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Overview | Treatment | Surgery | Precautions | After Surgery Care
Bladder Cancer
Bladder Cancer
OVERVIEW
Bladder cancer is a common type of cancer that begins in the cells of the bladder. The bladder is a hollow muscular organ in your lower abdomen that stores urine.
Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder. Urothelial cells are also found in your kidneys and the tubes (ureters) that connect the kidneys to the bladder. Urothelial cancer can happen in the kidneys and ureters, too, but it’s much more common in the bladder.
Most bladder cancers are diagnosed at an early stage, when the cancer is highly treatable. But even early-stage bladder cancers can come back after successful treatment. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs.
Types of Bladder Cancer
Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. Doctors use this information to determine which treatments may work best for you.
Types of bladder cancer include:
- Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well. Urothelial carcinoma is the most common type of bladder cancer in the United States.
- Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder — for instance, from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the United States. It’s more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections.
- Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is very rare.
Some bladder cancers include more than one type of cell.
Risk Factors for Bladder Cancer
Factors that may increase bladder cancer risk include:
Increasing Age
Bladder cancer risk increases as you age. Though it can occur at any age, most people diagnosed with bladder cancer are older than 55.
Gender
Men are more likely to develop bladder cancer than women are.
Exposure to Certain Chemicals
Kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it's thought that being around certain chemicals may increase the risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
Smoking
Smoking cigarettes, cigars or pipes may increase the risk of bladder cancer by causing harmful chemicals to accumulate in the urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
Previous Cancer Treatment
Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have a higher risk of developing bladder cancer.
Chronic Bladder Inflammation
Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis
Personal Or Family History Of Cancer
If you've had bladder cancer, you're more likely to get it again. If one of your blood relatives — a parent, sibling or child — has a history of bladder cancer, you may have an increased risk of the disease, although it's rare for bladder cancer to run in families. A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organs.
Prevention Bladder Cancer?
Although there’s no guaranteed way to prevent bladder cancer, you can take steps to help reduce your risk. For instance:
- Don’t smoke. If you don’t smoke, don’t start. If you smoke, talk to your doctor about a plan to help you stop. Support groups, medications and other methods may help you quit.
- Take caution around chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
- Choose a variety of fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.
What’s usually the first symptom of Bladder Cancer?
Blood in your pee (urine) is the most common bladder cancer symptom. That said, simply having blood in your pee isn’t a sure sign of bladder cancer. Other conditions cause this issue, too. But you should contact a healthcare provider whenever you spot blood in your pee. Other bladder cancer symptoms include:
Visible blood in your pee (hematuria): Healthcare providers can also spot microscopic amounts of blood in pee when they do a urinalysis
Pain when you pee (dysuria): This is a burning or stinging sensation that you may feel when you start to pee or after you pee. Men and DMAB may have pain in their penises before or after peeing.
Needing to pee a lot: Frequent urination means you’re peeing many times during a 24-hour period.
Having trouble peeing: The flow of your pee may start and stop or the flow may not be as strong as usual.
Persistent bladder infections: Bladder infections and bladder cancer symptoms have common symptoms. Contact your healthcare provider if you have a bladder infection that doesn’t go away after treatment with antibiotics.
How Bladder Cancer Is Diagnosed
Tests and procedures used to diagnose bladder cancer may include:
- Using a scope to examine the inside of your bladder (cystoscopy). To perform a cystoscopy, your doctor inserts a small, narrow tube (cystoscope) through your urethra. The cystoscope has a lens that allows your doctor to see the inside of your urethra and bladder, to examine these structures for signs of disease. Cystoscopy can be done in a doctor’s office or in the hospital.
- Removing a sample of tissue for testing (biopsy). During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.
- Examining a urine sample (urine cytology). A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
- Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, allow your doctor to examine the structures of your urinary tract.
During a CT urogram, a contrast dye injected into a vein in your hand eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.
Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.
Determining the extent of the cancer
After confirming that you have bladder cancer, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.
Tests may include:
- CT scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
- Bone scan
- Chest X-ray
Your doctor uses information from these procedures to assign your cancer a stage. The stages of bladder cancer are indicated by Roman numerals ranging from 0 to IV. The lowest stages indicate cancer that’s confined to the inner layers of the bladder and that hasn’t grown to affect the muscular bladder wall. The highest stage — stage IV — indicates cancer that has spread to lymph nodes or organs in distant areas of the body
Bladder cancer grade
Bladder cancers are further classified based on how the cancer cells appear when viewed through a microscope. This is known as the grade, and your doctor may describe bladder cancer as either low grade or high grade:
- Low-grade bladder cancer. This type of cancer has cells that are closer in appearance and organization to normal cells (well-differentiated). A low-grade tumor usually grows more slowly and is less likely to invade the muscular wall of the bladder than a high-grade tumor.
