Most of the time, bladder cancer begins in the inner wall of the lining of the bladder (urothelium or transitional epithelium). Untreated, it can spread into nearby tissues and lymph nodes.
Men are three to four times more likely to develop bladder cancer than women. Caucasian men have the greatest risk. Read on to learn more about bladder cancer and how it affects men and women differently.
Differences between incidence and death rates
|Estimated cases for 2017||60,490||18,540|
|Estimated deaths in 2017||12,240||4,630|
|Chance of developing||1 in 26||1 in 88|
Each person’s risk also depends on other factors such as environment, medication, and more.
Nine out of 10 new diagnoses occur after age 55. The average age at diagnosis is 73.
Although women have a lower rate of bladder cancer, they tend to be diagnosed at a later age. Delayed treatment can result in a poor outcome.
Caucasians are twice as likely as African-Americans or Hispanic-Americans to get bladder cancer. But African-American women are at particularly high risk for getting a late diagnosis. Even so, mortality rate for Caucasians is still slightly higher.
Incidence and mortality rates are lower for Hispanics, Native Americans, Asians, and Pacific Islanders.
About 50 percent of the time, bladder cancer is found before it spreads beyond the inner layer of the bladder wall. One third of diagnosed bladder cancers have invaded deeper, but not beyond the bladder. About 4 percent of the time, it’s not diagnosed until it has spread to a distant site. The other cases are usually discovered at a later stage, when the cancer has spread to nearby lymph nodes or tissue.
Despite differences in anatomy, the symptoms of bladder cancer for both sexes are similar.
Signs may be very mild at first, making them easy to dismiss, but they include:
- frequent urination
- painful urination
- lower back pain
- pelvic pain
- blood in the urine
These symptoms are often more likely caused by a urinary tract infection, bladder stones, or an enlarged prostate.
Women may also have a tendency to ignore blood in the urine if they’re still menstruating or approaching menopause. For these reasons, women often delay seeing a doctor, giving the cancer cells more time to spread.
The single biggest risk factor is smoking, which increases your risk for cancer by three times. The American Cancer Society says smoking causes about 50 percent of bladder cancers.
Other risk factors include:
- Exposure to chemicals in the workplace. Regular exposure to dye, rubber, leather, textiles, paint, printing products, and similar chemicals increase your risk.
- Some medications and herbal supplements. These may include pioglitazone (Actos), a drug used to treat diabetes. This link is still being researched. Dietary supplements that contain aristolochic acid are associated with a higher risk of bladder cancer.
- Exposure to arsenic in drinking water. This is unlikely in the United States, but cities with low standards tend to have high arsenic content in their drinking water.
- Insufficient fluid intake. People who drink more fluids have a lower rate of bladder cancer.
- Smoking. Smokers are three times more likely to get bladder cancer than nonsmokers.
Unmodifiable risk factors
There are some factors you cannot change. These include:
- race and ethnicity
- genetics (some bladder cancer cases are the result of a faulty gene)
- family history (due to potential exposure to the same carcinogens)
Medical risk factors
Other bladder problems such as chronic bladder infections and bladder irritations also increase your risk. Previous chemotherapy or radiation treatment, especially for bladder cancers, increases risk as well. Bladder cancers have a 50 percent recurrence rate.
Your doctor will ask about your symptoms and conduct a physical exam. This will include a rectal exam and, for women, a vaginal exam. They’ll be checking for lumps or other irregularities. Your doctor may also order diagnostic testing, such as the following:
- A complete urinalysis and microscopic examination for abnormal cells.
- A cystoscopy, a procedure that allows the doctor to see inside the bladder and take tissue samples for biopsy. If there’s a tumor, it can often be removed during the cystoscopy.
- A biopsy, which allows your doctor to look at samples of your bladder for cancerous cells. A biopsy can confirm or rule out a bladder cancer diagnosis.
- An intravenous pyelogram, which is a series of X-rays that provide a view of the bladder, ureters, and kidneys.
Treatment depends on stage of cancer during diagnosis, your overall health, age, and other factors. There are standard treatments (surgery, radiation, chemotherapy, and biologic therapy) and clinical trials.
Transurethral resection with fulguration: Using a cystoscope, the doctor enters the bladder through the urethra. The tumor can then be removed or destroyed with high-energy electricity.
Partial (segmental) cystectomy: This is a procedure to remove the cancerous part of the bladder.
Radical cystectomy: In this surgery, the entire bladder is removed. If nearby lymph nodes or tissue contain cancer, they can be removed as well. The surgeon constructs an alternate route for the passage of urine (urinary diversion).
Even if you had a successful surgery, your doctor may recommend chemotherapy to destroy any cancer cells left behind, as well as any that may have migrated. Treatment is usually given intravenously.
Depending on how serious your cancer is, your doctor may recommend radiation treatments. Your surgeon can place a radioactive substance near the cancer during surgery (internal radiation therapy). Alternatively, a machine can send radiation to the area where the cancer was found (external radiation therapy). The high-energy X-rays can kill cancer cells or stop them from growing.
Immunotherapy uses your own immune system to kill cancer cells. In bladder cancer, the therapy is called BCG (bacillus Calmette-Guérin). A doctor will use a catheter to place the substance into your bladder.
There are certain side effects with each type of treatment. With bladder cancer treatments, you can experience any of the following:
- bladder irritation
- vaginal dryness
- weight loss
- hair loss
- kidney damage
Some of these symptoms may go away after treatment.
With surgery, side effects depend on the type of surgery. After a partial cystectomy, you may not be able to hold as much urine as before. For a radical cystectomy:
- Women will get their uterus, ovaries, and part of the vagina removed. Afterward, women will experience immediate menopause.
- Men will have their prostate and seminal vesicles removed. This can cause impotence afterward.
The overall five-year survival rate for bladder cancer is 77 percent. Ten years after diagnosis, the survival rate is 70 percent. The 15-year survival rate is 65 percent.
Much depends on the stage at diagnosis, age, and overall health. Your doctor is in the best position to evaluate those factors and let you know what you can expect.
There’s no way to completely prevent bladder cancer. If at all possible, try to limit your exposure to chemicals in the workplace and avoid smoking. Talk to your doctor if you think you’re at risk for bladder cancer and want to stop smoking.
- Consult with your doctor. There are smoking cessation products and local resources that may help, and your doctor can point you in the right direction.
- Reach out for support. Call the National Cancer Institute’s Smoking QuitLine at 1-877-44U-QUIT or visit LiveHelp for information about quitting smoking and referrals to other groups that can help.
- Be patient. Smoking is addictive. It may take several tries before you hit your stride.