By Max Hammonds, MD

The urinary bladder is a relatively small organ of the body, about the size of one’s fist, sitting just behind the pubic bone. It serves a very useful function – to catch and hold the urine produced in the kidneys and passed down by two long tubes (ureters) to the bladder. The kidneys function as blood filters, removing the water-soluble metabolic by-products of the body, plus the impurities, the toxins, the chemicals that were taken in through the mouth, the lungs, or the skin that are to be eliminated from the body. The urinary bladder catches and holds all of these products in the urine until the bladder gets full (1/2 – 1 cup) and is emptied.

The bladder has the unique ability to stretch without pain. Most hollow organs do not like to be stretched. But the bladder has a lining of transitional cells that can expand or shrink and easily slide over one another to allow the bladder to increase or decrease in size. 

In the usual course of life, the transitional cells, like all normal cells, live and function, age and die, and are replaced by new cells. But sometimes, the DNA of the cells is changed. These new mutated cancer cells do not die but multiply rapidly. Initially, they build up in a mass that swells, protruding into the hollow space of the bladder, then begin to invade the wall of the bladder, first through the lining, then into the underlying muscle, then into the capsule of the bladder, and then into the surrounding tissues and other organs nearby in the pelvis.

Fortunately, these cancerous, bladder transitional cells do not like to be stretched. Their areas of growth cause pain when they are stretched. Further, these areas bleed easily when pulled, causing blood to appear in the urine (80-90% of the cases). Sometimes this blood is easily seen in the toilet; sometimes, it can be detected only by a lab test, a urinalysis. The presence of blood inside the bladder is irritating, causing frequent urination, pain on urination, and low back pain.

Fortunately, 95% of all bladder cancers are cancers of the transitional cells. These cancers can be treated with simple procedures, laser removal, bladder infusions, and radiation or chemotherapy. The five-year survival rate for these kinds of bladder cancer is 95%. However, these cancers recur 70% of the time, requiring close monitoring and re-treatment over time.

In 2019, there were 62,000 newly diagnosed bladder cancers in men and 19,000 newly diagnosed cancers in women, making cancer of the bladder the 6th most common cancer in men and the 12th most common cancer in women. 

Most bladder cancers occur in people over 55 years of age. But the most common cause of bladder cancer is the inhaled chemicals in smoking of all kinds, causing 50% of bladder cancers. The other common cause is chemical exposure in occupations: people who work with dyes, rubber, textiles, leather, and paint – including bus drivers, mechanics, painters, blacksmiths, and hairdressers. All of these people are breathing in and immersing their hands and clothes in chemicals and heavy metals of various kinds – which will be detoxified by the liver and sent to the kidney – or be directly filtered out by the kidney in the urine, which will be held in the bladder, exposing it to the potential changes of DNA in the transitional cells which cause the cancerous growths. 

Other causes of bladder cancer include radiation for other cancers in the pelvis, chronic irritation of the bladder by recurring infections, by the presence of a long-term catheter, or by the recurring company of chemotherapy for other cancers in the body. A family history of bladder cancer and obesity also increases the risk of developing bladder cancer.

As the old saying goes: An ounce of prevention is worth a pound of cure. Drinking lots of water will wash out the harmful chemicals that accumulate in the bladder, not allowing them to sit in the bladder for long periods. Stop smoking or quitting smoking will eliminate 50% of bladder cancers. And everyone who is working around or is exposed to chemicals should wear protective clothing and work in well-ventilated spaces (or wear special breathing apparatus) to protect against breathing in the chemicals or absorption of the dangerous substances through the skin.

The anti-oxidants and selenium in fruits, vegetables (especially the yellow-orange ones), and whole grains help detoxify the chemicals that get into the body. A good diet, exercise, and sufficient sleep also strengthen the body’s immune cells, attacking and removing early-appearing cancer cells. If bladder cancer occurs, do not be fearful. Establish a plan with your doctor, follow the procedure scrupulously, and be hopeful. The cure rate is reasonably high, and the survival rate for interstitial cancer is relatively high.

But the obvious best course is to do the things that will avoid this relatively common cancer in the first place. Treatment of the problem is really “second aid.” Preventing the problem is “first aid.”