Quick Facts
Bladder Cancer
- Risk factors include smoking, age, and environment
- Painless blood in urine could be a sign
Our Bladder Cancer Specialists
Bladder Cancer
Bladder cancer usually begins in the inner lining of the bladder, in special cells called transitional cells. It can also grow in other parts of your urinary tract system including your kidneys, ureters, and urethra.
Testing and Treatment
If your doctor cannot prove that another condition is causing blood your the urine, he or she will perform tests to confirm or rule out bladder cancer. If your diagnosis is bladder cancer, additional tests will find out the stage of your disease. It will also give your doctor an idea of what treatment is best for you. Some of these tests are described here.
The following tests most likely will be done:
- Urine cytology. The color and content of your urine will be checked. This test will also look at body cells under a microscope.to test for cancer cells.
- Blood tests: A comprehensive metabolic panel (CMP), which includes kidney and liver function tests will be among the blood tests your doctor will order.
- A Computerized tomography scan (also known as CT or CAT scans) with a bladder scope “cystoscopy” are often good enough to diagnose bladder cancer.
- Cystoscopy: A doctor will use a thin tube that has a light and camera at the end of it (cystoscope) to pass through the urethra into the bladder. It allows your doctor to see inside the bladder cavity. Usually your doctor will use a flexible cystoscope and a local anesthetic for your exam in the office. The doctor will take a tissue sample with a cystoscope in the operating room. Taking the tissue at this time will allow your doctor to look at the cells. The tissue sample will be sent to a laboratory where they will find out the stage of your cancer. This will help with choosing the right treatment.
- Rigid cystoscopy: The scope that the doctor uses when you are put to sleep is not flexible like the one used in the office, but rigid. This means that it is straight and does not bend. This cystoscope is bigger, has a light at the end, and surgical instruments can pass through it. This allows for more extensive work like the transurethral resection of bladder tumor (TURBT) described below.
If any of these tests suggest that you have bladder cancer, the next step to confirm the diagnosis is a transurethral resection of a bladder tumor (TURBT) described below. You will likely be put to sleep for this procedure. During a TURBT the doctor will both try to remove all visible tumors and take tissue. The tissue sample will be sent to a laboratory where they will find out important information about your cancer. They will also see whether the cancer has spread. This will help with choosing the right treatment.
- Transurethral resection of bladder tumor (TURBT). This is a very important procedure for accurate tumor typing, staging and grading. Your doctor can look inside the bladder, take tumor samples and resect (cut away) what he/she sees of your tumor.
- Blue light cystoscopy with TURBT. For this test, your doctor uses a catheter to place an imaging solution into your bladder through your urethra. The solution is left in the bladder for about an hour. The doctor then uses the cystoscope to inspect the bladder with regular white light and then with blue light. The bladder cancer cells show up better with blue light.
Other Additional Imaging tests: These tests may help your doctor diagnose and stage bladder cancer.
- Retrograde pyelogram: This test uses x-rays to look at your bladder, ureters and kidneys. The test is done during a cystoscopy.
- Magnetic resonance imaging (MRI) These tests use a powerful magnetic field, radio waves and a computer to produce detailed pictures of the inside of your body.
Treatments
A cancer diagnosis can be very frightening. However, your doctor and medical team are there to help you.
Talk with your health care team about all the available forms of treatment. They will tell you about possible risks and the side effects of treatment on your quality of life.
Your options for treatment will depend on how much your cancer has grown. Your urologist will stage and grade your cancer and assess the best way to manage your care considering your risk. Risks are classified as low, intermediate or high and suggests the likelihood of tumor recurrence and/or progression. Treatment also depends on your general health and age.
Options and Choices for Treatment
Treatments for non-muscle invasive bladder cancer include:
- Cystoscopic transurethral resection of the bladder tumor (TURBT)
- Intravesical Therapy
- Surgery
If these options fail to treat your cancer, your doctor may recommend removing the complete bladder.
TURBT
Transurethral resection of bladder tumor (TURBT) is usually done under anesthesia. The surgery is done through the urethra using a cystoscope, so there is no cutting into the abdomen. You will be given general or spinal anesthesia.
