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Urinary Tract Cancers

Bladder Cancer

Bladder Anatomy

Urine from the kidneys is deposited in the bladder via tubes known as ureters. The liquid is held in the bladder, which is a hollow container consisting of mostly muscle, until it gets so full that it must be emptied. Tumors can develop in the bladder for a number of reasons. Cigarette smoking is the most common cause. Overall, bladder cancer is the sixth most common type of cancer.

Risk Factors

The following are the leading risk factors for the development of bladder cancer:

Symptoms

Hematuria

The most common symptom of bladder cancer is the painless presence of blood in the urine.  This condition is also known as hematuria.  In most cases, the blood can be seen in the urine, but in other cases the amount is so small that it can only be found with a microscope. There are many causes of hematuria, so doctors conduct several tests before diagnosing bladder cancer.

Dysuria

Other symptoms can include frequent urination and pain upon urination.  This is called dysuria.

Diagnosis

X-Ray

If you’re experiencing blood in the urine, your doctor might order an X-ray as a way of pinpointing the location of the problem within your urinary tract.

Cytoscopy

The most commonly used diagnostic tool is cystoscopy. This is a procedure that gives your doctor a view into your bladder. The patient is first given a local anesthesia to reduce or eliminate discomfort. Once the area is numbed, a viewing device is inserted through the urethra and into the bladder. The doctor can check for tumors—which is an abnormal mass of tissue on the lining of the bladder.

Biopsy

If a tumor is found, your doctor can remove of biopsy sample tissue for examination by a pathologist. Keep in mind that not all tumors are cancerous. The pathologist will be able to make that determination through a biopsy of the tissue.

Treatment

Transurethral Resection of Bladder Cancer (TURBT)

TURBT is the preferred treatment option in about 80 percent of cases, especially when tumors are detected at an early stage. These generally low-risk cancer cases are called "superficial" bladder cancers. This surgical method is performed in the hospital, with the patient under general anesthesia. A small, lit camera called a cystoscope is inserted into the bladder through the urethra.  Through this tube, a tiny surgical instrument with a wire loop at the end of it is advanced, and used to pass a high frequency electric current which removes and burns away the tumor.

In some other cases, laser surgery will be used along with cystoscopy, but since the laser totally destroys the tumor and surrounding tissue, this method isn’t used when the tumor hasn’t been biopsied to confirm that it is cancerous.

Depending on the risk of the tumor recurrence and/or spreading, intravesical chemotherapy or intravesical immunotherapy may be recommended in addition to TURBT. "Intrevesical" simply means "within the bladder." Intravesical agents are placed in the bladder through a catheter, and later expelled through the urine.

In about 70 percent of non-invasive, superficial bladder cancer cases, the cancer recurs within five years. So a follow-up evaluation is a standard part of TURBT treatment.

Cystectomy

Cystectomy is complete removal of the bladder, and is generally recommended when the cancer is at a more advanced state. If the cancer cells have penetrated the muscle of the bladder, a stage known as invasive cancer, the removal of the bladder might be recommended.

If that does happen, a new bladder can often be reconstructed using part of the patient's intestines. In other cases, the patient will be required to wear a small and unobtrusive pouch outside the body for the collection of urine.  This procedure is known as an ostomy.

A radical cystectomy in a male patient can include removal of the prostate, seminal vesicles and the vas deferens. In a female patient, it can include removal of the ovaries, fallopian tubes and part of the vagina.

Trimodality therapy

Trimodality therapy is a three-step treatment used in the most advanced, or "invasive" cases, in an effort to avoid a cystectomy. This new treatment option is a combination of three therapies used in trying to stop an invasive cancer without removing the bladder: transurethral resection, radiation and chemotherapy. This can be successful in some, but not all, cases.

Cancers of the urological system have varying risk factors, symptoms, treatments and outcomes. Please use the following links for more information about Kidney Cancer, Prostate Cancer and Testicular Cancer.

For more information:

Go to the Urinary Tract Cancers health topic, where you can:

This article is a NetWellness exclusive.

Last Reviewed: Feb 06, 2006

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University