The emphasis is also on the quality of life. Combined modality therapy is being increasingly used. In select cases you can save the bladder using surgery, chemotherapy and/or radiation. If not, innovative means of bladder replacement using the large and small intestines can often be used to avoid the need to wear an ostomy bag. Continence and near normal voiding through the urethra may be achieved and nerve sparing for potency is possible.

What is Bladder Cancer?
Cancer is a disease that results from abnormal growth and division of cells that make up the body’s tissues and organs. Under normal circumstances, cells reproduce in an orderly fashion to maintain tissue health and to repair injuries. However, when growth control is lost and cells divide too much and too fast, a cellular mass – or “Tumor” – is formed. If the tumor is confined to a few cell layers and it does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumor spreads to surrounding tissues or organs, it is considered malignant, or cancerous. If cancerous cells break away from the original tumor, travel, and grow within other body parts, the process is known as metastasis.
The bladder is a hollow, balloon–shaped organ that is located within the pelvis. The bladder stores urine – the liquid waste made by the kidneys when they clean the blood. Muscular tissue within the bladder wall allows it to enlarge or shrink, as urine is held or voided. When cancer occurs in the bladder, it usually grows within the inner lining of the bladder, which is composed of specialized expanding and deflating cells known as transitional cells. From here, the cancer may spread deeper into the lining, extend into the bladder’s muscular wall, and eventually invade nearby reproductive organs, abdominal tissues, the pelvis (hip bones) and lymph nodes. Although most bladder cancers are slow growing, once they have spread to the bladder’s muscular tissue, they often metastasize to sites such as the lungs, liver, bone, or lymph nodes.

Symptoms of Bladder Cancer
Bladder cancer that is in an early stage of growth may not produce any noticeable signs or symptoms. The most common sign of bladder cancer – hematuria (bloody urine, urine that appears bright red or rusty) – usually is painless and may appear only from time to time over a period of months. Over 80% of all bladder cancer patients eventually do experience either gross (visible to the naked eye) or microscopic (visible by microscope) hematuria.
When bladder cancer causes noticeable symptoms, such symptoms are usually related to the irritation brought about by tumor growth. "Irritation" voiding symptoms include urination that is frequent, urgent, or painful or difficult (known as dysuria). Irritating symptoms are more common among patients with the “Carcinoma in situ” (CIS or TIS, cancer that has not spread and is still “In place”) type of bladder cancer versus patients with low–grade wart–like (papillary) tumors. In fact, irritable voiding may be the only noticeable symptom of CIS. Since irritable voiding symptoms also are caused by bacterial infections and kidney stones, it is essential to see a physician to rule out these conditions. Any symptoms that last longer than two weeks should be evaluated by a health care practitioner.

If a bladder tumor blocks an ureter (one of two tubes that pass urine out of the kidneys and into the bladder), a patient may experience pain in the flank – the side of the body between the ribs and the top of the hip. In some cases, tumorous growth may constrict the urethra (the tube that passes urine from the bladder out of the body) and slow the flow of the urine stream. Bladder cancers that become necrotic (have decomposed areas) may shed pieces of dead tissue into the urine. Fragments of papillary tissue and calcareous (chalky) deposits, are other forms of tumor–related matter that may be passed out with the urine. If the tumor has spread outside of the bladder to surrounding tissues, the patient may experience pelvic pain. In addition, metastases from bladder cancer may cause secondary symptoms, such as bone pain at the site of the new cancer or leg edema (swelling) due to involvement of the lymph nodes.
Bladder cancer that has progressed to the point of organ invasion and metastasis, may eventually cause the patient to lose weight and strength. Anemia (low red blood cell count) and uremia (high blood levels of urea and other metabolic by–products, often due to urinary tract obstruction) are further indications of late–stage bladder cancer.

Diagnosis and Treatment of Bladder Cancer

1. Bladder cancer is the fifth most common neoplasm and the twelfth leading cause of cancer death. Men are affected three times more frequently than women.
   Numerous chemicals are suspected bladder cancer forming agents, however, only cigarette smoking and occupational exposure to a certain class of organic chemicals called aromatic amines (beta–naphthylamines, xenylamine, 4–nirtobiphenyl benzidine,) are well–established risk factors.
2. Bladder cancer due to aromatic amine exposure has been documented in the textile, leather, rubber, dye, paint, hairdressing, and organic chemical industries. A period of five to 50 years may follow the exposure of carcinogenic agents and the diagnosis of bladder cancer by a physician. The more one smokes, the greater the risk of bladder cancer, in most cases, the risk from smoking increases the chance of bladder cancer two to five–fold. No direct relationship between second hand smoke inhalation and bladder cancer has been established.

The most common clinical presentation is blood in the urine or hematuria. Usually, this is painless and the blood may be visible to the naked eye (gross hematuria) or can be seen only under the microscope (microscopic hematuria). Frequently, the diagnosis of bladder cancer is delayed because bleeding is intermittent or attributed to other causes such as urinary tract infection or blood thinners. However, a substantial proportion of these patients will have a significant problem such as kidney stones or tumors, urinary tract obstruction and bladder cancer.