Bladder cancer is generally considered a disease of aging since the average age at diagnosis is about 68. More than 62,000 cases are diagnosed each year in the U.S. Since the major risk factors for bladder cancer are environmental, rather than hereditary, the prospects for preventing this cancer from occurring are promising. 

Bladder cancer occurs when healthy cells in the bladder start to grow at an unusually fast rate. This usually happens because the cells develop the ability to divide sooner than normal. The increased tissue growth produces masses called tumors or cancers. There are three main types of bladder cancer:

• Transitional cell carcinoma (TCC) arises from the cells that line the bladder. This is the most common form of bladder cancer and accounts for almost 90 percent of all bladder cancers in the U.S.
• Squamous cell carcinomas also come from the lining cells, but grow differently than TCC. They represent five to seven percent of all bladder cancers in the U.S.
• Adenocarcinomas come from glandular cells in the bladder wall. They are rare, representing perhaps one to two percent of all bladder cancers in the U.S.

The cause of transitional cell carcinoma is unknown, but those who smoke or work in the textile, rubber and dye industries have the greatest risk of acquiring the disease. For those who both smoke and experience chemical exposure in the workplace, the risk is greatly increased. Generally there are two types of transitional cell carcinoma, superficial and invasive, the difference depends on whether the tumor has grown into or invaded the layers underneath the bladder lining.

Risk Factors

As with many cancers, the cause of bladder cancer is unknown. Men are three to four times more likely to acquire bladder cancer than women are, and Caucasian/European-American males are nearly twice as susceptible as African-American males. At the same time, women and black men have reduced chances for recovery. Bladder cancer is generally considered a disease of aging since the average age at diagnosis is between 68 and 69. It is rare for a person under 40 to get the disease.

Prevention

Some risk factors offer important opportunities for prevention. Bear in mind that a risk factor is not the same as a cause. The primary risk factor for bladder cancer (up to 50 percent of cases) is cigarette smoking, with smokers having at least twice the chance of acquiring bladder cancer as non-smokers. At present, people exposed to secondhand smoke are not thought to be at increased risk for bladder cancer. But increasingly, research is raising health concerns about secondary smoke inhalation. The level of risk for smokers is related to the number of packs smoked daily. It is thought that some cancer-causing chemicals found in smoke enter the bloodstream after being absorbed by the lungs, then filtered through the kidneys and finally settling in the urine where they can then damage the cellular lining of the bladder.

There is a strong link between the development of bladder cancer and occupational exposure to arylamines or aromatic amines, commonly used in the textile, rubber and dye industries. Other industries that use these chemicals include the makers of paint products, printers and leather. Practices that protect workers from exposure to known cancer-causing chemicals are crucial for those employed in these industries.

Those with a previous history of bladder cancer are at increased risk of recurrent disease in the bladder, the lining of the kidney and possibly other nearby organs.

Bladder Cancer Treatments: Improvements in Radical Cystectomy and Continent Urinary Tract Reconstruction

Radical cystectomy or surgical removal of the bladder is the most effective treatment for bladder cancer that has invaded the muscle wall of the bladder. Until recently, however, this surgery was associated with major complications including complete loss of urinary and sexual function.

Only a decade ago, patients undergoing bladder removal had to wear an appliance on their abdomen to collect urine. Dr. Gary Steinberg reconstructs a new urinary bladder from an intestine that in most cases can be joined to the urethra allowing for normal urination.

We have performed this operation in over 400 patients for the past 12 years in men and women. This technique uses about 20 inches of small intestine that is configured into a sphere. This provides a high capacity, low-pressure urinary reservoir that allows for normal urination and preservation of kidney function. Furthermore, removing only this small amount of the intestine has no adverse effects on bowel function. The entire operation, including removal of the bladder and construction of a new intestinal bladder takes about 4 hours. Patients are hospitalized for only about one week, and have experienced very few complications with this technique. With this new bladder, about 90 percent of patients have excellent urinary control, and the other 10 percent usually experience only mild urinary incontinence.

It is now possible for many men and women to maintain their sexual function following bladder removal. In men, preservation of the nerves to the penis that are adjacent to the bladder and prostate allows about 50 to 70 percent of men to regain their erections. In women, it is now possible to preserve the entire vagina and external genitalia allowing for normal sexual activity. These ongoing advances in the surgical treatment of bladder cancer allow patients the best chance of being cured of their disease and to enjoy an excellent quality of life following surgery.

Robot-assisted laparascopic radical cystectomy is also offered here at The University of Chicago. In addition, a large number of clinical trials for the early detection, prevention and treatment of early or advanced bladder cancer are presently available.