Bladder Cancer Overview, Treatment & More

Bladder Cancer

Overview

Your bladder is a hollow organ in the lower abdomen. It stores urine, the liquid waste made by the kidneys.

Your bladder is part of the urinary tract. Urine passes from each kidney into the bladder through a long tube called a ureter. Urine leaves the bladder through a shorter tube (the urethra).

The wall of the bladder has layers of tissue. The inner layer of tissue is also called the lining. As your bladder fills up with urine, the transitional cells on the surface stretch. When you empty your bladder, these cells shrink. The middle layer is muscle tissue. When you empty your bladder, the muscle layer in the bladder wall squeezes the urine out of your body. The outer layer covers the bladder. It has fat, fibrous tissue, and blood vessels.

Cancer Cells

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the bladder and the other organs of the body.

Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Tumors in the bladder can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:

Benign tumors:

are usually not a threat to life
can be treated or removed and usually don’t grow back
don’t invade the tissues around them
don’t spread to other parts of the body

Malignant growths:

may be a threat to life
usually can be removed but can grow back
can invade and damage nearby tissues and organs (such as the prostate in a man, or the uterus or vagina in a woman)
can spread to other parts of the body

Bladder cancer cells can spread by breaking away from the original tumor. They can spread through the blood vessels to the liver, lungs, and bones. In addition, bladder cancer cells can spread through lymph vessels to nearby lymph nodes. After spreading, the cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about bladder cancer that has spread.

Symptoms

Bladder cancer may cause these common symptoms:

Finding blood in your urine (which may make the urine look rusty or darker red)
Feeling an urgent need to empty your bladder
Having to empty your bladder more often than you used to
Feeling the need to empty your bladder without results
Needing to strain (bear down) when you empty your bladder
Feeling pain when you empty your bladder

These symptoms may be caused by bladder cancer or by other health problems, such as an infection. People with these symptoms should tell their doctor so that problems can be diagnosed and treated as early as possible.

Diagnosis

If you have symptoms that suggest bladder cancer, your doctor will try to find out what’s causing the problems.

You may have a physical exam. Also, you may have one or more of the following tests:

Urine tests: The lab checks your urine for blood, cancer cells, and other signs of disease.
Cystoscopy: Your doctor uses a thin, lighted tube (a cystoscope) to look directly into your bladder. It may be done at your doctor’s office. This test can
be uncomfortable because the doctor will insert the cystoscope into the bladder through your urethra. You may need local anesthesia for this test.
Biopsy: Your doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present.

For a small number of patients, the doctor removes the entire area with cancer during the biopsy. For these patients, bladder cancer is diagnosed and treated at the same time.

These are the stages of bladder cancer:

Stage 0: The cancer cells are found only on the surface of the inner lining of the bladder. The doctor may call this carcinoma in situ.
Stage I: The tumor has grown deeper into the inner lining of the bladder. But it hasn’t invaded the muscle layer of the bladder.
Stage II: The tumor has invaded the muscle layer of the bladder.
Stage III: The tumor has grown through the muscle layer to reach tissues near the bladder, such as the prostate, uterus, or vagina.
Stage IV: The tumor has invaded the wall of the pelvis or abdomen, but cancer is not found in any lymph nodes. Or, the cancer cells have spread to at least one lymph node or to parts of the body far away from the bladder, such as the liver, lungs, or bones.

Treatments

Treatment options for people with bladder cancer are surgery, chemotherapy, biological therapy, and radiation therapy. You may receive more than one type of treatment.

The treatment that’s right for you depends mainly on the following:

The location of the tumor in the bladder
Whether the tumor has invaded the muscle layer or tissues outside the bladder
Whether the tumor has spread to other parts of the body
The grade of the tumor
Your age and general health

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a urologist, a surgeon who specializes in treating problems in the urinary tract. Other specialists who treat bladder cancer include urologic oncologists (surgeons who specialize in cancers of the urinary tract), medical oncologists, and radiation oncologists.

