Q&A about Bladder Cancer

1. How common is bladder cancer?
Approximately 54,300 new cases of bladder cancer were diagnosed in 2001 in the United States, and 12,400 patients died. The male-to-female ratio is almost 3:1.

2. What are the risk factors for bladder cancer?
Cigarette smoking, exposure to aniline dyes or aromatic amines, phenacetin abuse, and chemotherapy (cyclophosphamide).

3. How does bladder cancer present?
Painless hematuria (gross or microscopic). Frequency, urgency, and dysuria also may be presenting symptoms, especially for carcinoma in situ (CIS).

4. What is the most common histologic type of bladder cancer?
Transitional cell carcinoma (TCC) makes up > 90% of bladder cancers. Other histologic types include adenocarcinoma, squamous cell carcinoma, and urachal carcinoma.

5. How is TCC of the bladder treated?
With transurethral resection of the bladder tumor. Further treatment is determined by the pathologic stage of the disease.

6. Is CIS a less aggressive type of bladder cancer?
No. TCC in situ is a flat but poorly differentiated tumor. It can metastasize and should be treated as an aggressive form of bladder cancer.

7. How is CIS treated?
Immunotherapy with intravesical bacillus Calmette-Guérin (BCG) is currently the first-line treatment. Response rates to BCG approach 70%. Other intravesical agents, such as mitomycin C, are generally less effective than BCG.

8. What are the side effects of BCG?
Mild symptoms of urinary frequency, urgency, and dysuria are common. Myalgias and low-grade fever (flulike symptoms) also occur. High or persistent fever suggests a more serious problem requiring antituberculous therapy. Rarely, death from BCG has been reported.

9. How is muscle-invasive bladder cancer treated?
Radical cystectomy (or cystoprostatectomy in men) with some form of urinary diversion.

10. What types of urinary diversion are used with radical cystectomy?
Diversion techniques require either a conduit or a continent reservoir. The most common is an ileal conduit. An external collection device must be worn with a conduit. Continent reservoirs are made of combinations of large and small bowel and must be emptied via the urethra or a continent stoma

11. How is metastatic bladder cancer treated?
Metastatic bladder cancer requires chemotherapy. Most regimens include a platinum-based agent.

12. Can invasive bladder cancer be cured without removal of the entire bladder?
This issue is controversial. Some cancers may be suitable for partial cystectomy (i.e., tumors isolated in the dome of the bladder). Investigations are ongoing to evaluate transurethral resection of bladder tumor plus radiation and chemotherapy to try to preserve the bladder in invasive TCC.