The bladder is a balloon shaped organ that collects urine from the kidneys and stores it until it is eliminated through a tube called the urethra. The most common type of bladder cancer, transitional cell (also known as urothelial cell) carcinoma 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 the urine which may only be seen 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 are also common in other conditions 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
- Exposure to industrial chemicals
- Sex (men are at higher risk)
- Race (more common in Caucasians)
- 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 perform a thorough history and physical exam. Other tests may include:
- Urine cytology – examining urine cells under a microscope
- CT scan Urogram – a special x-ray that includes contrast dye to view the kidneys, ureters and bladder
- Cystoscopy – putting a thin scope into the urethra to view it and the bladder.
- Fluorescence in Situ Hybridization (FISH) test – 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 I – confined to the bladder lining. (60 to 70%) of bladder cancers are stage 1
- Stage II – spread to the muscle wall of the bladder
- Stage III – spread to tissues around the bladder
- Stage IV – spread to other organs
Determining the appropriate treatment depends on a number of factors, including your health and age, your cancer stage, 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 immunotherapy, radiation and/or chemotherapy in addition to or instead of surgery.
- Transurethral resection of bladder tumor (TURBT) – using a cystoscope and instruments, your doctor can see and remove cancerous tissue through the urethra
- Partial Cystectomy – removing part of the bladder, usually done when the cancer affects only one area of the bladder
- Radical Cystectomy – required when the cancer has invaded deep into the wall of the bladder (stages II and III). This procedure usually also involves removal of lymph nodes and in men, the prostate may also be removed. This procedure is done either robotically using the daVinci system, or as an open abdominal surgery.
A substance called BCG is injected into the bladder weekly for about 6 weeks to trigger the body’s immune response against the cancer cells. It is often used to prevent superficial cancer cells from recurring.
Can sometimes be used in conjunction with chemotherapy in patients with invasive cancer or patients who are not candidates for surgery.
One or more drugs kill the cancer cells, either through injection into the urethra and bladder (intravesical) or into a vein (intravenous).