Your health care team may also include an oncology nurse and a registered dietitian. If your treatment involves surgery to remove the bladder, a wound, ostomy and continence nurse may also be part of your team.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type and extent of treatment.

Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

Causes

When you get a diagnosis of bladder cancer, it’s natural to wonder what may have caused the disease. Doctors can’t always explain why one person gets bladder cancer and another doesn’t.

However, we do know that people with certain risk factors may be more likely than others to develop bladder cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for bladder cancer:

Smoking: Smoking tobacco is the most important risk factor for bladder cancer. Smoking causes most of the cases of bladder cancer. People who smoke for many years have a higher risk than nonsmokers or those who smoke for a short time.
Chemicals in the workplace: Some people have a higher risk of bladder cancer because of cancer-causing chemicals in their workplace. Workers in the dye, rubber, chemical, metal, textile, and leather industries may be at risk of bladder cancer. Also at risk are hairdressers, machinists, printers, painters, and truck drivers.
Personal history of bladder cancer: People who have had bladder cancer have an increased risk of getting the disease again.
Certain cancer treatments: People with cancer who have been treated with certain drugs (such as cyclophosphamide) may be at increased risk of bladder cancer. Also, people who have had radiation therapy to the abdomen or pelvis may be at increased risk.
Arsenic: Arsenic is a poison that increases the risk of bladder cancer. In some areas of the world, arsenic may be found at high levels in drinking water. However, the United States has safety measures limiting the arsenic level in public drinking water.
Family history of bladder cancer: People with family members who have bladder cancer have a slightly increased risk of the disease.
Many people who get bladder cancer have none of these risk factors, and many people who have known risk factors don’t develop the disease.

Getting Help

Every cancer diagnosis is different, just as every person who is diagnosed with cancer is different. Cancer knows no barriers to race, age, or social group. However there is one thing that each and every person who is diagnosed with cancer will have in common: help with fighting and beating the disease.

Life after being diagnosed with cancer will be different for everyone. Some people will have minimal disease and it will be a short chapter of their lives, while others will have a diagnosis that will change the course of the rest of their lives. Cancer diagnoses can change relationships, your routines, your work and home life. One thing is certain, no one person’s experience will be exactly the same. There are however, plenty of resources to learn about what life was like for other people, and what they did to achieve balance, maintain their health and personal life, keep peace of mind, and enjoy their lives with or after cancer.

Clinical Trials

The search for a cure for cancer is an ongoing, constant battle. Clinical trials are the basis upon which new treatments and medications are proven to help the fight against cancer, or if researchers should pursue another tactic. The advancement of medicine depends on willing and able cancer patients to volunteer for experimental treatments so that future generations will have proven and effective cures. Not every patient with cancer will be eligible for a clinical trial, as the scientific method needs specific patients with specific types of cancers. However, patients who are selected for trials may benefit from being at the cutting edge of new research, and gain time they otherwise might not have had.

The National Cancer Institute at the National Institutes of Health has a comprehensive database of over 10,000 ongoing clinical trials that both help advance medicine and help patients.

Financial Help

Unfortunately, cancer treatment can be costly, even if a patient has very comprehensive health insurance. For patients who do not have health insurance, the cost of treatment may seem insurmountable. Fortunately many pharmaceutical companies offer cost assistance to help make treatment more affordable. The National Comprehensive Cancer Network has compiled a Virtual Reimbursement Room where patients can find information for accessing financial help with their treatment costs.

Related Information

According to the American Cancer Society, some 73,500 Americans will learn they have bladder cancer this year. If the cancer has not spread beyond the bladder, 98 percent of these people will be alive five years after being diagnosed.

Still, the disease takes nearly 15,000 people in the United States every year.

Living With

Your experience with cancer will depend on the type of cancer you have, your choices of treatment and the lifestyle you lead. Be sure to speak with your Doctor about the side effects of your disease and the treatments you choose. Your Doctor will be able to consult with you on realistic lifestyle expectations.