The bladder is part of the urinary tract. It is at the bottom of the tummy (abdomen). It fills with urine and we pass urine out from time to time through a tube called the urethra. The urethra passes through the prostate gland and penis in men. The urethra is shorter in women and opens just above the vagina.
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control. Cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to obtain reliable information on treatment options and outlook.
Bladder cancer is a common cancer; it is the seventh most common cancer in the UK. About 10,000 people develop bladder cancer in the UK each year. In most cases in the UK, the bladder cancer develops from the transitional cells which line the inside of the bladder. This type of cancer is called transitional cell bladder cancer. Other types of bladder cancer are rare in the UK.
Cancer of the urinary bladder develops in almost 77,000 Americans each year, leading to over 16,000 deaths. According to the American Cancer Society, the chance of a man developing this form of cancer at any time during his life is about one in 26, and for a woman, the chance is one in 88.
Since bladder cancer that is detected in the early stages has a good chance of cure, awareness of the signs and symptoms of this malignancy are critical. Anyone experiencing the signs or symptoms of bladder cancer should be checked by a urologist, who can perform tests to diagnose bladder cancer even in its early stages.
SYMPTOMS OF BLADDER CANCER
It is very important that you visit your GP as soon as you notice anything unusual - the earlier that bladder cancer is diagnosed, the more quickly it can be treated and the better the outcome.
The most common symptoms are:
- Blood in the urine (even just once)
- Recurrent urinary infections
- Frequency or urgency or pain on passing urine when no infection found on urine tests by the doctor
BLOOD IN THE URINE
The most common symptom of bladder cancer is when someone passes blood in their urine when they go to the toilet (called Visible or Macroscopic Haematuria). Your urine could look pink, red or rusty/brown coloured. It might be very slight or sometimes the bleeding can be heavy, and you might see streaks or clots in the urine.
Sometimes the clots formed in the bladder may be difficult to pass and the person is unable to urinate, which leads to urine retention - not being able to wee. If this happens, a visit to the A&E department of a hospital is needed to relieve the retention with a catheter (a fine tube passed into the bladder to drain off urine and blood).
It may only happen once. It may only be a little. It might go away and not come back again until months after the initial bleed. Just because the bleeding has stopped doesn't mean that the problem has resolved.
It is very important that you go to see your doctor at the first sign of blood. Even if it goes away for now - don't wait.
WHAT CAUSES OF BLADDER CANCER?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. See separate leaflet called What Causes Cancer? for more details.
In many cases, the reason why a bladder cancer develops is not known. However, there are factors which are known to alter the risk of bladder cancer developing. These include:
- Increasing age. Most bladder cancers occur in people over the age of 50. It is rare in people aged younger than 40.
- Smoking. Bladder cancer is 2-6 times more common in smokers than in non-smokers. Some of the chemicals from tobacco get into the body and are passed out in urine. These chemicals in the urine are damaging (carcinogenic) to the bladder cells. It is estimated that about half of bladder cancers are related to smoking.
- Other chemicals. Certain workplace and environmental chemicals have been linked to bladder cancer - for example, substances used in the rubber and dye industries. Many of these chemicals are now banned in the UK. However, bladder cancer may develop as late as 10-25 years after exposure to certain chemicals. This means that some cases are still being diagnosed in people who worked with these chemicals years ago.
- Gender. Bladder cancer is about three times more common in men than in women.
- Ethnic background. Bladder cancer is more common in white people than in black people.
- Previous radiotherapy or chemotherapy slightly increases the risk.
- Schistosomiasis. This bladder infection, which is caused by a parasite in certain hot countries, increases the risk.
- Repeated bouts of other types of bladder infection may also slightly increase the risk in some people.
RISK FACTORS OF BLADDER CANCER
Factors that may increase your risk of bladder cancer include:
- Smoking. Smoking cigarettes, cigars or pipes may increase your risk of bladder cancer by causing harmful chemicals to accumulate in your urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
- Increasing age. Your risk of bladder cancer increases as you age. Bladder cancer can occur at any age, but it's rarely found in people younger than 40.
- Being white. Whites have a greater risk of bladder cancer than do people of other races.
- Being a man. Men are more likely to develop bladder cancer than women are.
- Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it's thought that being around certain chemicals may increase your risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
- Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases your risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have an elevated risk of developing bladder cancer.
- Taking a certain diabetes medication. People who take the diabetes medication pioglitazone (Actos) for more than a year have an increased risk of bladder cancer. Other diabetes medications contain pioglitazone, including pioglitazone and metformin (Actoplus Met) and pioglitazone and glimepiride (Duetact).
- Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase your risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis.
- Personal or family history of cancer. If you've had bladder cancer, you're more likely to get it again. If one or more of your immediate relatives have a history of bladder cancer, you may have an increased risk of the disease, although it's rare for bladder cancer to run in families. A family history of hereditary nonpolyposis colorectal cancer, also called Lynch syndrome, can increase your risk of cancer in your urinary system, as well as in your colon, uterus, ovaries and other organs.