Risk and Screening
- Bladder cancer is different from some other kinds of cancer in that asymptomatic individuals are not typically screened. Even people with high risk for bladder cancer are not routinely screened in many cases.
- When it comes to bladder cancer, high risk people include people who have had bladder cancer in the past, people who were born with defects affecting the bladder, and people who have had extended exposure to certain chemicals.
- If a person notices blood in their urine and the problem is not solved by antibiotics, the next step is typically a cystoscopy. This is a procedure in which a urologist inserts a long, flexible tube with a small camera at one end into the bladder to look for signs of cancerous tumors.
High-risk individuals should be screened, according to the U.S. Preventive Services Task Force (USPSTF), only if they present with symptoms, such as blood in the urine (hematuria). Dr. Jay Shah, a staff surgeon and associate professor of urology at Stanford University, as well as the leader of Stanford's Cancer Care Program for Urologic Oncology, explains that researchers have studied whether bladder cancer screening for everyone makes sense. The research consistently suggests that universal screening is not appropriate because it is unlikely to lower the risk of dying in individuals who are at average risk.
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Defining High Risk
Some doctors may suggest bladder cancer screening for asymptomatic adults who would be considered high risk by the following criteria:- Had bladder cancer previously
- Have birth defects that affect the bladder
- Experienced long-term exposure to certain chemicals in the workplace
Other common risk factors for bladder cancer, according to the USPSTF, include:
- Smoking, the number one risk factor for bladder cancer
- Male sex (men are four times as likely as women to be diagnosed with
bladder cancer) - Older age
- White race
- Parasites that infect the bladder
The presence of other bladder cancer risk factors may also put a person in the high-risk category. However, the screening decision is one that a patient and physician should discuss if there are no obvious symptoms.
Testing for Bladder Cancer
A routine urinalysis that reveals hematuria won't always trigger further testing. Blood in the urine usually has a benign cause, such as a bacterial infection or a kidney stone. If a bladder infection is suspected, but treatment with antibiotics doesn't clear it up, further testing is appropriate, says Arjun Balar, MD, director of the genitourinary oncology program at NYU Langone's Perlmutter Cancer Center.
The next screening is usually a cystoscopy. During a cystoscopy, a urologist inserts a cystoscopea long, flexible tube with a tiny light and camera at one endinto the urethra and up into the bladder. In addition to signs of inflammation or other problems, the doctor will look for cancerous nodules.
"If such an abnormal appearance in the bladder is noted, then ultimately the urologist will take the patient to the operating room to perform what is called a TURBT (transurethral resection of the bladder tumor)," Dr. Balar says, noting that this procedure is done under general anesthesia with a more rigid cystoscope.
The instrument scrapes the inner lining of the bladder to assess how invasive the cancer might be. "What we want to know there really is the stage," Dr. Balar says. "Within bladder cancer, we have tumors that can grow into the lining and outward into the lumen of the bladder. We call those papillary tumors or in situ cancers, which means they don't invade into the bladder wall, but they are simply present."
The American Cancer Society reports that the five-year survival rate for in situ bladder cancer is 96 percent. Of course, bladder cancer can become invasive, moving into the muscle wall and beyond. It's worth noting that bladder cancer can sometimes begin in more than one part of the bladder, so tissue samples may be taken from multiple locations.
Takeaway
Bladder cancer claims more than 16,000 lives in the United States each year, according to the Centers for Disease Control and Prevention. But if bladder cancer is detected and treated early, before it has had a chance to metastasize, the prognosis is encouraging.
And while hematuria is the most common and noticeable potential sign of bladder cancer, you should also pay attention to other symptoms of irritation in your urinary tract or changes in your bladder habits. If you find yourself having to urinate more frequently or you experience pain or burning during urination, share this information with your primary care physician or urologist. These are more likely to have benign causes, but they may be the first signs of a potentially serious disease.
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