What is the Bladder?
The bladder is a balloon-shaped organ in your pelvic area that stores urine and is made up of four layers. The first inside layer is the mucosa, which contains urothelial (or transitional) cells that can stretch. The next layer is made up of connective tissue and blood vessels called the lamina propia. The third layer is the muscular layer, which contains muscles that contract during urination. Finally, urothelial cells line much of the urinary tract, including the renal pelvis, the ureters, the bladder, and parts of the urethra.
What is Cancer?
Cancer begins in the cells, which are the body’s basic unit of life. Normal functioning cells grow and divide in a controlled way. Cells are produced only when they are needed, and always in an effort to maintain a healthy body. Thus, as cells become old or damaged, they die and are replaced with new healthy cells.
Cancer is the abnormal dividing of cells that begin to grow out of control and are able to invade other tissues.
“Cancer” is not just one disease but encompasses hundreds of types of cancer. Most cancers are named for the organ or type of cell in which they start—for example, cancer that begins in the cells of the bladder is called “bladder cancer.” Different types of cancers can behave differently.
What is Bladder Cancer?
Bladder cancer is a cancer that begins in the bladder. A person with bladder cancer has one or more malignant tumors comprised of abnormal and unhealthy cells. Often, cancer begins in the urothelial cells of the bladder.
There are three types of bladder cancer:
- Urothelial cell carcinoma/Transitional cell carcinoma accounts for approximately 90 percent of bladder cancer diagnoses and is the most common type of bladder cancer in the United This cancer occurs in the cells that line the inside of parts of the bladder. These cells expand when your bladder is full and contract when your bladder is empty.
- Squamous cell carcinoma accounts for approximately 5 percent of bladder cancer Development of squamous cell carcinoma is associated with persistent irritation of the bladder. Over time, the cells can become cancerous. This cancer is more prevalent in areas where a bladder infection caused by a certain parasite (schistosomiasis) is common.
- Adenocarcinoma is the rarest type of bladder cancer and affects approximately 2 percent of the United States This cancer occurs in mucus-secreting glands of bladder cells.
What are the Statistics for Bladder Cancer?
Annually, more than 72,000 people will be diagnosed with bladder cancer, and about 54,000 will be men and 18,000 will be women. More than 15,000 are expected to die from the disease each year. Bladder cancer is diagnosed most often in older persons, with 73 as the average age at diagnosis.
Bladder cancer is the fourth most commonly diagnosed cancer in men, with one in 26 men developing it in his lifetime. Men are also three times more likely than women to develop the disease.
In more than half of bladder cancer diagnoses, patients are diagnosed with cancer that is still confined to the inner layer of the bladder (carcinoma in situ, or non-invasive cancer).
About 35 percent have bladder cancer that has invaded the deeper tissue layers but is still contained in the bladder. In most of the remaining cases, cancer has spread to nearby tissues outside the bladder. It is rare that bladder cancer has metastasized to other parts of the body.
What Causes Bladder Cancer?
It is not always clear what causes bladder cancer. Bladder cancer has been linked to smoking, radiation, and chemical exposure.
Smoking cigarettes, cigars, or pipes may increase your risk of bladder cancer by causing harmful chemicals to accumulate in your urine. When you smoke, your body processes these chemicals in the smoke and excretes some of them into your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
Exposure to certain chemicals can also increase your risk of developing bladder cancer. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder.
Therefore, breathing in, absorbing, or ingesting certain chemicals may increase your risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacturing of dyes, rubber, leather, textiles, and paint products. Smokers who are exposed to toxic chemicals may have an even higher risk of bladder cancer.
What are the Symptoms of Bladder Cancer?
While many people will experience symptoms that aid in the detection of bladder cancer, others will report not experiencing any problems that are often associated with the disease. While every person is different, it is important to understand that symptoms associated with bladder cancer could also indicate the presence of other problematic urologic conditions.
Thus, it is important to consult with your urologist should you experience any of the following symptoms:
- Hematuria (blood in the urine)
- Frequent and urgent urination
- Painful urination
- Abdominal pain
- Back pain
How do Urologists Screen for and Diagnose Bladder Cancer?
