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Glossary

Bladder Cancer
Medical Author: Gary David Steinberg, MD Medical Author: Mark H. Katz, MD Medical Editor: Melissa Conrad Stppler, MD, Chief Medical Editor

Bladder Cancer Overview Bladder Cancer Causes Bladder Cancer Symptoms When to Seek Medical Care Exams and Tests Bladder Cancer Treatment Medical Treatment Surgery Other Therapy Next Steps Follow-up Prevention Prognosis Support Groups and Counseling For More Information Web Links Synonyms and Keywords Authors and Editors Related Bladder Cancer articles: Bladder Cancer - on MedicineNet Read more on Bladder Cancer from Healthwise Viewer Comments: Bladder Cancer - Effective Treatment

Bladder Cancer
Bladder Cancer Causes

We do not know exactly what causes bladder cancer; however, a number of carcinogens have been identified that are potential causes, especially in cigarette smoke. Research is focusing on conditions that alter the genetic structure of cells, causing abnormal cell reproduction. We do know that the following factors increase a person's risk of developing a bladder cancer:

Smoking: Smoking is the single greatest risk factor for bladder cancer. Smokers have more than

twice the risk of developing bladder cancer as nonsmokers.

Chemical exposures at work: People who regularly work with certain chemicals or in certain industries have a

greater risk of bladder cancer than the general population. Organic chemicals called aromatic amines are particularly linked with bladder cancer. These chemicals are used in the dye industry. Other industries linked to bladder cancer include rubber and leather processing, textiles, hair coloring, paints, and printing. Strict workplace protections can prevent much of the exposure that is believed to cause cancer.

Diet: People whose diets include large amounts of fried meats and animal fats are thought to be at higher risk of

bladder cancer. Learn about other bladder cancer causes and risk factors

Bladder Cancer Overview


The bladder is a hollow organ in the lower abdomen (pelvis). It collects and stores urine produced by the kidneys. As it fills with urine, the muscular wall of the bladder stretches and the bladder gets larger.

When the bladder reaches its capacity of urine, the bladder wall contracts, although adults have voluntary control over the timing of this contraction. At the same time, a urinary control muscle (sphincter) in the urethrarelaxes. The urine is then expelled from the bladder. The urine flows through a narrow tube called the urethra and leaves the body. This process is called urination, or micturition. Cancer occurs when normal cells undergo a transformation whereby they grow and multiply without normal controls. As the cells multiply, they form an area of abnormal cells. Medical professionals call this a tumor. As more and more cells are produced, the tumor increases in size.

Tumors overwhelm surrounding tissues by invading their space and taking the oxygen and nutrients they need to survive and function. Tumors are cancerous only if they are malignant. This means that, because of their uncontrolled growth, they encroach on and invade neighboring tissues.

Malignant tumors may also travel to remote organs via the bloodstream or thelymphatic system.

This process of invading and spreading to other organs is called metastasis. Bladder cancers are most likely to spread to neighboring organs and lymph nodes prior to spreading through the blood stream to the lungs, liver, bones, or other organs. Of the different types of cells that form the bladder, the cells lining the inside of the bladder wall are most likely to develop cancer. Any of three different cell types can become cancerous. The resulting cancers are named after the cell types. Urothelial carcinoma (transitional cell carcinoma): This is by far the most common type of bladder cancer in the United States. The so-called transitional cells are normal cells that form the innermost lining of the bladder wall. In transitional cell carcinoma, these normal lining cells undergo changes that lead to the uncontrolled cell growth characteristic of cancer. Squamous cell carcinoma: These cancers originate from the thin, flat cells that typically form as a result of bladder inflammation or irritation that has taken place for many months or years. Adenocarcinoma: These cancers form from cells that make up glands. Glands are specialized structures that produce and release fluids such as mucus. In the United States, urothelial carcinomas account for more than 90% of all bladder cancers. Squamous cell carcinomas make up 3%-8%, and adenocarcinomas make up 1%-2%. Only transitional cells normally line the rest of the urinary tract. The kidneys, the ureters (narrow tubes that carry urine from the kidneys to the bladder), the bladder, and the urethra are lined with these cells. However, these three types of cancer can develop anywhere in the urinary tract.

If abnormal cells are found anywhere in the urinary tract, a search for other areas of abnormal cells is warranted. For example, if cancerous cells are found in the bladder, an evaluation of the kidneys and ureters is essential. Bladder cancers are classified (staged) by how deeply they invade into the bladder wall, which has several layers. Many physicians subdivide bladder cancer into superficial and invasive disease. Superficial bladder cancer is limited to the innermost linings of the bladder (known as the mucosa and lamina propria). Invasive bladder cancer has at least penetrated the muscular layer of the bladder wall. Nearly all adenocarcinomas and squamous cell carcinomas are invasive. Thus, by the time these cancers are detected, they have usually already invaded the bladder wall. Many urothelial cell carcinomas are not invasive. This means that they go no deeper than the superficial layer (mucosa) of the bladder. In addition to stage (how deep the cancer penetrates in the bladder wall), the grade of the bladder cancer provides important information and can help guide treatment. The tumor grade is based on the degree of abnormality observed in a microscopicevaluation of the tumor. Cells from a high-grade cancer have more changes in form and have a greater degree of abnormality when viewed microscopically than do cells from

a low-grade tumor. This information is provided by the pathologist, a physician trained in the science of tissue diagnosis. Low-grade tumors are less aggressive. High-grade tumors are more dangerous and have a propensity to become invasive.

