Bladder Cancer – Causes
Different cancers have different risk factors. Risk factors increase your chances of getting a disease. Keep in mind, many people with one or more risk factors may never develop bladder cancer. Others with this disease have no risk factors at all.
It is important to know the risk factors so that action can be taken to reduce your chances of getting this disease. Common causes and risk factors include:1
The greatest risk factor for bladder cancer is smoking. Smokers are more than twice as likely to get bladder cancer as nonsmokers. Smoking causes nearly half of the deaths from bladder cancer among men (48%) and nearly a third of bladder cancer deaths in women (28%).1 Some of the carcinogens (cancer-causing chemicals) in tobacco smoke are absorbed from the lungs and get in the blood. From the blood, they are filtered by the kidneys and concentrated in the urine. These chemicals in the urine damage the urothelial cells that line the inside of the bladder. This damage increases the chance of cancer developing.
Because the bladder is the final exit from the body for many chemicals, they are the primary risk factors for bladder cancer. This is the case whether the chemicals are from tobacco smoke or from occupational exposure as explained below.
Certain industrial chemicals are linked to bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, that are sometimes used in the dye industry, can cause bladder cancer.
Other industries that use certain organic chemicals may also put workers at risk for bladder cancer if good work place safety practices are not in place. The industries carrying highest risks include the makers of rubber, leather, textiles, and paint products as well as printing companies. Other workers with an increased risk of developing bladder cancer include painters, hairdressers, machinists, printers and also truck drivers because of exposure to diesel fumes.
Cigarette smoking and occupational exposures may act together in the development of bladder cancer. Also, smokers who work with the cancer-causing chemicals noted above have an especially high risk of developing bladder cancer.
Caucasians are about twice as likely to develop bladder cancer as compared with African American and Latino populations. The reason for this difference is not well understood. People of Asian descent have the lowest incidence of bladder cancer.
The risk of bladder cancer increases with age. Over 70% of people with bladder cancer are older than 65 years old.
Men get bladder cancer at a rate 4 times greater than women.
Chronic Bladder Inflammation
Urinary infections, kidney and bladder stones, and other causes of chronic bladder irritation have been linked to bladder cancer, especially squamous cell carcinoma of the bladder, but they do not necessarily cause bladder cancer. Schistosomiasis, also known as bilharziasis is an infection with a parasitic worm that can get into the bladder and increase the risk for bladder cancer. Although this parasite is found mostly in Northern Africa, it does cause rare cases of bladder cancer in the United States among people who had been infected by the worm before moving to this country.
Personal History of Bladder Cancer
Urothelial carcinoma is cancer of the urinary tract that begins with cells that form in the bladder as well as in the urothelium – the lining of the kidney, the ureters, and urethra. The ureters carry urine from the kidneys to the bladder. The urethra is a canal that carries urine from the bladder and in men also carries semen from the body. Even when one bladder tumor is completely removed, you will have a higher risk of forming another tumor in the same or another portion of the urothelium. For this reason, people who have had bladder cancer need close, routine medical follow-up. People who have family members who have or have had bladder cancer are at increased risk.
Bladder Birth Defects
Before birth, there is a connection between the belly button and the bladder. This connection, called the urachus, normally disappears before birth. If part of the urachus remains after birth, it could become cancerous. Cancers that start in the urachus are usually made up of malignant (cancerous) gland cells and are called adenocarcinomas. Cancer starting in this way is rare, causing less than a half of 1% of bladder cancers but it does represent about one third of the adenocarcinomas (cancerous gland tumors) of the bladder, which are also rare.
There is another rare birth defect called exstrophy, which greatly increases a person's risk of developing bladder cancer. In exstrophy, the skin, muscle, and connective tissue in front of the bladder fail to close completely so there is a hole or defect in the wall of the abdomen. This leaves the inside of the bladder exposed to chronic infection and that may eventually lead to formation of an adenocarcinoma of the bladder.
Bladder cancer is common within some families. This may account for 1% of all cases.5 People with a mutation of the retinoblastoma gene, which causes them to develop cancer of their eye as infants, have a higher rate of bladder cancer. Many studies have found people differ in their ability to break down chemicals in their body and this is determined by certain genes they inherit. People who inherit genes that lead to slow breakdown of chemicals are more likely to develop bladder cancer.
Chemotherapy and Radiation Therapy
High doses of cyclophosphamide (Cytoxan), a drug used in the treatment of cancer, and ifosfamide (Ifex), a drug similar to cyclophosphamide, increase the risk of bladder cancer. A typical patient would be someone with a lymphoma – a tumor that begins in the lymph nodes - often cured by chemotherapy drugs that include cyclophosphamide. A drug called mesna is used with these two drugs to protect the bladder from irritation and decrease the risk of bladder cancer. People who receive radiation treatment to the pelvis are more likely to develop bladder cancer.
Drinking Water and Arsenic
Arsenic in drinking water has been associated with an increased risk of bladder cancer. Risk depends in large part on where you live, and whether your water system meets suggested standards for arsenic content.
Low fluid consumption increases risk. People who drink a lot of fluids each day have a lower rate of bladder cancer. This is thought to be because they empty their bladders often. By doing this, they keep chemicals from lingering in their bodies.
- “Detailed Guide: Bladder Cancer”, American Cancer Society, www.cancer.org URL: http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-risk-factors
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PN 1002319 Rev A 04/2013