Bladder Cancer General Information - About Bladder Cancer

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Cells in the body normally reproduce themselves in an orderly manner. Normal cell growth, division to make new cells, and death is an orderly process controlled by genes that direct replacement of cells as needed. Changes in these genes can cause abnormal, uncontrolled growth and result in a tumor. Tumors may be benign or malignant.

Benign tumors are generally not life threatening. Benign tumors are made up of cells that appear similar to normal cells but grow in an abnormal way. They do not invade other tissues and when they are removed they very seldom return.
Malignant tumors are cancerous. These tumors contain cells that divide and grow without order. Cancer cells have genetic changes that cause unchecked cell division, invasion of normal tissues, and the ability to metastasize (distant spread) to other areas of the body through the body's bloodstream and lymphatic system.

Survival

Bladder cancer is the sixth most common form of cancer in the United States. The American Cancer Society predicts that in the year 2009 approximately 70,980 people will be diagnosed with bladder cancer and 14,330 will 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 European-Americans 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 an early stage and appropriately treated, the survival rate is good; over 92 percent of such 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, and if the cancer has spread to distant organs, the survival rate is only 6 percent. Early detection is very important.

Types of Bladder Cancer

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 percent 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 percent 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.

Risk Factors

A risk factor is something that increases a person's chance of getting a disease. For example, smoking is a risk factor for lung cancer, and prolonged sun exposure is a risk factor for skin cancer. It is important to remember that even though a person has one or more risk factors, it does not mean that the person will get the disease - it just means that it may be more likely. Some people with no known risk factors develop bladder cancer.

There are several known risk factors for bladder cancer:

Smoking: Smokers are more than twice as likely to develop bladder cancer as nonsmokers. The National Cancer Institute estimates that smoking causes about half of the bladder cancers in men and almost a third of the cases in women. One theory holds that carcinogens (cancer-causing chemicals) found in tobacco smoke enter the lungs and are carried by the bloodstream to the kidneys. The kidneys filter the carcinogens and concentrate them in the urine. These carcinogens damage the cells lining the bladder while the urine is being stored and increase the risk of developing bladder cancer.
Chemical exposure: People who have had long exposure to a certain group of chemicals (aromatic amines) are suspected to have a higher risk of developing bladder cancer. Many of these chemicals (such as benzidine and beta-naphthylamine which have been banned) are commonly used in the paint, printing, dye, leather, and rubber industries. Additional industries with a higher risk of bladder cancer are textile, petroleum, hairdressers, aluminum workers and truck drivers. Occupational exposures combined with cigarette smoking may act together in the development of bladder cancer.
Race: Whites develop bladder cancer about twice as often as African Americans or Hispanics. Asians have the lowest risk.
Age: The risk of developing bladder cancer increases with age. People older than 70 years of age have 15 to 20 times the risk of developing bladder cancer than someone who is younger than 54 years of age.
Gender: Men get bladder cancer 3-4 times as often as women.
Chronic bladder irritation: Patients with a long history of bladder problems (such as frequent urinary tract infections or kidney and bladder stones) have a higher risk of developing squamous cell bladder cancer. These conditions do not cause the cancer, but they cause ongoing irritation of the bladder lining and may make it more likely that cancer will develop. Bladder infection caused by the parasitic worm Schistosoma hematobium is found mostly in Northern Africa and is also a risk factor for bladder cancer.
History of bladder cancer: Patients with a previous history of bladder cancer have an increased risk of developing a second bladder tumor in the same area or in another area of the bladder lining.
Bladder birth defects: Before birth, the urachus is the continuation of the urinary bladder into the belly button (umbilicus). The urachus normally seals off before birth. If a part of the urachus is present after birth, it provides another potential site for cancer to develop. This occurs in less than 0.5 percent of bladder cancers. More than 90 percent of urachal cancers are adenocarcinomas. The remaining types seen are either TCC or squamous cell in origin. Treatment options include chemotherapy and cystectomy. Exstrophy is a rare birth defect in which the bladder does not close completely and the inside of the bladder is exposed to chronic infection. Exstrophy is rare but when it occurs, it increases the risk of bladder cancer 400-fold.
Family history: Some families have a higher incidence of bladder cancer. Family history may account for about 1 percent of cases. A higher incidence of bladder cancer is found in families with a mutation of the retinoblastoma gene.
Chemotherapy and Radiation Therapy: Two similar chemotherapy drugs increase the risk of bladder cancer: cyclophosphamide (Neosar®) and ifosfamide (Ifex®). Radiation therapy to the pelvis also increases the risk for developing bladder cancer.
Arsenic: Drinking water that contains arsenic has been associated with an increased risk of bladder cancer.
Not drinking enough liquids: People who do not drink adequate fluids each day appear to have a higher rate of bladder cancer.

Prevention

Some of these risk factors such as age, race, and medical history cannot be controlled, but you can reduce your risk of developing bladder cancer by limiting your exposure to industrial chemicals and tobacco smoke. Drinking plenty of fluids (mainly water) and eating a diet high in fruits and vegetables may protect against bladder cancer.

Anatomy

This content is reviewed regularly. Last Updated 6/17/2009

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