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JAMA Patient Page
November 3, 2015

Bladder Cancer

JAMA. 2015;314(17):1886. doi:10.1001/jama.2015.13738

Bladder cancer is one of the 10 most common cancers in the United States.

Bladder Cancer Facts

Bladder cancer is about 4 times more common in men than in women. However, women more frequently have advanced bladder cancer by the time it is diagnosed.

The urinary bladder is an organ in the pelvis. Its main function is storing and emptying urine. The most common type of bladder cancer is called urothelial cancer. This type of cancer starts from cells that build the inner lining of the bladder. Currently, no screening test is recommended for early detection of bladder cancer. People who smoke have 4 times the risk of bladder cancer compared with people who do not smoke. People with work-related exposure to certain chemicals (such as in the dye, rubber, leather, and aluminum industries or painters, printers, machinists, and hairstylists) have an increased risk as well. Furthermore, areas with high levels of arsenic in the drinking water pose a risk for bladder cancer in residents.

Signs of Bladder Cancer

The most common sign of bladder cancer is blood in the urine (hematuria). This can be in the form of visible blood, like small blood clots or a color change of the urine to pink or red. Sometimes, however, a small amount of blood in the urine is not visible and can only be confirmed by a urine analysis and microscopic examination. There might be intervals during which the urine is clear for weeks or months before the blood returns. Hematuria requires a thorough diagnostic examination unless there is a clear explanation (such as urinary tract infection or a stone in the urinary tract) and the hematuria resolves after treatment of the suspected cause. Appropriate evaluation of hematuria always includes cystoscopy, a visual inspection of the inside of the bladder with a thin, tube-like camera, and a computed tomographic (CT) urogram, a special x-ray examination of the urinary system. The reason for the CT urogram is to make sure that the source of bleeding is not the kidneys or ureters.

Treatment

Bladder cancer is often diagnosed at an early stage, when the cancer is easier to treat. If the cancer has not invaded the muscle layers of the bladder wall, it can be treated by removing the tumor from the inside of the bladder by means of cystoscopy. This treatment is often followed by chemotherapy or immunotherapy administered directly into the bladder over a period of time. This additional step aims at eradicating any remaining cancer tissue that could not be seen during cystoscopy and preventing the recurrence of cancer. If the cancer has already grown into the muscle layers of the bladder wall, complete removal of the bladder (cystectomy) is recommended. Cystectomy is often combined with chemotherapy. To replace the bladder, a short piece of intestine is used to drain the urine from the ureters to an opening in the abdominal wall (stoma) and then into a bag attached to the skin (urostomy or ileal conduit). As another option, a segment of intestine is rearranged to form an expandable organ similar to the bladder to contain urine (neobladder). In some patients, chemotherapy and radiation are an alternative to bladder removal. It is important to have regular checkups after treatment because bladder cancer has a high rate of recurrence.

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To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.

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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Sources: National Cancer Institute, American Cancer Society, Bladder Cancer Advocacy Network

Wein AJ, Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh Urology. Vol 3. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:2309-2506.

Topic: Cancer

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