Papillary tumors are urothelial carcinomas that grow narrow, finger-like projections. Benign (noncancerous) papillary tumors (papillomas) grow projections out into the hollow part of the bladder. These can be easily removed, but they sometimes grow back. These tumors vary greatly in their potential to come back (recur). Some types rarely recur after treatment; other types are very likely to do so. Papillary tumors also vary greatly in their potential to be malignant (invasive). A small percentage (15%) do invade the bladder wall. Some invasive papillary tumors grow projections both into the bladder wall and into the hollow part of the bladder. In addition to papillary tumors, bladder cancer can develop in the form of a flat, red (erythematous) patch on the mucosal surface. This is called carcinoma-in-situ (CIS). Although these tumors are superficial, they are high-grade and have a high risk for becoming invasive. Of all types of cancer, bladder cancer has an unusually high propensity for recurring after treatment. Bladder cancer has a recurrence rate of 50%-80%. The recurring cancer is usually, but not always, of the same type as the first (primary) cancer. It may be in the bladder or in another part of the urinary tract (kidneys or ureters). Bladder cancer is most common in industrialized countries. It is the fifth most common type of cancer in the United States-the fourth most common in men and the ninth in women. Each year, about 67,000 new cases of bladder cancer are expected, and about 13,000 people will die of the disease in the U.S. Bladder cancer affects three times as many men as women. Women, however, often have more advanced tumors than men at the time of diagnosis. Whites, both men and women, develop bladder cancers twice as often as other ethnic groups. In the United States, African Americans and Hispanics have similar rates of this cancer. Rates are lowest in Asians. Bladder cancer can occur at any age, but it is most common in people older than 50 years of age. The average age at the time of diagnosis is in the 60s. However, it clearly appears to be a disease of aging, with people in their 80s and 90s developing bladder cancer as well.

Because of its high recurrence rate and the need for lifelong surveillance, bladder cancer is the most expensive cancer to treat on a per patient basis.
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Bladder Cancer Causes

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. Enlarge

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Anatomy of the male urinary system (left) and female urinary system (right) 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.

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. 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. See the following PDQ summaries for more information: Screening for Bladder and Other Urothelial Cancers Unusual Cancers of Childhood

Smoking, gender, and diet can affect the risk of developing bladder cancer.
Anything that increases your chance of getting a disease is called a risk factor. Risk factors for bladder cancer include the following: Smoking.

Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies. A diet high in fried meats and fat. Being older, male, or white. Having an infection caused by a certain parasite.

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. A doctor should be consulted if any of the following problems occur: 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:

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 beinjected 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. Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, andwhite blood cells. 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. 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. Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscopeis 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.

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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.

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 tumor during biopsy. Urine cytology: Examination of urine under a microscope to check for abnormal cells.

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 patients age and general health.

Treatment options depend on the stage of bladder cancer.

After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body.
The process used to find out if cancer has spread within the bladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process: Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscopeis 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.

Enlarge

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.

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 beinjected 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.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). 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 patients health habits and past illnesses and treatments will also be taken. Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

There are three ways that cancer spreads in the body.


The three ways that cancer spreads in the body are: Through tissue. Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body. Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for bladder cancer: Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may becomecancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor: Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder. Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.

Stage I
In stage I, cancer has formed and spread to the layer of tissue under the inner lining of the bladder.

Stage II
In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III
In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina).

Stage IV
In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.

Drugs Approved for Bladder Cancer


This page lists cancer drugs approved by the Food and Drug Administration (FDA) for bladder cancer. The list includes generic names and brand names. The drug names link to NCIs Cancer Drug Information summaries. There may be drugs used in bladder cancer that are not listed here. Adriamycin PFS (Doxorubicin Hydrochloride) Adriamycin RDF (Doxorubicin Hydrochloride) Cisplatin Doxorubicin Hydrochloride Platinol (Cisplatin) Platinol-AQ (Cisplatin)

NAME OF HOSPITAL Govt. General Hospital Apollo Hospitals

ADDRESS Guntur Jubilee Hills

CITY Guntur

STATE Andhra Pradesh

PIN 522001 500033 500428 500004 500024 500029 500001

Hyderaba Andhra d Pradesh Hyderaba Andhra d Pradesh Hyderaba Andhra d Pradesh Hyderaba Andhra d Pradesh Hyderaba Andhra d Pradesh Hyderaba Andhra d Pradesh

Nizams Institute of Medical Sciences Panjagutta M.N.J. Cancer Hospital & Radium Institute B.I.B.I. General Hospital Jagdish Cancer & Research Centre Medwin Hospitals (Jaya Diagnostics & Research Centre) Red Hills 16-3-991/1/C Govt. Printing Press Rd.Malakpet 3-6-20, Tirumala Apts. Skyline Lane,Bashir Bagh 100, Raghava Ratna Towers, Nampalli