Table of Contents
All cancers begin when cell growth in a particular part of the body becomes abnormal and the cells begin to grow uncontrollably.
The bladder is the balloon-shaped hollow organ in the pelvic region of the body with muscular and flexible walls that allow it to expand in order to store urine that comes from the kidneys through the two tubes called ureters.
The urine remains stored in the bladder until the body is ready to excrete it through the urethra.
As cancer becomes more aggressive and develops more cells, these cancer cells can bind together to form a tumor or tumors.
If not diagnosed and treated at an early stage, this cancer can spread to other regions of the body, not just in the pelvic region but to distant lymph nodes as well as to the bones, the lungs, or the liver.
Most bladder cancers start to develop in the urothelium or transitional epithelium, which is the innermost lining of the bladder.
This urothelial carcinoma is by far the most common form of bladder cancer; and since urothelial cells also exist in other parts of the urinary tract like the ureters and the urethra, it is important that these areas are checked for abnormal cells too.
If left untreated, the cancer advances and grows into or through the other layers of the lining of the bladder wall, which are made up of different types of cells.
With approximately 79,000 cases diagnosed annually, bladder cancer is considered the sixth most common type of cancer in the U.S., following breast, lung, colorectal (colon cancer and rectal cancer combined), prostate, and melanoma.
But while it is the sixth most common cancer overall, it is actually the fourth most common among men (over 60,000 of the 79,000 diagnosed cases will be men), while it is much less common in women (making up only approximately 18,000 of the 79,000).
Men are three to four times more likely than women to develop bladder cancer over their lifetime, with one in 26 men and one in 88 women likely to be diagnosed.
This is cancer that is often diagnosed early, mainly because one of its most common symptoms – blood in the urine – is an obvious and alarming one.
When it is diagnosed in the early stages, bladder cancer is extremely treatable, but it’s important to be aware that this type of cancer does have a high rate of recurrence.
Even if the cancer is caught early and all the tumors are successfully removed, there still is a 75% chance that this cancer will return, forming new tumors in other parts of the organ.
Because of this, bladder cancer patients normally go through follow-up tests for several years in order to spot or rule out the development of new tumors.
History and Types of Bladder Cancer
Bladder cancer is genitourinary cancer that has historically been grouped in with prostate, kidney, and testicular cancers.
Up until the late 1990s, it was thought that the connection between prostate and bladder cancer was strong and that there was an extremely high incidence of patients who presented with both cancers.
But in an ongoing study that ran between 1997 and 2003, nearly 500 patients with possible prostate cancer underwent biopsies and urethrocystoscopies to see if the prostate cancer had also invaded the bladder.
Prostate cancer was verified in just over 35% of the patients while bladder cancer was found in only 2.5% of the patients.
Earlier, in 1965, cisplatin – a platinum-based treatment – was found to stop some cell growth.
Expanding the potential impact of cisplatin despite the fact that most researchers did not believe platinum could be used safely, researchers discovered that the drug could help shrink tumors as well.
In 1978 the FDA passed approval for cisplatin as a treatment to be used in conjunction with chemotherapy to treat both bladder and testicular cancer.
Ongoing research continues in creating other cisplatin-based cancer treatments that are not as difficult for patients to tolerate.
Types of Bladder Cancer
- Urothelial carcinoma: As touched on above, urothelial or transitional cell carcinoma is the most common type of bladder cancer and is responsible for over 90% of all diagnosed bladder cancers.
- Squamous cell carcinoma: This bladder cancer is far less common than urothelial carcinoma. Squamous cell cancers involve abnormal cell growth that results from UTI’s or bladder inflammations/irritations that may have been developing for a long time – from several months to several years. This type of cancer makes up three to eight% of bladder cancers.
- Adenocarcinoma: This is a bladder cancer that is formed from cells that make up glands, rather than cells that comprise the lining of the bladder. Only one to two percent of bladder cancers are adenocarcinomas.
While the exact causes of bladder cancer have not been determined, there are several risk factors that are known to contribute to the chances of developing it.
- Smoking: Smoking is the biggest known risk in developing bladder cancer. Studies indicate that smokers are anywhere between twice and four times as likely to develop this cancer and that smoking causes approximately half of all bladder cancers developed in both women and men. The harmful chemicals in cigarette smoke are filtered from the lungs into the kidneys and urine, and this culminates in the concentration of these chemicals inside the bladder.
- Workplace Chemical Exposure: There are chemicals used in specific workplaces that can increase the risk of the development of bladder cancer in workers who are regularly exposed to them. Organic chemicals called aromatic amines used in industries involving dyeing are linked to bladder cancer. Mechanics, metal workers, and hairdressers are also exposed to cancer-causing chemicals, as are those who work in the manufacturing of paint, textiles, rubber, and leather. Smokers who work in these areas are even more at risk.