There are currently no screenings available to determine if a person has bladder cancer. However, through routine examinations such as a urinalysis, health care providers can detect microscopic levels of blood, which will often warrant further testing to determine conclusively if the blood is a result of bladder cancer. The tests that your doctor may order include:
A sample of your urine is analyzed under a microscope to check for cancer cells.
Allow your urologist to examine your urinary tract and its surrounding structures and One of the commonly performed tests is the computerized tomography (CT) scan, which is a type of X-ray that allows your urologist to see your urinary tract and the surrounding tissues.
A medical procedure in which your urologist inserts a narrow tube through your This tube has a lens and fiber-optic lighting system that allows your urologist to see the inside of your urethra and bladder.
This procedure is generally performed using a local anesthetic to make you more comfortable. It is the only procedure that will allow your doctor to locate a tumor, and then perform a possible transurethral resection of bladder tumor.
Transurethral resection of bladder tumor (TURBT)
This procedure is performed during a cystoscopy. Your urologist will pass the cystoscope through your urethra into your bladder and will collect a sample of cells, which will be biopsied to determine if cancer is present. This procedure is performed under general anesthesia. TURBT can also be used to treat bladder cancer.
What is the Bladder Cancer Tumor Stage?
Before any treatment begins, your urologist must first know how far the tumor has progressed or moved. The tumor stage and tumor grade provide information about the tumor and how serious it is. Based on that information, your urologist can recommend a course of treatment.
The following are the stages of bladder cancer:
- Ta: Non-invasive papillary carcinoma
- Tis: Carcinoma in situ—High-grade cancer that appears as a flat, reddish, velvety patch on the bladder lining
- T1: Tumor goes through the bladder lining but does not reach the muscle layer of the bladder
- T2a and T2b: Tumor goes into the muscle layer of the bladder
- T3a and T3b: Tumor goes past the muscle layer into tissue surrounding the bladder
- T4a and T4b: Tumor has spread to neighboring lymph nodes or to distant sites (metastatic disease)
To determine the stage, your doctor may order additional tests such as:
- CT scan
- Magnetic resonance imaging (MRI)
- Bone scan
- Chest X-ray
What is Non-Muscle Invasive Bladder Cancer?
This guide only focuses on Ta, Tis, and T1 stages, when cancer has not spread into the muscle layer. These stages are known as non-muscle-invasive bladder cancer. Stages T2-T4 are known as muscle-invasive bladder cancer because cancer has spread to the muscle layer of the bladder.
What is Bladder Cancer Tumor Grade?
A pathologist is a doctor who specializes in the anatomic (structural) and chemical changes that occur with the disease. He or she examines biopsy specimens to determine tumor grade.
A tumor grade depends on the tumor’s microscopic appearance. The grade also indicates how aggressive or fast the tumors are likely to grow and spread. The pathologist can see how different the cancerous cells look from normal cells. The grade is one of the most important ways to know if the disease will recur and how quickly it may grow and/or spread. Tumors can be low, intermediate, or high grade:
- Low-grade tumor cells are slightly
- High-grade tumor cells are very abnormal and disorganized. They are the most aggressive and more likely to grow into the muscle where they are considered more
- Intermediate-grade tumor cells are generally treated like high-grade tumor cells because it is hard to distinguish whether the tumor will be aggressive and in some cases if it will
Stage and grade are two of the most important factors in determining how your cancer will be treated based on its current state.
What Should Be Considered in Choosing a Bladder Cancer Treatment
Patients should talk with their urologist about what to do next to treat the cancer. Your urologist can explain the benefits and risks of any type of surgery and other treatments. Other questions to ask include:
- How does your urologist plan to prevent the tumor from recurring or developing to the next stage?
- What kind of discomfort/pain is involved?
- What side-effects may result from different types of treatments?
- What are the risks of surgery and other treatments?
In addition, some patients seek out the advice of other urologists to get a second opinion about their diagnosis. A second opinion may make sense for patients who have questions about the findings and possible Bladder Cancer Treatment options.
There are many valuable resources to help patients find doctors; patients should ask their urologist for the names of specialists who treat bladder cancer. They can also check with their local medical society, a nearby hospital, or medical school for additional names.
What is the Bladder Cancer Treatment Treatment Choices for Non-muscle Invasive Bladder Cancer?
