.
  • Being exposed to certain substances, such as soot from coal, or chemicals used to make rubber, certain dyes, or textiles.
  • Working as a dry cleaner or in places where paper, rope, twine, or clothing is made.
  • Taking Aristolochia fangchi, a Chinese herb.
  • Drinking water that has high levels of arsenic.
  • Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
  • Using urinary catheters for a long time.
  • Having a history of kidney or bladder stones.
  • Past treatment with certain anticancer drugs or radiation therapy to the pelvis.
  • Having a kidney transplant.
  • Having hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).

Possible signs of bladder cancer include blood in the urine or pain during urination.

These and other symptoms may be caused by bladder cancer. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:

  • Blood in the urine (slightly rusty to bright red in color).
  • Frequent urination, or feeling the need to urinate without being able to do so.
  • Pain during urination.
  • Lower back pain.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
  • Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
  • Urine cytology: Examination of urine under a microscope to check for abnormal cells.
  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Cystoscopy; drawing shows a side view of the lower pelvis containing the bladder, uterus, and rectum. Also shown are the vagina and anus. The flexible tube of a cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is shown passing through the urethra and into the bladder. Fluid is used to fill the bladder. An inset shows a woman lying on an examination table with her knees bent and legs apart. She is covered by a drape. The doctor looks at an image of the inner wall of the bladder on a computer monitor.

Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor. 

  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumour during biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
  • The type of bladder cancer cells and how they look under a microscope.
  • The patient’s age and general health.
  • Treatment options depend on the stage of bladder cancer.

For more information on Bladder Cancer click here

This link is to the National Cancer Institute (NCI) cancer website in the United States. There may be references to drugs and clinical trials that are not available here in Australia.

For information courtesy of Cancer Australia, click here

Information has also been sourced from cancerresearchuk.org, actionbladdercanceruk.org, emedicine.medscape.com and ncbi.nlm.nih.gov