The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be "shaved off" using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors. BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy, such as valrubicin (Valstar) into the bladder can also be used to treat BCG-refractory CIS disease when cystectomy is not an option^.
Epidemiology-Bladder Cancer:In the United States, bladder cancer is the fourth most common type of cancer in men and the ninth most common cancer in women. More than 50,000 men and 16,000 women are diagnosed with bladder cancer each year. One reason for its higher incidence in men is that the androgen receptor, which is much more active in men than in women, plays a major part in the development of the cancer.

• You may want to talk to more than one urologist to find the one with whom you feel most comfortable. Clinical experience in treating bladder cancer is of the utmost importance.
  
  
• Talk to family members, friends, and your health-care provider to get referrals. Many communities, medical societies, and cancer centers offer telephone or Internet referral services.

After you have chosen a urologist to treat your cancer, you will have ample opportunity to ask questions and discuss the treatments available to you.

• Your doctor will describe each type of treatment, give you the pros and cons, and make recommendations based on published treatment guidelines and his or her own experience.
  
  
• Treatment for bladder cancer depends on the type of cancer and its stage. Factors such as your age, your overall health, and whether you have already been treated for the cancer before are included in the treatment decision-making process.
  
  
• The decision of which treatment to pursue is made with your doctor (with input from other members of your care team) and your family members, but the decision is ultimately yours.
  
  
• Be certain you understand exactly what will be done and why, and what you can expect from your choices. With bladder cancer, understanding the side effects of treatment is especially important.

Like all cancers, bladder cancer is most likely to be cured if it is diagnosed early and treated promptly.

• A combination of radiation and chemotherapy can also be used to treat invasive disease. It has not yet been determined how the effectiveness of this form of treatment compares to that of radical ablative surgery.
  
  
• Immunotherapy or biological therapy, which takes advantage of the body's innate cancer-fighting ability, is used in some cases, especially for patients with stages Ta, T1, and CIS.
  
  
• The hemocyanin found in Concholepas concholepas blood has immunotherapeutic effects against bladder and prostate cancer. In a research made in 2006 mice were primed with C. concholepas before implantation of bladder tumor (MBT-2) cells. Mice treated with C. concholepas showed a significant antitumor effect as well. The effects included prolonged survival, decreased tumor growth and incidence and lack of toxic effects.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
• Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
• Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
• Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Bladder Cancer Symptoms:Bladder cancer characteristically causes blood in the urine; this may be visible to the naked eye (frank hematuria) or detectable only by microscope (microscopic hematuria). Other possible symptoms of bladder cancer include pain during urination, frequent urination (Polyuria) or feeling the need to urinate without results. These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis. Kidney cancer also can cause hematuria.

• Blood in the urine {hematuria}:Usually Blood in the urine is the first sign of bladder cancer.The urine may have a slightly pink or orange hue, or it may be bright red with or without clots.If there any changes in urine color, then that person need to take health check up as soon as possible.
  
  
• Pain or burning during urination without evidence of urinary tract infection
  
  
• Change in bladder habits, such as having to urinate more often or feeling the strong urge to urinate without producing much urine.

If anyone have any of these symptoms, they should check up with the doctor right away. People who can see blood in their urine, especially older males who smoke, are considered to have a high likelihood of bladder cancer until proven otherwise.

Bladder cancer often causes no symptoms until it reaches an advanced state that is difficult to cure. Therefore, you may want to talk to your health-care provider about screening tests if you have risk factors for bladder cancer. Screening is testing for cancer in people who have never had the disease and have no symptoms but who have one or more risk factors.

In Brief........
Possible signs of bladder cancer include blood in the urine or pain during urination.

These and other symptoms may be caused by bladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Blood in the urine (slightly rusty to bright red in color).
• Frequent urination, or feeling the need to urinate without being able to do so.
• Pain during urination.
• Lower back pain.

Stages of Bladder Cancer

The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:

• Stage 0: Cancer cells are found only on the inner lining of the bladder.

• Stage I: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.

• Stage II: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.

• Stage III: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.

• Stage IV: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.

• Recurrent: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.

