Adenocarcinoma Bladder Cancer
Adenocarcinoma is a type of cancer that can begin in the glands of many organs, including the stomach, colon, and bladder. When this type of cancer affects your bladder, it can also be called adenocarcinoma of the urinary bladder or just adenocarcinoma of the bladder. It can start there, or it can spread to your bladder from elsewhere in your body. It’s a rare type of bladder cancer, making up only 1% to 2% of all cases.
"I think here, in an academic institution, I may have seen five cases," says Heather Mannuel, MD, a medical oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center and an associate professor of medicine at the University of Maryland School of Medicine.
Adenocarcinoma of the bladder is very different from urothelial bladder cancers, the ones most people are diagnosed with. It affects more men than women, usually when they’re in their 60s. It’s a very aggressive form of cancer.
Types of Bladder Adenocarcinoma
Doctors divide bladder adenocarcinoma into several subtypes based on where the cancer started and the traits of its cells. They include:
Bladder mucinous adenocarcinoma
Bladder mucinous adenocarcinoma is very rare. The cancer starts in the cells in the bladder lining and is marked by abnormal amounts of mucus in the tumor. Oncologists diagnose it if these areas of mucus (called mucinous areas) make up at least half of the tumor.
Clear cell adenocarcinoma
Clear cell adenocarcinoma affects mostly women, although men can have it. It’s diagnosed by how the cells are arranged. The tumor can look like a long finger. This is called a papillary growth or tumor.
Signet ring cell adenocarcinoma
Signet ring cell adenocarcinoma is an aggressive adenocarcinoma, and it's also quite rare. When seen under a microscope, the cells look like a signet ring.
Bladder Adenocarcinoma Symptoms
Although bladder adenocarcinoma is different from the more common types of bladder cancer, the symptoms are the same. Women tend to ignore these symptoms more than men do because they can be like those of a urinary tract infection (UTI) or menopause, Mannuel says. They include:
- Needing to pee often
- Feeling pain or burning while peeing
- Feeling like your bladder is never empty
- Getting up to pee at night a lot
If the cancer has progressed, you could have:
- An inability to pee when you want to
- Pain in the lower back, usually on just one side
- Belly pain
- Bone pain
- Unintended weight loss
- Loss of appetite
- Swollen feet
- Fatigue
Because the symptoms of different types of bladder cancers are so similar, your oncologist will have to do tests to find out what type you have.
Bladder Adenocarcinoma Risk Factors
Risk factors for bladder adenocarcinoma overlap with those of other types of bladder cancer, specifically smoking. Other risk factors for adenocarcinoma include:
- Being born with the bladder open to the outside your body, called exstrophy of the bladder. About 90% of people with this type of bladder cancer had exstrophy.
- Having chronic bladder irritation
- Having urachal remnants. This is when part of the urachus – a tether that develops between your belly button and bladder when you're in the womb – remains after you're born.
"After birth, it becomes this small kind of tentacle or string, that, when it’s normal, it’s very hard to see on CT scan and not anything that we tend to worry about," Mannuel says. "In a very small percentage of cases, you can have a primary adenocarcinoma arise from this."
A primary bladder adenocarcinoma is one that starts in the bladder tissue rather than spreading from somewhere else.
Bladder Adenocarcinoma Diagnosis
Once you’ve told your doctor about your symptoms, you may need tests to find out if you have bladder cancer and, if you do, what type and what stage it is (how far along it’s progressed).
First, your doctor will ask about what types of illnesses you’ve had as well as your family health history. It’s important for them to know whether any close relatives have had cancer and, if so, what type. You'll also have a physical exam, which could include a rectal exam and, for women, a pelvic exam. This allows your doctor to check for any tumors that can be felt.
After examining you, your doctor might send you to a urologist, a urinary system specialist, to look for the cause of your symptoms.
Doctors can use several types of tests to help diagnose bladder adenocarcinoma, including:
Urinalysis. This is the most common urine test that most people have had at least once in their life. It checks for blood and other substances in your pee.
Urine culture. A sample of pee is sent to a lab, where it’s placed in a special medium to see if any bacteria or fungi grow.
Urine tumor marker test. A tumor marker test, or biomarker test, looks for chemicals and substances that aren’t usually in your urine because they’re produced by cancer cells.
