People with bladder cancer often experience symptoms like blood in the urine (haematuria). These are caused by changes to cells that line the inside of the bladder.
A doctor will examine your bladder and may do a biopsy to check for cancerous tissue. The information from the biopsy will be used to determine your stage of bladder cancer.
Types
Cancer cells grow out of control and form a tumor, or mass. These masses can spread (metastasize) to other parts of the body. They can also grow back (recur) in the original site where they started, called a primary cancer.
Bladder cancer usually starts in the urothelial cells, which line the inside of the bladder. About 90% of all bladder cancers begin in these cells. The other types of bladder cancer start in other cells that line the urinary tract or other tissue, such as squamous cell carcinoma, which starts in thin, flat cells and makes up about 5% of all bladder cancers. Another type of bladder cancer, adenocarcinoma, starts in glandular cells. Small cell carcinoma is very rare and begins in the muscle cells of the bladder wall.
The type of bladder cancer you have and its stage determines your treatment options. Doctors describe the stage of a cancer based on how much it has grown into the tissue around it. They use the TNM system to describe the size of a tumor (T), how far the cancer has grown into the bladder wall (N) and whether it has spread to nearby lymph nodes (M).
If a cancer has not grown into the muscle layer of the bladder wall, doctors may call it noninvasive or nonmuscle-invasive. If it has spread into the connective tissue layer but not the muscle, doctors call it carcinoma in situ (CIS).
When a cancer has grown into the muscular layer of the bladder, doctors refer to it as muscle-invasive or invasive. Invasive cancers can spread to other tissues within the bladder, including the fatty tissue that surrounds it (perivesical tissue). They can also spread to other parts of the body, such as the lungs, prostate, rectum and ovary.
Doctors can also classify bladder cancer by its grade, based on how abnormal the cancer cells look under a microscope. Low-grade cancers look similar to normal cells and tend to grow slowly. High-grade cancers look more abnormal and grow faster. They are more likely to spread and come back after treatment.
Symptoms
Bladder cancer most often starts in the lining of the bladder. It can also start in the cells that line other parts of the urinary tract or in muscle cells. Different types of cancers tend to grow in different ways and cause different symptoms. The most common symptom is blood in the urine. It’s usually rusty red to bright red in color and may appear more than once. Bladder cancer can sometimes cause pain when you pee or a burning sensation. It can also make you urinate more frequently or have a hard time urinating. It’s important to see your doctor if you have any of these symptoms.
The first step in diagnosing bladder cancer is to take a sample of your urine. This is done to look for signs of cancer, such as hematuria (blood in the urine). It’s also helpful for doctors to know how long you’ve had these symptoms and whether they come back or get worse.
If the results of the urinalysis show signs of bladder cancer, the doctor will perform additional tests to find out how far the cancer has spread. This is called staging. For example, stage I bladder cancer is when the cancer is in the lining of the bladder but hasn’t gone into the muscle tissue yet. Stage II is when the cancer is in the inner or outer layer of muscle but hasn’t gone all the way through to the fatty tissue on the bladder wall.
Stage III is when the cancer has spread beyond the bladder lining to other tissues or organs in the body. In some cases, the cancer has reached the lungs and can cause shortness of breath or coughing. Cancer that has spread to the liver can cause jaundice, which is yellowing of the skin and whites of the eyes. It can also affect other organs, such as the kidneys and can cause pain in your back or pelvic area.
Certain things can increase your chances of getting bladder cancer, such as smoking tobacco and being older. People who smoke are two to three times more likely to have bladder cancer than nonsmokers. It’s also more common in men than in women. And if you’re black, you have a higher risk of getting the disease than Caucasians.
Diagnosis
The first step in diagnosing bladder cancer is usually a visit to your family doctor. Your doctor will ask you about your symptoms and do a physical exam. Your doctor may also order a blood test to check for the presence of cancer cells.
Bladder cancer is a disease that happens when certain cells in the tissue lining your bladder grow abnormally and form tumors. If left untreated, these tumors can grow into the wall of your bladder and spread to other parts of your body such as your lungs and bones.
There are several types of bladder cancer, and different ones behave differently. About 90 percent of bladder cancers are transitional cell carcinomas (also called urothelial carcinomas). This type of cancer begins in the cells that line the inner lining of the bladder. Other types of bladder cancer include squamous cell carcinomas (which begin in flat cells) and adenocarcinomas (which start in mucus-producing gland cells).
A key diagnostic procedure for bladder cancer is a cystoscopy. During this procedure, your doctor inserts a thin, lighted tube with a lens on the end into your urethra and bladder. The doctor can then look for signs of a tumor and take samples of tissue from the bladder to look at under a microscope. Your doctor may also perform a biopsy during this procedure.
Other tests that your doctor may use to help diagnose bladder cancer include a urine test and an ultrasound. Urine tests can detect small amounts of blood in the urine. The color of the blood in your urine can give your doctor clues about whether you have bladder cancer or another health problem.
An ultrasound is a test that uses sound waves to create pictures of your organs and tissues. Your doctor may also want to do a computed tomography (CT) scan or magnetic resonance imaging (MRI). These tests are useful for checking if the cancer has spread inside your body.
Once your doctor knows the stage of your tumor, he or she will be able to recommend the best treatment for you. If your cancer is in the early stages, a surgical procedure called a transurethral resection of bladder tumor (TURBT) or a procedure to remove only the affected part of your bladder may be enough. For more advanced cancers, you may need radiation therapy and chemotherapy.
Treatment
The treatment options for bladder cancer depend on the stage and grade of the tumor. The stage of the cancer indicates how deeply the cancer has grown into the muscle layer of the bladder wall (T stage). It also shows whether it has spread to nearby lymph nodes in the body (N stage) and to other parts of the body (M stage). Tumor grade is determined by how abnormal the cells look under a microscope.
The most common treatment for a person with bladder cancer is surgery to remove the affected part of the bladder. This is called a cystectomy. Doctors may also use other treatments in combination with the surgery to kill any remaining cancer cells and reduce a person’s risk of the cancer coming back. These other treatments include chemotherapy and radiation therapy.
For people with early-stage cancer, providers often recommend a procedure called transurethral resection of the bladder tumor or TURBT. This is an endoscopic or robotic procedure that uses a scope to remove the tumor from the bladder without making an incision in the abdomen. Doctors also may use a technique known as intravesical drug delivery to give medicine directly into the bladder through a tube inserted into your urethra. This lowers the recurrence rate of bladder tumors. Doctors also may prescribe a vaccine that helps boost your body’s immune system, such as Bacillus Calmette-Guerin (BCG).
Chemotherapy uses medicines to kill cancer cells or stop them from growing. In many cases, doctors recommend getting chemotherapy before surgery for muscle-invasive cancer (stages T3 and higher). This is called neoadjuvant therapy. Doctors may also recommend adjuvant chemotherapy after surgery to kill any undetected cancer cells that remain in the bladder and to improve survival rates.
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. It can be used in combination with other treatments, such as chemotherapy or BCG, to reduce the chance of the cancer returning after surgery.
Follow-up tests help doctors check for signs that the cancer has come back or spread to other parts of the body. These may include blood tests and urine exams. Follow-up exams are important because about 75% of early-stage bladder cancers come back. Try to go to your follow-up appointments even if you feel nervous about the exam. You can try coping strategies, such as writing your thoughts in a journal or talking to a friend, to make the test less stressful.
