Risk Factors

Doctors can't always explain why one person gets bladder cancer and another doesn't. However, certain risk factors may make a person more likely to develop bladder cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a person will get bladder cancer. Many people who get bladder cancer have none of these risk factors, and many people who have known risk factors never have cancer. A person with one or more of these risk factors should talk with his or her doctor about cancer risk.

Risk factors for bladder cancer include the following:

• Smoking: Smoking tobacco is the most important risk factor for bladder cancer. Smoking causes most cases of bladder cancer. People who smoke for many years have a higher risk than nonsmokers or those who smoke for a short time.
• Chemicals in the workplace: Some people have a higher risk of bladder cancer because of cancer-causing chemicals in their workplace. Workers in the dye, rubber, chemical, metal, textile, and leather industries may be at risk for bladder cancer. Also at risk are hairdressers, machinists, printers, painters, and truck drivers.
• Personal history of bladder cancer: People who have had bladder cancer have a higher risk of getting the disease again.
• Certain cancer treatments: People with cancer who have been treated with certain drugs (such as cyclophosphamide) may have a higher risk of bladder cancer. Also, people who have had radiation therapy to the abdomen or pelvis may have a higher risk.
• Arsenic: Arsenic is a poison that increases the risk of bladder cancer. In some areas of the world, arsenic may be found at high levels in drinking water. However, the United States has safety measures limiting the arsenic level in public drinking water.
• Family history of bladder cancer: People with family members who have bladder cancer have a slightly increased risk of the disease. Learn more about inherited cancer risk from our Family Cancer Assessment Clinic.

Symptoms

Bladder cancer may cause these common symptoms:

• An urgent need to empty the bladder
• Blood in the urine (which may make the urine look rusty or dark red)
• Pain when emptying the bladder
• The feeling of needing to empty the bladder without results
• The need to empty the bladder more often than usual
• The need to strain (bear down) when emptying the bladder

Most often, these symptoms are not due to cancer. A person with these symptoms should tell his or her doctor so any problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

If symptoms suggest bladder cancer, the doctor will try to find out what's causing the problems. The doctor may perform a physical exam and order one or more of the following tests:

• Urine tests: The lab checks the urine for blood, cancer cells, and other signs of disease.
• Cystoscopy: The doctor uses a thin, lighted tube (a cystoscope) to look directly into the bladder. This test can be uncomfortable because the doctor will insert the cystoscope into the bladder through the urethra. Local anesthesia is used for this test.
• Biopsy: The doctor can remove samples of tissue with the cystoscope and send it to a lab. The doctor in the lab looks at the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present.
  For a small number of patients, the doctor removes the entire area with cancer during the biopsy. For these patients, bladder cancer is diagnosed and treated at the same time.

Staging

If bladder cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.

Staging is a careful attempt to find out the following:

• Whether the tumor has invaded the muscle layer of the bladder
• Whether the tumor has invaded nearby tissues
• Whether the cancer has spread, and if so, to what parts of the body

The doctor may order one or more of these staging tests:

• Blood tests: Blood tests can show how well the liver and kidneys are working.
• Chest x-ray: An x-ray of the chest can show whether bladder cancer has spread to the lung.
• Intravenous pyelogram (IVP): A dye that shows up on x-rays is injected into a blood vessel. The dye collects in the urine, which makes the bladder and the rest of the urinary tract show up on x-rays.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the abdomen. The patient may receive an injection of contrast material so the urinary tract and lymph nodes show up clearly in the pictures. The CT scan can show cancer in the bladder, lymph nodes, or elsewhere in the abdomen.
• MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of the urinary tract and lymph nodes. The patient may receive an injection of contrast material. MRI can show cancer in the bladder, lymph nodes, or other tissues in the abdomen.
• Ultrasound: The ultrasound device uses sound waves that can't be heard by humans. The sound waves make a pattern of echoes as they bounce off internal organs. The echoes create a picture of the kidneys and other organs in the abdomen. The picture can show a tumor or blockage in the urinary tract.

Stages of Bladder Cancer

Stage 0: Cancer cells are found only on the surface of the bladder's inner lining. The doctor may call this carcinoma in situ.

Stage I: The cancer has grown deeper into the inner lining of the bladder.

Stage II: The cancer has invaded the middle (muscle) layer of the bladder.

Stage III: The cancer has grown through the muscle layer to reach tissues near the bladder.

Stage IV: The cancer may have invaded the wall of the pelvis or abdomen. Cancer cells may have spread to lymph nodes or to other parts of the body.

Treatment

At Huntsman Cancer Institute, bladder cancer is treated by a team of specialists, including urologists (doctors who specialize in diseases of the urinary system), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Common treatment options for bladder cancer include the following:

• Surgery
• Chemotherapy
• Biological therapy
• Radiation therapy
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The location of the tumor in the bladder
• Whether the tumor has invaded the muscle layer or tissues outside the bladder
• Whether the tumor has spread to other parts of the body
• The patient's age and general health

The health care team can describe all of treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next.

Surgery

Surgery is an option for most people with bladder cancer. Common types of surgery for bladder cancer include the following:

• Transurethral resection (TUR): The doctor inserts a cystoscope into the bladder through the urethra. A cutting tool is slipped through the cystoscope. A small wire loop at the end of the tool removes the cancer and burns away remaining cancer cells with an electric current.
• Partial cystectomy: The surgeon makes an incision into the body to remove the tumor, the part of the bladder containing the tumor, and nearby lymph nodes.
• Radical cystectomy: The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra. In addition, the surgeon usually removes the prostate from a man and may remove the uterus from a woman. Other nearby tissues may also be removed.

When the entire bladder is removed, the surgeon makes another way for urine to be collected from the kidneys and stored. The patient may wear a flat bag outside the body under the clothes, or the surgeon may use part of the patient's intestine to create a pouch inside the body.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells. It may be used to treat bladder cancer before or after surgery. A patient may receive chemotherapy in different ways:

• Into the bladder: After TUR for early bladder cancer, the doctor inserts a tube (catheter) through the urethra to put a liquid drug into the bladder. The drug remains in the bladder for several hours. This treatment may be given once a week for six weeks.
• By mouth: Some drugs are pills that can be swallowed. They may be given before or after surgery.
• Into a vein: For cancer that has invaded the muscle of the bladder or spread to other tissues, drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout the body. Chemotherapy may be given before or after surgery.

Learn more about this treatment in our introduction to chemotherapy video.

Biological therapy

Biological therapies help the body's immune system fight cancer. If a patient has TUR surgery, he or she may receive a treatment called BCG. This is a liquid containing weakened bacteria that is put into the bladder through a tube in the urethra. The bacteria help the body's immune system to kill cancer cells in the bladder.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area. The radiation comes from a large machine outside the body. The machine aims beams of radiation at the bladder area in the abdomen. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the bladder.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.