- Diesel fuel is also suspected to contribute to an increase in risk, and currently, there is a question about the safety of hormone replacement therapy for women in terms of increasing the risk for this cancer.
- Previous illness: Someone who has had bladder cancer previously is at increased risk. Bladder irritants such as kidney stones or chronic urinary tract infections (UTI’s) increase the likelihood of developing bladder cancer. Anyone who suffers from these problems is wise to take precautions and get regular screenings so that any cancer will be caught and treated early.
It’s no surprise that some medical professionals believe that eating a diet that is high in vegetables and fruits may help people protect themselves against the development of bladder cancer.
But studies have been inconclusive: some suggest that an eating regimen high in fiber from fruits and vegetables may help protect against bladder cancer, but other studies either do not prove it or are inconclusive.
Also unproven but considered by many is the idea that drinking a lot of water or other healthy fluids may help protect you, too.
Some risk factors are unavoidable since we do not control our age, gender, family disease history, or ethnicity.
But while there is no way to guarantee you can avoid getting bladder cancer, there are certainly some lifestyle changes that can be made; and even in high-risk workplaces, there are precautions such as masks and gloves that can be taken and should be considered.
Screening for cancer can help detect the disease at a very early stage.
This means that an accurate diagnosis and early treatment combine to cure cancer, prolong, and significantly improve the quality of the patient’s life.
Screening is not the same as diagnosis, because it is used to detect diseases that are often asymptomatic and it is used on either the general population or a specific group of individuals.
Screening for bladder cancer is one way of discovering if cancer is present in someone who may have no signs or symptoms of illness at all.
Screening uses some of the same tests that a doctor will use when a patient does present with symptoms.
A screening test usually includes a physical exam and a medical history, followed by a physical exam to check for any signs of disease or anything out of the ordinary that might point to a problem.
The screening will also involve lab tests of blood, urine, and sometimes tissue.
Imaging tests such as x-rays or MRIs and genetic tests looking for specific gene mutations that may signal different types of cancers can also be used.
There can be risks and problems associated with screening. Colon cancer screening that involves a colonoscopy or sigmoidoscopy can cause small tears in the lining of the colon.
Both false-positive tests that indicate abnormalities that don’t exist and false-negative tests that show no cancer when it is really there can happen.
Screening does help the medical community better identify some human commonalities (gender, race, ethnicity) that may be linked to certain specific cancers.
Screening is different than surveillance, which is the technique used to detect a recurrence of cancer in patients who have had and been treated for cancer previously.
Surveillance is ongoing testing, while screening is not.
The most common early symptoms of bladder cancer are considered nonspecific, which means these same symptoms can indicate a wide variety of other conditions that may have nothing to do with bladder or any other kind of cancer.
- Hematuria is the name for blood in the urine, and while it can be an indicator of cancer, it can also be caused by many other physical problems.
- Pain or burning sensation during urination: if there is no urinary tract infection when these symptoms are felt, it may be an early indication of bladder cancer
- Changes in urination habits, such as a strong need to urinate without producing much urine or having to urinate more often are symptoms that are associated with prostate cancer as well as bladder cancer, and may not mean that either disease is present.
Any of these symptoms indicate a visit to your medical professional so that tests can be scheduled for an accurate diagnosis of the problem.
Older men who smoke are considered to be at much greater risk for bladder cancer, so it is especially important that tests to rule it out are done.
While urine in the blood is generally the first sign of possible bladder cancer, it can also indicate a simple urinary tract infection, kidney or bladder stones that are irritating the region, or that there are benign tumors present.
When blood is visible in the urine, this is known as microscopic or gross hematuria.
Microscopic hematuria (blood that can’t be detected by the naked eye is present in the urine) can only be diagnosed with a urine test.
This may often be caught in a routine check-up that includes a urinalysis.
While blood in the urine can be an early sign of bladder cancer, this is cancer that can remain asymptomatic until it reaches a later stage of the disease when it is more difficult to cure.
This is the best reason to always check with your health professional if you do notice blood or any other changes, even if there is no irritation or pain accompanying those changes.
Advanced Bladder Cancer Symptoms:
- Persistent or intermittent back pain located on one side
- Inability to pass urine
- Bone pain
- Weakness and/or fatigue
- Weight loss and/or loss of appetite
- Swelling of feet
Like the symptoms that appear early, these later-stage symptoms are also often the sign of other problems that have nothing to do with bladder cancer.
But these symptoms may also indicate that there is a bladder cancer that has grown and is spreading to other parts of the body, so it is crucial that the patient get these symptoms checked and tested.