A rigid cystoscope is what your doctor will use for this procedure. This scope is straight and does not bend. It has a light at the end and is bigger and allows surgical instruments to pass through it. Your doctor is able to see inside the bladder, take tumor samples and resect (cut away) the tumor.
If a tumor is clearly seen, the doctor will attempt to remove it all. The doctor may also remove very small samples of other areas of the bladder that may look abnormal. These samples will also be checked for grade and stage. You may be left with a Foley catheter in your bladder after this procedure to allow your bladder to heal.
You may need to have a TURBT more than once to remove all potential tumor. During your follow-up examinations your doctor will check to make sure all the cancer is removed.
Intravesical Therapy
Intravesical (“within the bladder”) therapy, is when a treatment drug is put directly into your bladder. The drug is put into the bladder with the help of a catheter (a thin tube that is placed through the urethra). You will hold the drug in your bladder for one to two hours and then pass it out. Intravesical chemotherapy is usually given immediately after surgery.
Intravesical Immunotherapy
Immunotherapy is a treatment that boosts the ability of your immune system to fight the cancer. Bacillus Calmette-Guerin (BCG) is the immunotherapy drug that is used for bladder cancer. BCG also has been used as a tuberculosis vaccine.
Your BCG therapy will probably last about six weeks for the first course. It is usually done in your doctor’s office, not in the hospital or operating room. You may get BCG treatment more than once and some patients need many courses.
The BCG drug is inserted into the bladder through a catheter. The therapy triggers the immune system to attack bladder cancer cells. It is one of the most effective treatments for bladder cancer, especially carcinoma in situ (CIS). It is not recommended if you have a weak immune system or certain symptoms. Side effects can include:
- Urinating often
- Pain when urinating
- Flu-like symptoms
- Joint pain
- Fever or chills
- Bacteria infecting whole body (less common)
Intravesical Chemotherapy
Intravesical chemotherapy is usually given immediately after surgery. With intravesical chemotherapy, drugs that are known to kill cancer cells are placed directly into the bladder, not in the bloodstream. As a result, many common side effects of chemotherapy – like hair loss – can be avoided. Because the drugs only reach the bladder lining, this type of treatment is only recommended for NMIBC.
Mitomycin C and gemcitabine are the most common chemotherapy drugs used for intravesical therapy. It is usually given after the initial TURBT. It helps stop cancer cells from going to another place and growing. It also reduces the recurrence rates. It can also be given as a six-week induction course similar to BCG and some people need more than one course.
Common side effects include:
- The need to urinate often
- Painful urination
- Flu-like symptoms
- Skin rash
Repeat Intravesical Therapy
Some patients may respond to repeat therapy if the cancer returns. If you have high-grade Ta or T1 cancer or CIS, or you tried BCG and it did not work, you may need something else to control the cancer. In this case, you should talk to your doctor about surgery to remove the bladder.
Maintenance Intravesical Therapy
After the bladder is free of disease, your doctor may suggest more treatment with the same drugs to keep the tumor from coming back. This may happen at the first three-month appointment after treatment.
Maintenance therapy is a good choice for people who have had BCG, less so for those who have had chemotherapy drugs. It is given for up to three years after treatment, and generally about every six months for three weeks at a time.
Your doctor will talk to you about whether you are a candidate for maintenance therapy. He/she will also talk about whether intravesical chemotherapy or BCG are good options for you.
Surgery to Remove the Bladder
If you have NMIBC, you may have to remove your bladder if intravesical BCG therapy fails. You may also need to remove it if you are at a greater risk of getting the cancer again or of it spreading. Cystectomy is being recommended more and more for tumors that are high-grade T1, T1+CIS (carcinoma in situ) and T1+LVI (lymphovascular invasion)
Partial Cystectomy(removal of part of the bladder)
Partial cystectomy is a good choice for some patients if the tumor is located in a specific part of the bladder and does not involve more than one spot in the bladder. The surgeon removes the tumor, the part of the bladder containing the tumor, and nearby lymph nodes. After part of the bladder is removed, you may not be able to hold as much urine in your bladder as before surgery. You may need to empty your bladder more often.
