Overview The bladder stores urine before it leaves the body during urination. Bladder cancer occurs when cells in the bladder become abnormal and grow uncontrollably, forming a mass of tissue.
Bladder cancer is the sixth most common form of cancer in the United States. The American Cancer Society (ACS) predicted that in the year 2009 approximately 70,980 people would be diagnosed with bladder cancer and 14,330 would die from the disease (ACS Cancer Facts & Figures, 2009). Men develop bladder cancer three times more often than women do, and it is more common in Caucasians than in African-Americans. Most bladder cancers occur in industrialized countries, and the risk of developing bladder cancer increases with age.
If bladder cancer is found in early stages and appropriately treated, the survival rate is good; over 92 percent of patients will be alive after five years. However, if the cancer has already spread to other organs in the pelvis when it is found, the five-year survival rate drops to 45 percent. When the cancer has spread to distant organs, the survival rate drops to 6 percent. Early detection is very important.
Tumor Types Several different types of normal cells are found in the bladder. Cancer of the bladder is most often made up of one type of these cells. The three most common types of bladder cancer are: transitional cell carcinoma (TCC), squamous cell carcinoma, and adenocarcinoma.
Transitional cell carcinoma (TCC) is by far the most common type of bladder cancer, and accounts for 90 percent of all bladder cancers. Squamous cell carcinomas account for 3 percent to 8 percent, and adenocarcinomas account for only 1 percent to 2 percent of all bladder cancers.
Transitional cell carcinoma (TCC) Some TCCs are flat and grow horizontally along the lining of the bladder, while others are like tiny, thin-stalked mushrooms, called papillary TCCs, that grow into the hollow center of the bladder. Both flat and papillary TCCs can be either superficial (in situ, or limited to the transitional urothelium layer) or invasive (where the tumor grows into the deeper layers of the bladder).
Squamous cell carcinoma (SCC) SCC is sometimes linked to a parasitic infection called schistosomiasis. SCC accounts for 3 to 8 percent of bladder cancers in most industrialized nations where schistosomiasis is not widespread. SCC accounts for 75 percent of bladder cancers in areas where schistosomiasis is widespread (Egypt, Africa, etc). Most squamous cell carcinomas of the bladder are invasive and have spread deeper in the tissues than the layer in which the cancer first began. Treatment for squamous cell carcinoma of the bladder not associated with schistosomiasis includes chemotherapy and cystectomy (surgical removal of the bladder). Chemotherapy regimens include the drugs 5-FU and mitomycin C.
Adenocarcinoma Adenocarcinoma of the bladder is uncommon and accounts for 1 to 2 percent of bladder cancers. Most of these cancers are invasive. Adenocarcinoma of the bladder may be associated with exstrophy of the bladder or endometriosis.
Most cases of adenocarcinoma, however, are not associated with either condition. The age and sex distribution of adenocarcinoma of the bladder is similar to that of TCC with most cancers occurring in men older than age 50. Eighty-five percent of exstrophy cases and 15 percent of nonfunctioning bladder cases can be associated with adenocarcinomas. Treatment options for adenocarcinoma include chemotherapy and cystectomy. Chemotherapy regimens used include the drugs 5FU, doxorubicin and mitomycin C or 5FU and cisplatin with or without mitomycin C. Mixed cell bladder cancer Mixed cell bladder cancer is rare and is seen in less than 1 percent of all bladder cancers. Treatment for these cancers also includes chemotherapy and cystectomy.
Symptoms Because the survival rates for bladder cancer are much better when the disease is caught early, it is important for people to be aware of its symptoms. In most cases the first symptom of bladder cancer is blood in the urine. The urine may appear normal color or bright red or rust-colored. The blood may not be visible all the time and change in color may come and go.
There may also be pain with urination or a change in bladder habits (for example, needing to urinate more often or feeling the urge to urinate but not being able to do so). Because these symptoms may also be caused by several benign conditions (e.g., bladder infections and kidney stones), it is important to see your doctor to determine the exact problem.
Treatment The type of treatment selected will depend upon tumor grade and stage as well as your general health. Four types of treatment are commonly used for bladder cancer: surgery, chemotherapy, immunotherapy (biologic therapy), and radiation therapy.