Diagnosis and Staging
If you suspect you have bladder cancer, if you show any symptoms described above, or if there is an irregularity found when you are screened for bladder cancer, your doctor will perform examinations and tests to determine what your diagnosis is.
Your interview with your doctor should cover all areas of your present and past overall medical condition, your workplace and work habits, your lifestyle, and your medications.
A physical exam may include a vaginal or rectal exam to find any lumps or other causes for blood in the urine.
- A urinalysis – a comprehensive test to find any abnormalities in the urine, including blood, glucose, and protein.
- Urine cytology – an examination of a urine sample to see if any abnormal cells appear among the cells from the inner lining of the bladder that have been sloughed off normally during urination.
- A cystoscopy – A thin tube with a camera and a light attached is inserted into the bladder through the urethra in order to send pictures to a video monitor. This reveals abnormalities of the bladder wall.
- Fluorescence or blue light cystoscopy – a specialized cystoscopy that inserts a light-activated drug into the bladder. The drug is picked up by any cancer cells in the bladder, and the blue light shining through the cystoscope will reveal those cells.
- A CT scan provides a three-dimensional picture of the bladder, urinary tract, kidneys, and pelvis.
- MRI (magnetic resonance imaging) is an alternate way to examine the bladder, ureters, and kidneys without using a contrasting dye, and can be used on patients who may be allergic to the dyes used in other methods of diagnosis.
- Biopsies involve removing small samples of the bladder wall that can be examined by a pathologist who can diagnose cancers and other diseases by examining the tissue and cells. Urine tumor makers are newer molecular tests that examine substances in the urine that can help determine the presence of bladder cancer.
- Ultrasound involves a noninvasive test that uses sound waves to evaluate the bladder.
- A chest x-ray may be performed to see if bladder cancer has metastasized and spread to the lungs or chest cavity.
- A bone scan is a test in which a very small amount of a radioactive substance is injected into the veins, followed by a full-body scan that can pinpoint any areas where cancer has spread to the bones.
Cancer staging is a way of identifying and defining how far cancer has spread in the body when it is first diagnosed.
Factors in staging include evaluating how invasive the cancer is, whether it is contained in the bladder, or if it has spread beyond the bladder to the lymph nodes or other organs.
Many cases of urothelial cell carcinoma (the most common bladder cancer) are non-invasive and don’t penetrate past the superficial layer of the bladder.
Most squamous cell carcinomas and adenocarcinomas are invasive, and when these cancers are detected they have often already invaded the bladder wall and possibly spread further.
Since different treatments are more effective for certain stages of cancer, it is a way for the patient and his or her doctors to hone in on the best treatment for an individual’s cancer.
The common clinical staging of bladder cancer is called the TNM system:
- T refers to the size of the primary tumor and if it has spread into the other tissues around the bladder.
- N refers to the location and number of lymph nodes around the bladder that have cancer cells in them.
- M is used to identify whether cancer has metastasized to other parts of the body.
This is a complex and extensive system of pinpointing the specifics of cancer, and discussing it with your healthcare provider is the way to understand your cancer treatment.
Here we’ve used the “T” classification in staging to give you an example of how complicated and precise staging is:
- Stage Ta is limited to the innermost lining but is noninvasive.
- Stage T1 is when cancer has spread through the inner or mucosal layer of the bladder lining into the submucosal lining.
- Stage T2 means cancer has penetrated the bladder wall.
- Stage T3 is the stage at which cancer has invaded all the way through the bladder wall and into the surrounding fat.
- Stage T4 means cancer has metastasized and invaded local areas like the uterus, prostate or vagina, but has not spread to the lymph nodes there.
N staging classifications indicate cancer has spread to the lymph nodes, with the numbers following the “N” classification indicating how far away the affected lymph nodes are from the local pelvic area.
M staging classifications identify the spread of cancer into the more distant organs like the lungs, bones, or liver, with the number following the “M” showing if the metastases are close to or distant from the site of origin.
Staging also runs from 0 through 4, with the higher numbers indicating the severity of cancer.
Each of the many stages has different treatment plans and options, and each has its own prognosis and chance for a cure.
Your doctor or treatment team may also use the terms localized, regional, and distant to describe the areas the cancer is contained in or has spread to.
Treatment and Drugs
There are standardized treatment protocols for bladder cancer that have been developed and refined according to the different stages of the disease, and intense research continues to be done in the field.
If your primary care doctor suspects bladder cancer or has seen from tests that it has developed, he or she will probably refer you to a urologist who specializes in diseases and disorders of the urinary tract.
Depending on the stage of cancer, you may also have an oncologist or a radiation oncologist on your team.
Your doctor or doctors will discuss your treatment options with you depending on the cancer stage, your overall physical health, your age, and whether this is a first-time diagnosis or a recurrence.