Radical Cystectomy(removal of the whole bladder)
For NMIBC, radical cystectomy is usually done if other therapies fail. The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra. In men, he/she may remove the prostate as well. In women, the surgeon may remove the uterus, ovaries, fallopian tubes, and part of the vagina. Other nearby tissues may also be removed.
Urinary diversion after bladder removal
When your bladder is removed or partly removed, your urine will be stored and made to leave your body by a different route. This is called urinary diversion. If you have a radical cystectomy, you will need to know about urinary diversion options.
Because the surgeon uses tissue from your intestines for bladder reconstruction, you must have sufficient bowel tissue for them to create your urinary diversion method. Before this is done, your surgeon will explain the procedure to you so that you can understand what will be done and the adjustments you will need to make. Here are some of the urinary diversion options your surgeon may offer:
- Ileal conduit: To make an ileal conduit, the surgeon will take a piece of your upper intestine and use it to create an opening (stoma) on the surface of your abdomen. The ureters are connected so that the urine leaves your body by the opening. A bag will be attached to collect the urine, and you will “dump” the bag several times a day. This is the most simple, and most commonly used diversion after bladder surgery.
- Continent cutaneous reservoir: Your surgeon creates a pouch inside your body and you will learn to use a catheter to remove the urine.
- Orthotopic neobladder: Your surgeon creates an internal pouch, much like your bladder, to store urine. Your ureters are connected to this new “bladder” and you are able to empty through your urethra the same way you did before the surgery. In some instances, you may need to use a catheter to remove the urine.
Talk with your doctor about your options for a urinary diversion. Having a urinary diversion will greatly impact your quality of life.
Grading and Staging
Grade and stage are two important ways to measure and describe how cancer develops. A tumor grade tells how aggressive the cancer cells are. A tumor stage tells how much the cancer has spread.
Tumor Grade
Grading is one of the ways to know if the disease will come back. It also tells us how quickly the cancer may grow and/or spread.Tumors can be low or high grade. High-grade tumor cells are very abnormal, poorly organized and tend to be more serious. They are the most aggressive type.
Tumor Stage
The tumor stage tells how much of the tissue has the cancer. Doctors can tell the grade and stage of bladder cancer by taking a small sample of the tumor. This is called a biopsy. A pathologist in a lab examines the sample under a microscope and determines the grade and stage of the cancer.
The stages of bladder cancer are:
- Ta: Tumor on the bladder lining that does not enter any layers of the bladder
- Tis: Carcinoma in situ (CIS)-A high-grade cancer but “flat” cancer. It looks like a reddish, velvety patch on the bladder lining
- T1: Tumor goes through the bladder lining, into the second layer, but does not reach the muscle layer
- T2 : Tumor grows into the muscle layer of the bladder
- T3: Tumor goes past the muscle layer into tissue surrounding the bladder, usually fat surrounding the bladder
- T4: Tumor has spread to nearby structures of the bladder such as the prostate in men or the vagina in females
After Treatment
You should expect to return to your doctor for re-evaluation and further tests for some time after treatment and surgery. After you complete your initial evaluation and treatment for NMIBC, your health care provider may bring you back in, within three to four months, for a cystoscopy to see how you are doing. This helps him/her evaluate if the entire tumor was removed and assess your risk for the tumor to recur.
If your health care provider stages you as low-risk for cancer progression, then you will be asked to return, usually in three months, just for a surveillance scope of your bladder.
If you are an intermediate-risk patient, then your health care provider may ask you to return for a cystoscopy with cytology every 3-6 months for two years, then 6-12 months for three to four years, and then every year after. Cytology is the examination of cells from the body under a microscope. If you are intermediate to high risk, your urologist may place you on maintenance therapy as described before.
If you are high-risk for cancer progression, your health care provider may bring you back every three to four months for two years, then six months for three to four years, and then every year after.
You may also be given imaging tests as your health care provider sees fit. These imaging tests will be done to look for cancer in your kidneys and ureters.
If you had bladder removal surgery, it takes time to heal. The time needed to recover is different for each person. It is common to feel weak or tired for a while. However, like any other major surgery, bladder surgery may have complications. Older patients and women are more likely to get complications after cystectomy.