It is important to understand that no single Bladder Cancer Treatment treatment plan will be the same for every man and woman. You should make sure that you have a thorough conversation with your doctor and medical team about what treatment choice is right for you.
In most cases, before you begin treatment, you will have already undergone a cystoscopic examination, which indicates the presence of the tumor. In addition, you may have had other examinations that allowed your doctor to view the entire urethra and bladder and will assist in future evaluation and follow-up treatment choices.
These examinations are critical to providing the following information to your doctor:
- Position of the tumor
- Type of tumor
- Number of the tumor(s)
- Size of the tumor(s)
If the tumor(s) is found after close examination of the bladder, your doctor may choose to perform a transurethral resection of bladder tumor (TURBT) as the first step in your Bladder Cancer Treatment.
It is generally the initial treatment for non-muscle-invasive Bladder Cancer Treatment. TURBT is a procedure that can be used both for diagnosis and treatment. Using a TURBT procedure to remove the tumor is generally reserved for non-aggressive cancer.
The TURBT procedure provides a microscopic study of the tumor tissue and tells the tumor type, grade, and stage, which helps the pathologist with more accurate staging. Repeat TURBT may also improve the control of the disease.
If TURBT is the only treatment used, the risk is high that the tumors will return after the TURBT treatment.
Approximately 45 percent of patients have a recurrence within one year if TURBT is the only treatment used. This is because:
- Some tumors may be missed;
- Some tumors may not be able to be seen or removed;
- Tumor cells may be shed (come off) during removal and replant in the bladder; and/or
- A new tumor maybe
Another risk factor of the TURBT is bleeding, perforation (a hole in the bladder wall), or dysuria (painful urination).
Patients with non-muscle invasive cancer located only in the bladder often can receive chemotherapy or immunotherapy drugs after a TURBT via intravesical therapy.
This targeted therapy involves chemotherapeutic or immunotherapy drugs placed directly into the bladder by a catheter. This treatment kills only non-muscle invasive tumor cells and cannot reach tumor cells that have spread to other organs.
There are several types of intravesical therapy bladder cancer treatment options:
BACILLE CALMETTE-GUERIN (BCG)
The vaccine is an immunotherapy drug. This form of therapy is designed to boost the body’s natural defenses to fight cancer. It uses substances either made by the body or in a laboratory to bolster, target, or restore immune system function.
Given through the catheter placed directly into the bladder, BCG attaches to the inside lining of the bladder and attracts the patient’s immune cells to the bladder to fight the tumor. BCG is used mostly for patients with nonmuscle invasive high-grade bladder cancer to reduce the risk of cancer recurring or progressing. Before BCG treatment, patients may need to have another TURBT to make sure that the cancer has not spread to the muscle.
BCG treatment may help patients avoid a cystectomy.
- Benefits: It is the first-line treatment for carcinoma that has not spread outside the bladder. It is effective in preventing bladder cancer recurrences following TURBT.
- Risks: It cannot be used immediately after surgery because of the risk that it will be absorbed into the bloodstream. It may cause flu-like symptoms in some patients as well as infection in a smaller number of patients. Pain and burning may occur during urination and patients may feel the need to urinate frequently.
It is a chemotherapeutic agent used to kill cancer cells. It is most often given to patients in their doctor’s office. However, some patients may receive treatment in an outpatient clinic or hospital.
- Benefits: Mitomycin C is easily absorbed into the bladder and has helped with preventing tumor recurrence. Recently, Mitomycin C has been used more often immediately after TURBT or sometimes within 24 hours after the initial TURBT treatment.
- Risks: Perioperative Mitomycin C (used immediately after TURBT) should not be used with patients whose bladder may have been punctured during a TURBT since some serious complications can occur. Others include a skin rash, pain, and burning during urination, and some patients may feel the need to urinate frequently.
INTERCALATING (INSERTING) AGENTS (DOXORUBICIN, VALRUBICIN, AND EPIRUBICIN)
- Benefits: These agents are known for good absorption into the bladder, and systemic toxicity is very rare. Doses may vary from three times a week to once a month.
- Risks: Patients taking intercalating agents may experience bladder irritation, nausea, vomiting, loss of appetite, rash, pain, fatigue, bruising, or bleeding.