Most standard treatment protocols for bladder cancer involve one or more of the following:
- Radiation therapy
- Immunotherapy or biological therapy
Surgery and radiation treatment are both considered local therapies because they involve destroying the cancer cells in a specific area only.
This may include the bladder alone or the adjacent pelvic region.
Chemotherapy is a systemic treatment, which means it will kill cancer cells wherever they occur in the body.
Immunotherapy, like surgery and radiation, is a localized treatment that involves targeting specific cancer cells for destruction using the body’s own enhanced natural responses.
There are different kinds of surgery used to treat bladder cancer depending on the stage of the tumor and how far it has metastasized.
A tumor may be cut or burned off the bladder wall; part of the bladder may be removed; the bladder and surrounding lymph nodes may be removed completely.
With the complete removal of the bladder, men may also have the prostate and seminal vessels removed and in women, the uterus, ovaries, and vagina (part or whole) may be removed along with the bladder.
Because this surgery means the body has to void itself of urine in a different way, the patient may wear a small bag either outside the body or inside the body to collect urine, with a small catheter attached to empty the bag.
Radiation therapy is invisible and painless to receive.
A machine that produces the radiation targets a concentrated beam at the tumor and is usually given to the patient for five days a week over a period of five to seven weeks.
It is often used in addition to surgery but can be used alone in patients whose systems are too compromised to be able to withstand surgery.
Radiation therapy can also be delivered internally via a small radioactive pellet that is inserted into the bladder through the urethra or a small incision in the lower abdomen.
There are some side effects from radiation, the severity of which depends on the dosage of the radiation and area of the body it is being used to treat.
People frequently report feeling very tired while receiving radiation therapy, and the skin over the target area may feel as if it has gotten a bad sunburn; it may become reddened, sore, dry, and itchy.
Bladder cancer requires radiation to the pelvic area, and this can cause nausea, rectal irritation, impotence in men, and vaginal dryness in women.
Radiation can also impact the bone marrow’s production of blood cells, creating a greater likelihood of bruising, bleeding, and infections.
In bladder cancer cases, chemotherapy may be utilized at different times during treatment.
It can be used by itself or in conjunction with radiation prior to any surgery to help shrink tumors, and it can also be used after surgery to make sure that all cancer cells in the body are destroyed.
Chemotherapy can be incredibly effective, but it does have some well-known debilitating side effects such as nausea, sores inside the mouth, hair loss, and anemia.
But new drugs that can counteract some of the worst of the side effects are constantly being developed.
Immunotherapy or Biological Therapy
Another type of treatment called biological therapy or immunotherapy, which is designed to use the body’s own resources to battle cancers.
When the body’s immune system becomes unable to deal with aggressive cancer cells, immunotherapy can be used to stimulate the immune system so it can fight back.
An example of this is BCG treatment, in which a weak strain of cow tuberculosis is delivered to the bladder via a catheter; it must be held in the bladder for a specific amount of time in order to stimulate the immune system.
This treatment is repeated weekly for six weeks and is often used again over a period of months.
Coping and Support
Anyone who has had cancer can attest to the fact that some of the biggest problems in coping with the disease arrive after treatment is over: the constant anxiety about a recurrence and the feeling of helplessness about what will or might happen.
Once the shock of the diagnosis and the sometimes-lengthy treatment is over, cancer survivors often feel alone despite the efforts and support of family and friends.
It’s a deeply human trait to want to have some control over life-and-death issues, and when the feeling of control is snatched out from beneath our feet, it’s a frightening feeling.
But there are some very effective ways of coping with uncertainty and managing the stress.
Take Charge of What You Can Take Charge Of
- Do stick with a plan for healthy living, including eating a diet that is high in fiber and low in fat, that includes lots of fresh fruit and vegetables, and that stays away from fried foods or fast foods most of the time.
- Do try to get some exercise (30 minutes daily if possible). Even if you aren’t ready for exercise, get yourself outside into the air – it’s good for you physically and mentally.
- Don’t smoke. If you do, quit.
- Get enough sleep. Fatigue can be overwhelming even after treatment, so remember that your body has been through an ordeal and treat fatigue with respect.
- Drink lots of fluids (mostly water) to help keep your system flushed out.
- Don’t skip any follow-up appointments and tests.
- Try some relaxation techniques like meditation or journaling.
Support groups and individual counseling are both effective ways to deal with your emotions surrounding cancer.
Check your community for cancer support groups or contact the American Cancer Society for help in finding support groups in your area.
If you don’t feel like in-person groups are a good fit for you, check online for support groups there.
Talking with other cancer survivors can help you deal with many of the aspects of this disease, especially the ones that have you feeling like you are completely alone in your experience – you aren’t.
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