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The bladder is a balloon-shaped organ that sits within the pelvic girdle, and temporarily holds urine produced by the kidneys.  Bladder cancer most often affects the cells that line the bladder's interior surfaces.  Normally, bladder cells grow, perform their function, and die on a predictable schedule.  Cancer develops when normal, orderly growth is interfered with in some way, causing cells to reproduce at an abnormally high rate. Tissue masses grow into tumors because cells persist long after they typically would have died.

Though bladder cancer can occur at any age in life, it's far more common in older adults.  The upside is that most malignancies of this sort are detected early, when the opportunity for effective treatment is at its most favorable.  Though the advanced therapies available at Florida Hospital Cancer Institute produce a high rate of success, bladder cancer also typically carries a higher likelihood of recurrence. Patients need to undergo regular follow-up testing for years afterward to prevent recurrence.

What are the causes?

That's a tough call. The causes are not clearly understood, but links have been established to smoking, exposure to certain industrial chemical agents and rarely, some types of prior parasitic infection.  Historically, patients with chronic bladder infections have a higher incidence of bladder cancer.

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Types of bladder cancer

As is the case with most cancers, the tissue of origin determines its clinical classification, and will influence subsequent treatment options. Some cancers involve more than one type of tissue.

Transitional cell carcinoma

This type of cancer overtakes the cells that line the interior of the bladder. Transitional cells expand and contract in response to the volume of urine within the bladder.  Transitional cell cancer can also the ureters and urethra because the cells there are identical to those that line the bladder.  This is far and away the most common type of bladder cancer in the United States.

Squamous cell carcinoma

The appearance of squamous cells in the bladder is part of your body's immune system response to infection or irritation, serving as a buffer to protect the bladder's lining. When squamous cells are present over time, they can turn cancerous.  In the United States, this cancer is relatively rare. It's far more common in parts of the world where a parasitic infection called schistosomiasis is more prevalent.  Typically, poor water quality (where schistosomiasis is present) triggers a greater likelihood of bladder infections and irritation. This can lead to an increase of squamous cells in the bladder, which can then turn cancerous over time.

Adenocarcinoma

In roughly 2% of bladder cancers, a malignancy originates in the mucus-producing glands that protect the bladder from waste products in urine.  This type of cancer is almost always invasive, forming a tumor within the bladder itself, or in surrounding tissues. 

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Symptoms

Blood in the urine is the most frequent advance indicator of bladder trouble. Though also indicative of a number of non-cancerous conditions, it should never be taken lightly. If blood is present, urine can have a number of different looks, ranging from dark yellow to bright red, or even cola-colored.  Your urine can also appear perfectly normal if blood is present on a microscopic level.  If you suspect blood in your urine, contact your doctor.

Other symptoms might include:

  • Frequent or painful urination
  • Urinary tract infection (UTI)
  • Unusual abdominal pain
  • Lower back pain
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Prevention & Reducing Risk

As is the case with all cancers, there is no sure-fire way to guarantee prevention.  That said, there are a number of ways you can minimize the risk.

Do not smoke

Smoking is the single most implicated risk factor involving cancers of all kinds.   Many of the carcinogens in cigarette smoke are filtered by the kidneys and excreted in the urine. Because associated cancer-causing compounds are present in the urine in higher concentrations, the bladder is more vulnerable to their effects. If you smoke, speak with your doctor about plans to quit. A number of very effective medications and strategies are available to greatly increase your chances of successfully quitting.

Avoid chemical exposure

If you work in a profession that requires working with chemical compounds, be sure to follow all recommended safety precautions to avoid direct exposure. Even household chemicals carry some degree of risk that should be minimized wherever possible. And like the carcinogens in cigarette smoke, chemical toxins accumulate in the urine where they can have cancerous consequences.

Drink lots of water

Dilution is the key. The less time toxins spend in your bladder, the better. Drinking water helps flush the urinary tract, removing toxins more quickly.

Eat plenty of fruits and vegetables

Colorful fruits and vegetables are high in antioxidants and fiber, and low in fat.  All three factors help your immune system fight cancer and lower your overall risk.

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Diagnosing Bladder Cancer

If your doctor suspects bladder cancer, a number of testing procedures may be recommended to further rule in, or rule out, a malignancy.

  • Cystoscopy

This procedure employs the use of a long, narrow, flexible tube fitted with a tiny lens and fiber-optic lighting system.  When inserted through the urethra, your doctor can look directly into your bladder for any signs of trouble. A local anesthetic is used to minimize discomfort.

  • Biopsy

The cystoscopy procedure is also used to collect tissue samples for further laboratory examination.  This is called a biopsy, and it allows your doctor to accurately diagnose your condition.  A small cutting tool is passed through the urethra to the bladder, enabling collection of the tissues in question, which will later be examined microscopically for any signs of malignancy.  When a cystoscopy is performed with a biopsy in mind, you'll be given a general anesthetic.  The procedure is also known as a transurethral resection of bladder tumor, or TURBT. It can also be used as a treatment therapy when a tumor is to be removed.

  • Urine cytology

This is a non-invasive procedure in which a urine sample is examined microscopically for cancer cells in suspension. Since it is collected as a conventional urine sample, no anesthesia is needed. 

  • Digital imaging tests

Frequently, cancer diagnosis involves use of computerized tomography, commonly known as a CT scan.  It's a type of X-ray that allows detailed examination of your entire urinary tract and surrounding tissues. A special dye is injected that highlights the structure of your kidneys, ureters and bladder when imaged by a CT scan. No anesthesia is needed for this procedure.

 

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Bladder Cancer Staging

If bladder cancer is confirmed, your doctor will want to precisely pinpoint its current state of development.  This is important because different stages of cancer require different treatments. You may undergo another CT scan, magnetic resonance imaging (MRI), bone scan or additional chest X-rays to more accurately assess what's going on in your body.

  • Stage I

This is cancer at its earliest, and most curable.  Cancer is seen in the inner lining of the bladder, but not yet to the point that it has penetrated the bladder's muscular walls.

  • Stage II

The cancer has breached the bladder wall, but has progressed no further.  It's still confined to the bladder only. 

  • Stage III

Cancer cells at this stage have penetrated the bladder wall and spread to surrounding tissues or organs.  In men, stage III bladder cancer might involve the prostate.  In women, it might have spread to the uterus or vagina.

  • Stage IV

This stage is marked by cancerous involvement at distant sites beyond the bladder.  Lymph nodes, lungs, bones, liver or other structures show signs of cancer.

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