- High-grade bladder cancer. This type of cancer has cells that are abnormal-looking and that lack any resemblance to normal-appearing tissues (poorly differentiated). A high-grade tumor tends to grow more aggressively than a low-grade tumor and may be more likely to spread to the muscular wall of the bladder and other tissues and organs.
Treatment of
In cancer care, different types of doctors—including medical oncologists, surgeons, and radiation oncologists, urologist, physician —often work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others
SURGERY
Treatment options for bladder cancer depend on a number of factors, including the type of cancer, grade of the cancer and stage of the cancer, which are taken into consideration along with your overall health and your treatment preferences.
Bladder cancer treatment may include:
- Surgery, to remove the cancer cells
- Chemotherapy in the bladder (intravesical chemotherapy), to treat cancers that are confined to the lining of the bladder but have a high risk of recurrence or progression to a higher stage
- Chemotherapy for the whole body (systemic chemotherapy), to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment when surgery isn’t an option
- Radiation therapy, to destroy cancer cells, often as a primary treatment when surgery isn’t an option or isn’t desired
- Immunotherapy, to trigger the body’s immune system to fight cancer cells, either in the bladder or throughout the body
- Targeted therapy, to treat advanced cancer when other treatments haven’t helped
A combination of treatment approaches may be recommended by your doctor and members of your care team.
Who treats bladder cancer?
Based on your treatment options, you might have different types of doctors on your treatment team. These doctors could include:
- Urologists: surgeons who specialize in treating diseases of the urinary system and male reproductive system
- Radiation oncologists: doctors who treat cancer with radiation therapy
- Medical oncologists: doctors who treat cancer with medicines such as chemotherapy and immunotherapy
You might have many other specialists on your treatment team as well, including physician assistants, nurse practitioners, nurses, nutrition specialists, social workers, and other health professionals.
Screening is recommended if you are a man:
- Between 55–69 years old
- Have a family history of bladder cancer
The most common warning sign is blood in your pee (urine). You should talk to a Doctor anytime you see blood in your pee.
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FAQ
What are the signs that bladder cancer has spread?
Bladder cancers that have grown large or have spread to other parts of the body can sometimes cause other symptoms, such as:
- Being unable to urinate.
- Lower back pain on one side.
- Loss of appetite and weight loss.
- Feeling tired or weak.
- Swelling in the feet.
- Bone pain.
Where does bladder cancer usually spread to first?
Not all bladder cancers will spread. But If it does it’s most likely to spread to the structures close to the bladder, such as the ureters, urethra, prostate, vagina, or into the pelvis.
Is it a urinary tract infection or bladder cancer?
Urinary tract infections and bladder cancer share many common symptoms. Therefore, if you have persistent UTI symptoms, it’s especially important to be evaluated by a urologist physician who can provide an accurate diagnosis.
How do bladder cancer symptoms differ in women versus men?
Bladder cancer symptoms are generally the same for women as they are for men.
However, the most common symptom is blood in the urine, which is commonly mistaken for menstruation by women, and thereby overlooked. As men are more likely to notice blood in the urine, bladder cancer is often diagnosed earlier in men than in women.
How will treatment affect my quality of life?
Quality of life is a very important consideration when deciding what treatment options are best for you. For non-muscle-invasive bladder cancer, we generally treat with intravesicle therapy. But there are side effects of treatment: Burning pain with urination, frequency, urgency, blood in the urine. They also involve catheterizations and can be painful during administrations. For patients who have muscle-invasive disease, and they’re trying to decide between whether to do a cystectomy, which is complete removal of the bladder, or radiation therapy, there are a number of quality of life implications there as well.
DR. ANAND UTTURE
MCh - Urology/Genito-Urinary Surgery, DNB - Urology/Genito - Urinary Surgery, MBBS, FICS, MS - General Surgery
Dr Anand Utture is a Senior Urologist who is internationally recognized for his surgical expertise and academic contribution to the field of Urology.
Book AppointmentWhen to see a Urologist Doctor
Make an appointment with your doctor if you have any signs and symptoms that worry you.
Seek immediate medical attention if you experience:
- Pain so severe that you can’t sit still or find a comfortable position
- Pain accompanied by nausea and vomiting
- Pain accompanied by fever and chills
- Blood in your urine
- Difficulty passing urine