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Bladder Cancer

Bladder Cancer Symptoms and Causes

Bladder cancer is the second most common urologic malignancy after prostate cancer. The incidence of bladder cancer is 53,000 new cases per year and increases with age. The disease is more common in Caucasians when compared to African and Hispanic populations in America. Bladder cancer accounts for approximately 90% of cancers of the urinary tract (renal pelvis, ureters, bladder, urethra).

The Urologic Oncology Program at North Shore-LIJ Health System brings together a team of urologic experts from Arthur Smith Institute for Urology, Radiation Medicine and Medical Oncology to provide the most progressive and comprehensive care to treat, educate and support patients with bladder cancer.

Bladder Cancer Overview

Bladder cancer usually originates in the bladder lining, which consists of a layer of surface cells (transitional epithelial cells), smooth muscle and a fibrous layer. Tumors are categorized as low-stage (superficial) or high-stage (muscle invasive).

Urine is produced by the kidneys, carried to the bladder by the ureters, stored and released from the bladder through the urethra. In developing countries, 75% of the bladder cancer cases are due to schistosoma haematobium, a parasitic organism, which leads to squamous cell carcinoma of the urothelium. In the United States, squamous cell carcinoma only accounts for 8%, and transitional cell carcinoma accounts for 90% of urothelial cancers.

Bladder Cancer Symptoms

The primary symptoms of bladder cancer are:

  • Blood in the urine — Known as hematuria, blood in the urine may be visible to the naked eye or visible only under a microscope and is usually painless
  • Frequent urination
  • Pain upon urination

Bladder Cancer Evaluation


  • History and physical exam
  • Urine analysis
    • Urine culture and sensitivity (rule out infection)
    • Urine for cytology
      • Examination of urine under a microscope to check for abnormal cells
    • Tumor marker test
      • BTA and NMP22
        • Checking a urine for proteins associated with bladder cancer
    • Fluorescence in situ hybridization (FISH).
      • Detect chromosomal abnormalities associated with bladder cancer
  • Cystoscopy
    • Allows visualization of bladder to ascertain if there are growths on the bladder walls
    • Biopsies may be taken


  • CT scan (CAT scan) or MRI
    • Detailed pictures of the upper urinary tract (kidneys and ureter) and the bladder. A dye may be injected into a vein or swallowed to help with visualization of the organs.


Once the initial evaluation determines the presence of bladder cancer, the next step is to stage the disease. Staging the disease will help determine the overall treatment profile for the patient.


  • Size of tumor
  • Multifocal vs. unifocal
  • Location of tumor
  • Spread of tumor (lymph nodes or distant sites)
  • Histopathology (analysis of biopsy)


The grade is an estimate of the speed of tumor growth and ability to spread as suggested by cell features seen under a microscope. Most systems are based upon the degree of tumor cell anaplasia — that is, the loss of cellular "differentiation," the distinguishing characteristics of a cell.

  • Grade 1 (well-differentiated)
  • Grade 2 (moderately differentiated)
  • Grade 3 or Grade 4 (poorly differentiated)

Bladder Cancer Causes and Risk Factors

Cancer-causing agents (carcinogens) in the urine may lead to the development of bladder cancer. Cigarette smoking is a major risk factor for bladder cancer and contributes to more than 50% of bladder cancer cases. Smoking cigars or pipes also increases the risk. Other risk factors include:

  • Chronic bladder inflammation
  • Dietary factors
  • Exposure to second-hand smoke
  • Pelvic irradiation
  • Family or personal history of bladder cancer
  • Being older, Caucasian or male
  • Infection with Schistosoma haematobium (parasite found in many developing countries; i.e., Egypt)
  • Workplace exposure to carcinogens
  • Treatment with certain drugs (Cyclophosphamide, ifosamide)
  • Workplace exposure to carcinogens

Bladder Cancer Clinical Trials

The North Shore-LIJ Cancer Institute offers a full array of clinical trials. The result of this research not only impacts survival, but also enhances the quality of life. For more information about clinical trials for Bladder Cancer, visit Cancer Clinical Trials.

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