Encyclopedia of Health and Medicine

ladder cancer 179
function please see the overview section “The Urinary
System.”
HEALTH CONDITIONS THAT CAN AFFECT THE BLADDER
BLADDER CANCER
CYSTINURIA
CYSTOCELE
pyelonephritis
URINARY INCONTINENCE
URINARY TRACT INFECTION (UTI)
UROLITHIASIS
BLADDER EXSTROPHY
CYSTITIS
NEUROGENIC BLADDER
SPINA BIFIDA
URINARY RETENTION
URINARY URGENCY
VESICOURETERAL REFLUX
See also AGING, URINARY SYSTEM CHANGES THAT
OCCUR WITH; BLADDER CATHETERIZATION; CYSTOSCOPY;
FECAL INCONTINENCE; KEGEL EXERCISES.
bladder cancer The growth of a malignant (cancerous)
tumor in the BLADDER. Bladder CANCER may
be primary or metastatic (travel to the bladder
from a point of origin elsewhere in the body).
Doctors diagnose bladder cancer in about 55,000
Americans each year. Bladder cancer is about
three times more common in men, and in the
United States is the fourth most common cancer
among men. Bladder cancer claims about 12,000
lives in the United States each year. The likelihood
of developing bladder cancer increases with age.
Cigarette smoking causes about 50 percent of
bladder cancers, and exposure to industrial chemicals
accounts for another 25 to 30 percent. Among
the chemicals known to cause bladder cancer are the
aromatic amines: aniline, benzidine, chlornaphazine,
methylene dianiline, naphthylamine, and
xenylamine. Numerous industries use these chemicals.
Tobacco smoke, too, contains aromatic amines.
There are several types of bladder cancers
though in the United States one type, transitionalcell
CARCINOMA (TCC), accounts for more than 90
percent of bladder cancers. TCC arises from the
epithelial (also called urothelial) cells that form
the innermost layer of the bladder’s structure and
typically undergo a series of predictable cell structure
changes before becoming malignant. Other
types of bladder cancer are relatively rare and
include squamous cell carcinoma, small-cell carcinoma,
LYMPHOMA, ADENOCARCINOMA, leiomyosarcoma,
and metastatic malignant melanoma.
Treatment options and outlook differ among the
types of cancer.
Symptoms and Diagnostic Path
Painless HEMATURIA (bloody URINE) is often the earliest
indication of bladder cancer. The hematuria
may be gross, meaning there is enough BLOOD
present to discolor the URINE, or microscopic,
detected through urinalysis. Symptoms and signs
of bladder cancer may include
• pink, red, or dark brown urine (hematuria)
• DYSURIA (discomfort when urinating)
• URINARY FREQUENCY
• URINARY URGENCY
• sensation of incomplete emptying of the bladder
with URINATION
The diagnostic path begins with a standard urinalysis
as well as specific urine tests to measure
antigens and proteins present in the urine with
TCC. These tests include
• NMP22 BladderChek, which detects the presence
of nuclear matrix protein (NMP) 22
• BTA-Stat, which detects the presence of bladder
tumor antigen (BTA)
• fibrin degradation products (FDPs), which
detects the breakdown of blood clots
Further diagnostic procedures include CYS-
TOSCOPY, INTRAVENOUS PYELOGRAM (IVP), or COMPUTED
TOMOGRAPHY (CT) SCAN to visualize the bladder and
urethra to detect tumors, and biopsy (which the
urologist typically does during cystoscopy) of identified
tumors or suspicious tissue. Biopsy provides
the conclusive diagnosis, allowing the pathologist
to identify the type of cancer and degree to which
it has spread (staging and grading).
Treatment Options and Outlook
The cancer’s type and stage determine treatment
options and outlook. Doctors diagnose about 70
percent of TCC in its early stages, when the tumor
is small and remains confined to a localized region
of the epithelium. These tumors, designated as
superficial or stage 0, are highly treatable with
minimally invasive therapies that generally preserve
the bladder and normal urinary functions.
These therapies may include