Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
Bladder cancer, the most common type of urinary tract cancer, affects men more frequently than women. The average five-year survival rate for all types of bladder cancer is 77%. However, if bladder cancer is found and treated before it spreads outside the bladder, the five-year survival rate is 96%. Risk factors include smoking, carcinogen exposure, chronic bladder infections, and hereditary predisposition.
Bladder cancer is usually asymptomatic, but it can produce blood in the urine and pelvic discomfort. It is diagnosed with imaging tests, and the type, grade, and stage are determined based on a biopsy. Urothelial cell cancer, also called transitional epithelial cancer, is the most common type of bladder cancer. Treatment includes a combination of surgery, chemotherapy, and radiation therapy, sometimes with surgical restructuring of affected parts of the urinary system.
Bladder cancer can be curable, and the likelihood of cure is higher if it is diagnosed at an early stage. Without treatment, bladder cancer does not go away on its own, and treatment is associated with a 60 to 70% recurrence rate. Coping with bladder cancer after treatment includes follow up surveillance to identify signs of recurrence.
Bladder cancer occurs when cells in the bladder mutate (their genetic structure is altered) in a way that allows them to proliferate and invade other tissue. Risk factors include smoking, exposure to certain toxins (arsenic, textiles, paint material and more), hereditary predisposition, chronic inflammation of the urinary system, and chronic schistosomiasis infection.
Often, bladder cancer doesn’t cause signs until late stages. The subtle effects that can occur at early or late stages of the disease are not specific to bladder cancer. Symptoms can include intermittent blood in the urine (it can be microscopic), pelvic discomfort, trouble urinating, urinary incontinence, fatigue, and bone pain.
The treatment strategy for bladder cancer involves a combined approach. Surgery can remove the tumor, chemotherapy and immunotherapy are used to destroy cancer cells, and radiation shrinks the tumor. Surgery can involve resection of a small region of the bladder, or the whole bladder might need to be removed. If the bladder is removed, a pouch is surgically placed for urine collection.
Adenocarcinoma is a type of cancer that develops from glandular cells, which are cells that produce enzymes or hormones. Adenocarcinoma comprises less than 5% of bladder cancer.
Bladder inflammation, (which is also called cystitis) can occur due to conditions such as infections, irritation (including from a bladder stone or a catheter), chemical exposure (including from medications or toxins), and radiation exposure. Chronic cystitis can damage the bladder, and it is a risk factor for bladder cancer.
Hematuria is blood in the urine. It can appear pink or red, or it might only be detectable with a laboratory test. Hematuria can be caused by a bladder infection, kidney disease, or damage to the lining of the bladder, urethra, or ureters. Often, hematuria that is caused by an infection is also accompanied by discomfort or pain with urination.
Metastatic cancer is cancer that invades nearby tissue or travels to distant organs through the blood vessels or lymphatic vessels. The cancer can continue to proliferate and damage invaded tissue, causing serious health consequences or death. Bladder cancer tends to metastasize to nearby lymph nodes, bones, peritoneum, and the liver.
Squamous cell carcinoma is a type of cancer that can affect areas of the body that contain squamous cells, a type of thin, flat cell that forms a lining that protects and shields tissue. Squamous cell carcinoma can occur in the bladder, accounting for about 2% of bladder cancer. Chronic infections, including HPV, or chronic irritation are the most commonly noted risk factors.
Urothelial carcinoma (also called transitional cell cancer) accounts for over 90% of bladder cancer diagnoses. LIke other types of bladder cancer, this cancer cell type is identified with a biopsy. The two subtypes of urothelial carcinoma, papillary carcinoma and flat carcinoma, both have a good outcome if the cancer doesn’t invade into the wall of the bladder. Transitional cell cancer can develop in other parts of the urinary tract as well.
Urothelial cells are found on the inner lining of the bladder, urethra, and ureters. These cells form the transitional epithelium. Normally, a few urothelial cells can be found in the urine. These cells can become damaged by irritation. Chronic irritation of the bladder transitional epithelium is a risk factor for different types of bladder cancer.
Explore interactive models that show how bladder cancer can progress in the body, and the changes that occur in each stage of the disease.
American Cancer Society. Survival rates for bladder cancer. Updated January 8, 2020.
American Cancer Society. Survival rates for bladder cancer. January 8, 2020.
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