There are some things you can do before surgery to help your recovery. If you smoke, try to get help so that you can quit before and after surgery. You also need to make sure you eat right so that your body can heal and can cope with the changes.
Here are some possible problems you may have after treatment:
- Gastrointestinal (GI) problems: Your bowel function may return more slowly after your surgery. This often happens after abdominal surgery. Your surgeon and other health care providers will take steps to monitor bowel function and avoid GI problems.
- Urinary diversion: Urinary diversion following bladder surgery may present challenges for which you should prepare yourself. You may need to learn how to remove urine from your body with a catheter. There also is potential for leakage from the stoma (opening) that is made to take away urine. Infections related to urinary diversion may occur, as may infections related to the kidneys. It is important for you to learn as much as you can about the urinary diversion method that you will use, and how to manage changes to your body. Before you leave the hospital, your health care providers will ensure that you get the education you need so you can manage your new way of life.
- Hormonal changes: For females who are not yet menopausal, you may have hot flashes after your ovaries are removed.
- Reproductive health: When the prostate is removed, a man can no longer father a child. Also, a man may be unable to have sex after surgery. When the uterus is removed, a woman can no longer get pregnant. If the surgeon removes part of a woman’s vagina, then sex may be difficult.
- Sexual dysfunction: In reality, bladder cancer surgery is likely to affect your sex life. If you have a partner, you may be worried about maintaining sexual intimacy and your relationship. It may help you and your partner to talk about your feelings. You can find other ways to be intimate after you had treatment.If you do not have a partner, you may want to explore how to manage your dating life after bladder cancer surgery. Either way, you (and your partner) may benefit from the advice of a counselor who specializes in discussing sexual issues.
- Managing Pain: You may have pain or discomfort for the first few days following bladder surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control. Refer to the Pain Management Fact Sheet
Remember that each person is different and each body may respond differently to therapy. It is important that you take care of yourself and remain in contact with your health care provider. Try to adopt healthy lifestyle habits including exercise, a well-balanced diet and no smoking. Your health care provider also may recommend a cancer support group or individual counseling
Risk Factors
Smoking and exposure to secondhand smoke are the strongest risk factors for bladder cancer. Cigarette smokers have a 2-3 times greater risk of developing bladder cancer than nonsmokers.
- Age is another risk factor for bladder cancer. Eighty percent of bladder cancer cases occur in individuals 60 and older. Older men have a 2-3 times higher risk than women.
- Working with toxic chemicals regularly also increases the risk for bladder cancer.
Symptoms
How do you know that you may have bladder cancer? Some people may have symptoms that suggest they have bladder cancer. Others may feel nothing at all. Some symptoms should never be ignored. You may need to talk to a urologist about your symptoms. A urologist is a doctor who focuses on problems of the urinary system and male reproductive system.
Talk to your doctor if you have the following symptoms:
- Hematuria (blood in the urine) – the most common symptom, often without pain
- Frequent and urgent urination
- Pain when you pass urine
- Pain in your lower abdomen
- Back pain
Symptoms You Should Not Ignore
Blood in the urine is the most common symptom of bladder cancer. It is generally painless. Often, you cannot see blood in your urine without a microscope. If you can see blood with your naked eye you should tell your health care provider immediately. Even if the blood goes away, you should still talk to your doctor about it.
Blood in the urine does not always mean that you have bladder cancer. There are a number of reasons why you may have blood in your urine. You may have an infection or kidney stones. But a very small amount of blood might be normal in some people.
Frequent urination and pain when you pass urine (dysuria) are less common symptoms of bladder cancer. If you have these symptoms, it’s important to see your health care provider. He/she will find out if you have a urinary tract infection or something more serious, like bladder cancer.
Smoking and exposure to secondhand smoke are the strongest risk factors for bladder cancer. Cigarette smokers have a 2-3 times greater risk of developing bladder cancer than nonsmokers.
- Age is another risk factor for bladder cancer. Eighty percent of bladder cancer cases occur in individuals 60 and older. Older men have a 2-3 times higher risk than women.
- Working with toxic chemicals regularly also increases the risk for bladder cancer.
Frequently Asked Questions
BCAN’s, the Bladder Cancer Support Network, provides information and support and raise awareness for bladder cancer.
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