It is used for more advanced bladder cancer care.
- Benefits: In patients who received previous therapy without a cure, it is a therapy that may be helpful.
- Risks: It is still unknown if this treatment is effective for non-invasive bladder cancer.
It involves using a laser to “burn” cancer cells.
- Benefits: The best patients for this therapy have low-grade papillary tumors and a history of low-grade, low-stage tumors.
- Risks: This technique is not recommended for the treatment of new bladder lesions (abnormal areas) because biopsies are required to determine the depth of invasion (stage) and tumor grade.
Includes office fulguration (burning of the tumor by electrocautery or laser instrument) and/or cystoscopic monitoring. Certain patients with low-risk non-muscle invasive bladder tumors may be managed conservatively.
- Benefits: Patients can avoid general or regional anesthesia. Only those patients with a well-documented history of low-grade tumors are appropriate for this approach.
- Risks: The disease may become worse if left untreated. However, the risks of surgery and anesthesia with multiple repeated TURBT procedures in certain patients may be more dangerous than the risk of the disease worsening. This treatment is reserved for only a very select group of patients.
It is the surgical removal of the bladder. This may be an option for patients with CIS or high-grade Ta or T1 cancers that have persisted or recurred after initial intravesical treatment. These cases pose a substantial risk of becoming muscle-invasive cancer. Therefore, these patients should consider having a cystectomy at this point or even as the first choice of treatment.
They should ask their doctor for information about the risks of cystectomy. In men, radical cystectomy involves the removal of the bladder, prostate, and seminal vesicles. In women, the bladder, urethra, uterus, and the front wall of the vagina is removed. Patients should ask their doctors about the methods of urinary reconstruction and the effects of the surgery.
- Benefits: May be appropriate for high-risk cases when previous treatments have not been successful.
- Risks: Requires a hospital stay, anesthesia, and surgery to remove and replace the bladder with another means of urination. Any of these may result in complications.
What Follow-up Care Will I Require After Bladder Cancer Treatment?
Bladder cancer patients need lifetime monitoring once they finish treatment. This is because of the high risk that non-muscle invasive bladder cancer tumors frequently reappear or become more aggressive.
Patients usually have follow-up exams every three months during the first two years, every six months for the next two to three years, and once a year thereafter. These exams may include patient histories such as voiding symptoms and hematuria, urinalysis, and cystoscopy.
Follow-up may also include taking images of the kidneys and ureters, especially for high-risk patients. Follow-up treatments may also include intravesical therapies if they are thought to be helpful.
Questions to Ask My Urologist About Bladder Cancer
- What is my diagnosis?
- Is there a chance I may have bladder cancer? How can we be certain?
- What is my stage and tumor grade?
- What is the prognosis for treatment and recovery?
- How will this affect my ability to work?
- Can this treatment be outpatient so that I can spend more time at home with family?
- Will I have any physical limitations?
- How will my current lifestyle change?
- What treatments do you recommend? What are my choices?
- Are there other treatment options available that you do not provide (e.g., protocol treatments, herbal therapy, touch therapy, other alternative therapies)?
- Are the benefits of each treatment?
- The side effects of each treatment?
- Medications you are prescribing?
- What are the medications for?
- Medications’ possible side effects?
- Are there any clinical trials I can participate in?
- How should I expect to feel during the treatment(s)?
- Risks of the treatment(s)?
- How much does treatment usually cost?
- Will my insurance cover the treatment plan?
- If I need other treatments such as laser ablation therapy, is this done in the doctor’s office or the hospital? How long would I need to be in the hospital?
- Do I need to do to take care of myself during treatment?
- Does treatment interfere with my other medical conditions or medications I am currently taking?
- How will we know if the treatment is working?
- If I choose cystectomy, how many days will I be in the hospital? How will I feel afterward?
Recovery and Follow-up
- How much time will I need to recover fully?
- How often will I need checkups?
- If I have surgery, how long will I have a catheter?
- Will I need to take off from work or other activities?
- Does surgery affect my sex life? My social life?
- Will there be any long-term effects?
ADULT PEDIATRIC UROLOGY & UROGYNECOLOGY | OMAHA UROLOGISTS
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