function please see the overview section “The Uri-
nary System.”
HEALTH CONDITIONS THAT CAN AFFECT THE BLADDERBLADDER CANCER BLADDER EXSTROPHY
CYSTINURIA CYSTITIS
CYSTOCELE NEUROGENIC BLADDER
pyelonephritis SPINA BIFIDA
URINARY INCONTINENCE URINARY RETENTION
URINARY TRACT INFECTION(UTI) URINARY URGENCY
UROLITHIASIS VESICOURETERAL REFLUX
See also AGING, URINARY SYSTEM CHANGES THAT
OCCUR WITH; BLADDER CATHETERIZATION; CYSTOSCOPY;
FECAL INCONTINENCE; KEGEL EXERCISES.
bladder cancer The growth of a malignant (can-
cerous) tumor in the BLADDER. Bladder CANCERmay
be primary or metastatic (travel to the bladder
from a point of origin elsewhere in the body).
Doctors diagnose bladder cancer in about 55,000
Americans each year. Bladder cancer is about
three times more common in men, and in the
United States is the fourth most common cancer
among men. Bladder cancer claims about 12,000
lives in the United States each year. The likelihood
of developing bladder cancer increases with age.
Cigarette smoking causes about 50 percent of
bladder cancers, and exposure to industrial chemi-
cals accounts for another 25 to 30 percent. Among
the chemicals known to cause bladder cancer are the
aromatic amines: aniline, benzidine, chlornap-
hazine, methylene dianiline, naphthylamine, and
xenylamine. Numerous industries use these chemi-
cals. Tobacco smoke, too, contains aromatic amines.
There are several types of bladder cancers
though in the United States one type, transitional-
cell CARCINOMA(TCC), accounts for more than 90
percent of bladder cancers. TCC arises from the
epithelial (also called urothelial) cells that form
the innermost layer of the bladder’s structure and
typically undergo a series of predictable cell struc-
ture changes before becoming malignant. Other
types of bladder cancer are relatively rare and
include squamous cell carcinoma, small-cell carci-
noma, LYMPHOMA, ADENOCARCINOMA, leiomyosar-
coma, and metastatic malignant melanoma.
Treatment options and outlook differ among the
types of cancer.
Symptoms and Diagnostic Path
Painless HEMATURIA(bloody URINE) is often the ear-
liest indication of bladder cancer. The hematuria
may be gross, meaning there is enough BLOOD
present to discolor the URINE, or microscopic,
detected through urinalysis. Symptoms and signs
of bladder cancer may include- pink, red, or dark brown urine (hematuria)
- DYSURIA(discomfort when urinating)
- URINARY FREQUENCY
- URINARY URGENCY
- sensation of incomplete emptying of the blad-
der with URINATION
The diagnostic path begins with a standard uri-
nalysis as well as specific urine tests to measure
antigens and proteins present in the urine with
TCC. These tests include- NMP22 BladderChek, which detects the pres-
ence of nuclear matrix protein (NMP) 22 - BTA-Stat, which detects the presence of bladder
tumor antigen (BTA) - fibrin degradation products (FDPs), which
detects the breakdown of blood clots
Further diagnostic procedures include CYS-
TOSCOPY, INTRAVENOUS PYELOGRAM(IVP), orCOMPUTED
TOMOGRAPHY(CT) SCANto visualize the bladder and
urethra to detect tumors, and biopsy (which the
urologist typically does during cystoscopy) of iden-
tified tumors or suspicious tissue. Biopsy provides
the conclusive diagnosis, allowing the pathologist
to identify the type of cancer and degree to which
it has spread (staging and grading).Treatment Options and Outlook
The cancer’s type and stage determine treatment
options and outlook. Doctors diagnose about 70
percent of TCC in its early stages, when the tumor
is small and remains confined to a localized region
of the epithelium. These tumors, designated as
superficial or stage 0, are highly treatable with
minimally invasive therapies that generally pre-
serve the bladder and normal urinary functions.
These therapies may includebladder cancer 179