The bladder is a balloon shaped organ that collects urine from the kidneys and stores it until it is eliminated through a channel called the urethra. The most common type of bladder cancer, transitional cell or urothelial cell, starts in the lining of the bladder.
Early stages of bladder cancer often produce no symptoms. Your first warning sign may be hematuria (blood in your urine) that may only be visible under a microscope).
Other common symptoms include:
- Painful urination
- Frequent urination or feeling an urge to urinate without results
- Slow or intermittent urine stream
- Pelvic pain
These symptoms may instead indicate other medical problems, such as urinary tract infections, bladder stones or prostate disorders; you will need a thorough evaluation to determine the cause.
The following factors increase your risk of bladder cancer:
- Cigarette smoking - the single greatest risk factor
- Exposure to industrial chemicals
- Age - the average age is 67
- Sex - men are at much higher risk
- Race - Caucasians are at higher risk
- Family or personal history of bladder cancer
- Chronic bladder inflammation or foley catheter use
- Chemotherapy or radiation therapy for other cancers
- A high fat diet
Your doctor will first perform a thorough history and physical exam. Other tests may include:
- Urine Cytology - examining urine cells under the microscope
- Intravenous Pyelogram (IVP) or CT Urography - special x-rays that include contrast dye, to view the kidneys, bladder and connecting tubes
- Cystoscopy - putting a thin scope into the urethra to view it and the bladder; if a mass is seen, a biopsy may be performed at that time or during more formal treatment
- Tumor Marker Tests - the FDA has approved several tests that look for BTA or NMP22, proteins in the urine that may indicate cancer
- Flourescence in Situ Hybridization (FISH) - a urine test that looks for chromosomal abnormalities and may provide early detection of transitional cell bladder cancer
Once it has been determined that you have bladder cancer, your doctor will determine what “stage” your cancer is in:
- Stage 1 - confined to the bladder lining; 60-70% of patients have Stage 1 disease
- Stage 2 - spread to the muscular walls of the bladder
- Stage 3 - spread to tissues around the bladder
- Stage 4 - spread to other organs
Determining the appropriate treatment depends on a number of factors, including your health and age, type of tumor, tumor grade, and the stage of the tumor, which is related to how deeply it invades the wall of the bladder.
Surgical treatment is often recommended for patients with bladder cancer. Some patients will receive radiation, chemotherapy orimmunotherapy in addition to or instead of surgery.
Surgery – there are several surgical approaches:
- Transurethral Resection (TUR) - using a tiny instrument called a cystoscope, your doctor can view and remove cancerous tissue through the urethra. Typically used for low risk bladder cancers (stage 1).
- Segmental Partial Cystectomy - removing part of the bladder to destroy cancer cells, usually when the cancer affects only one area.
- Radical Cystectomy - required when the cancer has invaded deep into the wall of the bladder (stage 2 & 3). Usually also involves removal of other sexual organs and lymph nodes (the seminal vesicles, vas deferens and/or prostate in men; the uterus and part of the vagina in women). In some cases, the doctor can create a new "bladder" using part of your intestine; in most cases, a small piece of intestine is used to carry the urine into an external appliance/bag. This surgery sometimes can be performed using smaller incisions with an operating robot.
Radiation Therapy – can sometimes be used with intravenous chemotherapy in patients with invasive cancer.
Chemotherapy – one or more drugs kill the cancer cells, either through injection into the urethra and bladder (intravesical) or into a vein (intravenous). Intravenous is usually indicated in preparation for surgery, or when the cancer has spread beyond the bladder.
Immunotherapy – a substance called BCG is injected into the bladder weekly for about six weeks to trigger the body’s immune response against the cancer cells. It is often used to prevent superficial cancer from recurring.
A rehab team may help you return to normal activities as soon as possible following treatment. If you have a stoma, an opening in your abdominal wall through which urine passes, an enterostomal therapist or nurse will help you learn about and care for your stomach.