Urine cytology. With this test, the doctor looks at a sample of your pee to see if it contains cancerous or precancerous cells. They can also do a urine cytology test by putting salt water into your bladder and then letting it flow out. What comes out is called "bladder washing." This is sent for testing to look for cancer cells. Your doctor can also take biopsy samples during the cystoscopy.
Cystoscopy. This allows your doctor to look inside your bladder. Your doctor will insert a cystoscope through your urethra and into your bladder. The cystoscope is a narrow, flexible tube with a camera and light on the end. Your doctor can also take tissue samples for a biopsy during the cystoscopy.
Fluorescence cystoscopy, or blue light cystoscopy. While doing a standard cystoscopy, your doctor may do this test as well. Your bladder is bathed with a light-activated drug that cancer cells absorb. If there are any cancer cells, they'll glow when your doctor shines a blue light through the cystoscope.
Computed tomography (CT) urogram or intravenous pyelogram (IVP). These imaging tests use a contrast dye to allow your doctor to see the inside of your bladder and urinary tract.
Biopsy. Imaging and other tests can tell your doctor that you likely have cancer, but not the type. Your doctor must take tissue samples from your bladder wall and send them to a lab for examination to get the final diagnosis of adenocarcinoma.
Bladder Adenocarcinoma Treatment
Treatment for bladder adenocarcinoma depends on how far along the cancer has progressed and your overall health. Many people with bladder cancer are in their 60s or older and have other health conditions. So if you have heart disease or diabetes, for example, chemotherapy could be too hard on your body or you might not be a candidate for surgery. Everyone’s treatment plan has to be tailored to fit their needs.
Bladder adenocarcinoma surgery
Removing the entire bladder, called a radical cystectomy, is considered the best treatment for bladder adenocarcinoma. But for some people, a partial cystectomy might work. "It depends on the person's anatomy and also the extent of disease," Mannuel says. "You can still be left with some of the bladder so you don't have to have an external bag or device."
Bladder adenocarcinoma radiology
Radiation treatment for adenocarcinoma of the bladder doesn’t seem to be very effective, especially if used alone. But it might be used along with chemotherapy, especially if you can’t have surgery.
Bladder adenocarcinoma chemotherapy
Chemotherapy treatments for bladder cancer are much better than they used to be, Mannuel says, and bladder cancer overall tends to respond well to it. You might get it to help shrink the tumor before or after surgery, or for advanced (metastatic) cancer. You might also get it along with radiation therapy. But because bladder adenocarcinoma is a rare cancer, there isn’t a lot of research that shows how well it works when it's used alone.
Adenocarcinoma of the Bladder Cancer Prognosis
Adenocarcinoma is a rare cancer, and when it’s diagnosed, it often has progressed quite far. The outlook, or prognosis, for many people who have it is poorer than for those with other types of bladder cancer. That said, the prognosis often depends on how early the cancer was found.
Adenocarcinoma of the bladder cancer survival rate
Because this is a rare type of cancer, with even rarer subtypes, we don't have a lot of information about survival rates. It appears that people who have urachal adenocarcinoma have better survival rates than those with primary bladder adenocarcinoma. That's probably because the urachal type most often affects younger people, who tend to be healthier.
Takeaways
Although bladder cancer overall isn’t rare, bladder adenocarcinoma is very uncommon. It has the same symptoms as other bladder cancers but is often diagnosed late. Many bladder cancer symptoms, like the frequent urge to pee and pain when you pee, resemble symptoms of urinary tract infections. If you have any symptoms, talk to your doctor. An earlier diagnosis of bladder cancer improves your chances of survival.
Bladder Adenocarcinoma FAQs
What is the survival rate for bladder cancer?
Early detection of all types of bladder cancer increases the survival rate. The overall five-year survival rate, meaning the number of people who are still alive five years after diagnosis, is between 72% and 97%. For regional bladder cancer, meaning it has spread but not very far, the rate is 40%. If the cancer is distant, which means it’s spread farther through the body, the five-year survival rate is 9%.
What is the best treatment for bladder adenocarcinoma?
A radical cystectomy, removing your entire bladder, is usually the first choice for treating bladder adenocarcinoma. That said, treatment depends on what type of cancer you have, how far along it’s progressed, and your overall health.
What is the survival rate for adenocarcinoma?
The survival rate for adenocarcinoma depends on what type of cancer it is, how far it has progressed, and which organ is involved. For example, adenocarcinoma of the prostate has an overall 99% five-year survival rate, while adenocarcinoma of the pancreas has a 10% five-year survival rate.
