Bladder Cancer Appears in Two Main Forms

There are approximately 50,000 new cases of bladder cancer identified each year in the US, with men developing the condition 2.7 times more frequently than women. The most common symptom is blood in the urine. In a smaller percentage of cases, there is irritation during urination, more frequent urination or increased urgency. But blood in the urine is never normal. Sometimes bleeding from cancer appears and then goes away, but it doesn't mean you are out of danger. See a urologist if you are experiencing abnormal symptoms.

Bladder cancer was the first cancer discovered to be chemically induced -- in the 1890s in Germany's aniline dye industry. The greatest risk factor for bladder cancer today is inhaled tobacco smoke. There is a less clearly defined link of industrial exposure to petrochemicals. There may also be a genetic predisposition in how an individual's body metabolizes carcinogens when exposed to them. In essence, it's a matter of both who you are and where you've been. There is contradictory evidence about how fluid intake may affect bladder cancer, but there is evidence to suggest that drinking green tea may have a beneficial effect in prevention.

The two main types of bladder cancer are: 1) superficial and 2) invasive. The former is four times more prevalent than the latter. Superficial bladder cancers do not invade the muscle wall while invasive tumors do. Superficial tumors are likely to reoccur after treatment and 70 percent of patients have more than one tumor. Invasive bladder tumors have a propensity to metastasize and spread to other areas of the body and are more likely to be fatal than superficial tumors.

Evidence suggests that superficial tumors act like dandelions -- spreading their seeds as tumor cells fall off and move to other sites within the bladder. Because there are seven categories of superficial bladder tumors, treating the disease is carefully tailored to address the most important clinical issues; often, reoccurrence and progression of the disease are the biggest issues.

Superficial tumors are typically scraped away with an instrument inserted through the urethra followed by chemotherapy instilled directly into the bladder. Through direct contact with the tumor site, it is hoped that spread of the disease within the bladder can be minimized. The Medical College of Wisconsin is helping develop an innovative laser treatment to kill the superficial tumor where it sits and decrease the risk of reoccurrence.

On the other hand, 40 percent of individuals with invasive bladder cancer have metastases, and the identification and treatment of additional cancer sites within the body present special challenges. With any cancer, once it has spread to other areas of the body, the likelihood of being cured falls off dramatically.

The most effective approach to defeating invasive bladder cancer is cystectomy -- removal of the bladder. But there are serious quality-of-life issues involved, such as body image, sexual function, voiding function and use of an external appliance to store urine. Sometimes bladder-sparing surgery can be performed, but its efficacy has not been thoroughly proven. Sometimes the bladder can be salvaged by treating invasive tumors like superficial tumors but with a more intensive scraping procedure and long-term chemotherapy. And with advanced invasive bladder tumors, chemotherapy may be used before surgery to shrink tumors.

As another alternative, the Medical College has been involved in creating an artificial bladder. Constructed out of intestine, it is hooked to the urethra so that urination can occur in as normal fashion as possible.

For more information or to set up an appointment, please call 414-456-6950.

William See, MD, Chairman and Professor, Medical College of Wisconsin Department of Urology.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.