Bladder TCC is staged according to the 1997 TNM system:

• Ta Non-invasive papillary tumour
• T1 Invasive but not as far as the muscular bladder layer
• T2 Invasive into the muscular layer
• T3 Invasive beyond the muscle into the fat outside the bladder
• T4 Invasive into surrounding structures like the prostate, uterus or pelvic wall

The nomenclature "G1", "G2" and "G3" refers to the degree of differentiation, or histopathological grade. "G1" superficial tumour is well differentiated, while a "G3" tumour is poorly differentiated.

Bladder cancer causes::There are many causes for Bladder cancer, the following factors increase a person's risk of developing a bladder cancer:

• Smoking is the single greatest risk factor for bladder cancer,it is the main known cause of urinary bladder cancer: in most populations, smoking causes over half of bladder cancer cases in men and a sizeable proportion in women. Smokers have more than twice the risk of developing bladder cancer as nonsmokers. There is a linear relationship between smoking and risk, and quitting smoking reduces the risk. In a 10-year study involving almost 48,000 men, researchers found that men who drank 1.5L of water a day had a significantly reduced incidence of bladder cancer when compared with men who drank less than 240mL (around 1 cup) per day. The authors proposed that bladder cancer might partly be caused by the bladder directly contacting carcinogens that are excreted in urine. It is postulated, therefore, that by drinking higher quantities of water, urine is more dilute, thereby reducing the chance of disease. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine, which is found in cigarette smoke, has also been shown to increase bladder cancer risk. Occupations at risk are metal industry workers, rubber industry workers, workers in the textile industry, and people who work in printing. Some studies also suggest that auto mechanics have an elevated risk of bladder cancer due to their frequent exposure to hydrocarbons and petroleum-based chemicals. Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes. It has been proposed that hair dyes are a risk factor, and some have shown an odds ratio of 2.1 to 3.3 for risk of developing bladder cancer among women who use permanent hair dyes, while others have shown no correlation between the use of hair dyes and bladder cancer. Certain drugs such as cyclophosphamide and phenacetin are known to predispose to bladder TCC. bladder irritation (infection, bladder stones, catheters, bilharzia) predisposes to squamous cell carcinoma of the bladder. Approximately 20% of bladder cancers occur in patients without predisposing risk factors.
• Chemical exposures at work: People who regularly work with certain chemicals or in certain industries have a greater risk of bladder cancer than the general population. Organic chemicals called aromatic amines are particularly linked with bladder cancer. These chemicals are used in the dye industry. Other industries linked to bladder cancer include rubber and leather processing, textiles, hair coloring, paints, and printing. Strict workplace protections can prevent much of the exposure that is believed to cause cancer.

Smoking, gender, and diet can affect the risk of developing bladder cancer.

Anything that increases your chance of getting a disease is called a risk factor. Risk factors for bladder cancer include the following:

• Smoking.
• Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies.
• A diet high in fried meats and fat.
• Being older, male, or white.
• Having an infection caused by a certain parasite.

• Diet: People whose diets include large amounts of fried meats and animal fats are thought to be at higher risk of bladder cancer.
  
  
• Aristolochia fangchi: This herb is used in some dietary supplements and Chinese herbal remedies. People who took this herb as part of a weight loss program had higher rates of bladder cancer and kidney failure than the general population. Scientific studies on this herb have shown that it contains chemicals that can cause cancer in rats.

These are factors you can do something about. You can stop smoking, learn to avoid workplace chemical exposures, or change your diet. You cannot do anything about the following risk factors for bladder cancer:

• Age: Seniors are at the highest risk of developing bladder cancer.
  
  
• Sex: Men are three times more likely than women to have bladder cancer.
  
  
• Race: Whites have a much higher risk of developing bladder cancer than other races.
  
  
• History of bladder cancer: If you have had bladder cancer in the past, your risk of developing another bladder cancer is higher than if you had never had bladder cancer.
  
  
• Chronic bladder inflammation: Frequent bladder infections, bladder stones, and other urinary tract problems that irritate the bladder increase the risk of developing a cancer, more commonly squamous cell carcinoma.
  
  
• Birth defects: Some people are born with a visible or invisible defect that connects their bladder with another organ in the abdomen or leaves the bladder exposed to continual infection. This increases the bladder's vulnerability to cellular abnormalities that can lead to cancer.