The bladder is a distensible pelvic organ that stores urine before urination. It is made up of layers including the urothelium(lining), smooth muscle, and connective tissue. It is surrounded by a thin layer of fat and lymphatics. When full it will hold about 500 ml, the size of a small grapefruit. The most common type of bladder cancer, transitional or urothelial cell, starts in the lining (urothelium) of the bladder wall. If left untreated it may then invade into the muscle or fatty layers of the bladder and eventually spread to other areas.
Early stages of bladder cancer often produce no symptoms. Your first warning sign may be hematuria (blood in your urine) that sometimes may only be visible under a microscope.
OTHER COMMON SYMPTOMS OF CANCER IN THE BLADDER INCLUDE:
- Painful urination
- Frequent urination or feeling an urge to urinate without results
- Slow or intermittent urine stream
- Pelvic pain
These symptoms are nonspecific and could indicate other medical problems, such as urinary tract infections, bladder stones or prostate disorders; you will need a thorough evaluation to determine the cause of the symptoms and to exclude bladder cancer.
The following factors increase your risk of cancer in the bladder (bladder cancer):
- Cigarette smoking — By far the greatest risk factor. Second-hand smoke is a likely risk factor as well.
- 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 urinary 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
- CT Urography — upper urinary tract imaging (usually a CAT scan) that includes contrast dye, to view the kidneys, bladder and ureters (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 at a later date under anesthesia.
- Tumor Marker Tests — There are times when specialized tests that look for markers or proteins in the urine may improve our ability to screen for or stage cancer of the urinary tract.
- Flourescence in Situ Hybridization (FISH) or CX Bladder — Urine tests that assay for chromosomal abnormalities and may provide early detection of transitional cell cancer of the urinary tract.
The stage of bladder cancer depends on the depth of invasion and whether there is cancer away from the site of origin based usually on imaging. The pathological stage refers to the presence or character of the cancer in tissues removed at surgery – like lymph nodes.
- Stage Ta superficial — cancer found only on the surface or lining of the bladder – 60-70% of patients have Stage Ta disease
- Stage Tis — Carcinoma in situ (CIS) this is an aggressive type of bladder cancer that is still only on the surface but has increased risk of invasion if left untreated.
- Stage T1 — invasion into the tissue below the lining but not into muscle.
- Stage T2 — invasion into the muscular walls of the bladder
- Stage T3 — invasion into the deepest layers of the muscle or into the fat beyond the muscle.
- Stage T4 — spread to other organs
Treatment is mostly based on tumor grade, stage, and presence or absence of distant spread. Patient age, health, and preferences are also important factors to be considered before recommendations are made.
Stage Ta – Superficial tumors that can be cured with resection (removal with the scope) alone. Recurrence rates are 20 – 50 % and so careful surveillance is needed. If Ta bladder cancer is high grade and becomes recurrent under surveillance, then selected patients may benefit from the addition of medicine placed in the bladder after resection to prevent recurrences. See BCG below.
Stage Tis – Carcinoma in situ (CIS) is high-grade cancer on the surface that is at increased risk of recurrence or invasion if left untreated. After biopsy-proven diagnoses, placing medicine into the bladder weekly for 6 weeks can reduce the risk of recurrences from over 80 percent to about 30 percent. The best medicine today is immunotherapy with BCG. BCG is an attenuated (deactivated) tuberculosis organism that is suspended into saline and instilled into the bladder weekly for a determined number of treatments. Cystectomy (removal of the bladder and surrounding tissues) is recommended for some patients with CIS when refractory to other treatments.
Stage T1 – Resection (surgical removal of the tumor through a cystoscope) is required to make the diagnosis of T1 bladder cancer and at times can be curative. BCG is usually used to prevent recurrence. Cystectomy is recommended for some T1 patients with aggressive cancer that is recurrent after local treatment.
Stage T2 – T4 – in general, staging lymph node resection and cystectomy are recommended for these stages of invasive bladder cancer. Some patients benefit from chemotherapy or radiation treatment as an alternative to (or in addition to) surgery.
Rehabilitation after Treatment for Cancer in the Bladder
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 stoma. A visiting nurse may also come to your home for a while to assist with the learning process.