Considered a cancer of the aging population, bladder cancer is not commonly recognized in the younger population. In the elderly, bladder cancer is most often found in men and it is often directly associated with a history of smoking.

Bladder cancer is a tumor that occurs in the lining of the bladder. More than 61,000 new cases of bladder cancer were diagnosed in the United States in 2006, with more than 13,000 deaths in the same period. The most common type, called transitional cell carcinoma, makes up more than 95 percent of all bladder tumors.

Transitional cells are specific cells that line the bladder wall, allowing the bladder to enlarge during the urine-storing phase. Transitional cells also line the ureters (the tubes that drain the kidneys) and the renal collecting system or the hollow portion of the kidneys.

Tumors of these other regions are uncommon compared to bladder cancer, but are often more dangerous and require more aggressive surgical removal.

What are the symptoms of bladder cancer?

The most common symptom is blood in the urine, either grossly visible or microscopic, which is invisible to the eye but can be found on urinalysis testing. Other symptoms include bladder pain (although at times pain may not be associated), frequency and other irritative voiding symptoms. Occasionally, the first symptoms are signs of advanced spread of the disease, as bladder cancer can affect the liver, bones or lung.

Who is at risk for developing the disease?

Smokers are at greatest risk, with rates double that of nonsmokers.

Males develop the disease at rates four times more than women.

Whites are at twice the risk than other races.

Occupational exposures in the dye, rubber and leather industries are important risk factors.

Firefighters and truck drivers are also thought to be at higher risk.

Environmental factors include increased arsenic levels in drinking water.

Genetic risks play a small but important role.

How is bladder cancer diagnosed?

Bladder cancer is most often diagnosed with a procedure called cystoscopy, which is an endoscopic procedure allowing a cystoscope (a thin, lighted viewing instrument) to be inserted into the urethra and advanced into the bladder.

This is often performed in the doctor’s office under local anesthesia.

If a tumor is large enough, it sometimes can be diagnosed with radiological studies.

When a bladder tumor is seen, a subsequent endoscopic operation under general anesthesia is often required to biopsy the bladder and remove all visual tumors through the cystoscope.

Other endoscopic techniques are required to evaluate and biopsy tumors that are present in the ureters or renal pelvis.

Urine tests are essential in the diagnosis and the screening for bladder cancer.

Routine urinalysis is used to evaluate the presence of hematuria (blood in the urine).

If hematuria is present, other urine tests may be ordered.

Urine cytology is an examination of the urinary sediment to evaluate the presence of malignant cells.

Unfortunately, this test has a low detection rate for bladder cancer.

Another urine test, BladderChek, screens the urine for the presence of a cancer-specific protein and is now FDA-approved for screening and monitoring for bladder cancer.

Much research is being done to improve the accuracy of bladder cancer testing.

What are the treatments for bladder cancer?

If the tumor is found early enough and has not invaded the muscular wall, treatment consists of endoscopic removal of the tumor and close surveillance of the bladder with cystoscopy, which may need to be done as often as every three months for the first few years, as the recurrence rates of tumors are very high.

To decrease the number of recurrences, the bladder can be treated with weekly injections of BCG (Bacillus Calmette-Guerin), an inactivated form of the bacterium tuberculosis, which works as a form of immunotherapy, boosting the body’s natural defenses against the disease. Other chemotherapeutic agents may also be used.

Bladder cancer that has invaded the muscular wall is very serious and life-threatening. If disease is confined to the bladder, surgical removal of the bladder is indicated.

Other treatment options can include bladder-sparing therapy where a combination of endoscopic surgery, radiation and chemotherapy is given.

This is an important option in those deemed medically unfit to undergo the extensive surgery involved in bladder removal.

If studies show that the tumor has spread beyond the bladder, chemotherapy is often given as primary therapy.

Is there any way to prevent bladder cancer?

The most important step would be smoking cessation and decreasing occupational and environmental exposures.

Early diagnosis and screening is essential in high-risk groups as five-year survival rates drop significantly in those patients who are found with advanced disease versus noninvasive local disease.

If you have questions about your risk of developing bladder cancer, ask your personal physician or call (800) BASSETT.

Dr. Raymond J. McGoldrick is an attending surgeon in urology at Bassett Healthcare in Cooperstown.