Bladder Cancer

What Is Bladder Cancer?

It is cancer that forms in the bladder. The most common type of bladder cancer is urothelial carcinoma (UC). It begins in the lining of the bladder and is the fourth most common cancer in men in the US. UC occurs mainly in men over the age of 55. Women are less likely to get bladder cancer. Most bladder cancer is diagnosed while confined to the inner lining of the bladder. The good news is that most bladder cancers are diagnosed early and are treatable. Other less common types include squamous cell carcinoma and adenocarcinoma and tend to be more aggressive. This article discusses UC.

What Are the Causes of Bladder Cancer?

• Smoking causes almost 50% of bladder cancers.
• Workplace chemicals increase the risk for bladder cancer. Hairdressers, machinists, printers, painters and truck drivers are all at increased risk for bladder cancer.
• Family history increases your risk for bladder cancer.
• Cancer treatments like chemotherapy and radiation therapy to the abdomen or pelvis can increase the risk.

However, many people without any of these risk factors get bladder cancer, and many people with these risk factors do not get bladder cancer.

Bladder Cancer Symptoms

• Blood in the urine without pain - producing urine that looks dark red or rusty
• Feeling an urgent need to urinate even when the bladder is not full
• Frequent urination - more than you are used to
• Pain on urination

These symptoms are similar to those of other health problems including bladder infections and kidney stones. It is important to talk to your doctor so that your problem can be diagnosed and treated early.

How is Bladder Cancer Diagnosed?

You will be referred to a urologist who specializes in treating bladder cancer. Your urologist will ask about your medical and family health history. You will receive a physical exam, and you may have these initial tests:

• Urinalysis to see if there are cancerous or precancerous cells in the urine or tumor markers
• Cystoscopy – the urologist will use a thin, lighted tube to view your bladder
• A biopsy of bladder tissue will be taken during the cystoscopy to see if cancer is present, and if so, determine the type
• X-ray imaging of the entire urinary tract using a CT Urogram to provide detailed information about the the kidney, ureters, and bladder

Additional tests may be needed and could include:

• Blood work
• Chest X-ray
• IVP dye and x-rays of your bladder and urinary tract
• MRI
• Ultrasound
• Bone scans

Grading and Staging the Tumor

Grading the cancer: When cancer cells are found in the bladder tissue samples they will be examined under a microscope. A pathologist will grade the cells, which means he will determine the grade by how much the abnormal tissue differs from normal tissue. The higher the grade, the faster the tumor will grow and spread. The results of these tests will help your doctor to determine treatment options.
Staging cancer: Staging is a determination of the extent of the disease. There are 5 stages of bladder cancer:

Stage zero is where the cancer cells are only on the inner lining of the bladder, called carcinoma in situ (CIS).

• Stage 1 is where the tumor has grown deeper into the bladder inner lining but has not invaded the bladder muscle. Most bladder cancers are stage 1.
• Stage 2 is where the tumor has invaded the bladder muscle.
• Stage 3 is where the tumor has spread through the muscles of the bladder to invade the prostate, uterus or vagina.
• Stage 4 is where the tumor has invaded the wall of the pelvis or abdomen, but not the lymph nodes. Or it has spread to the lymph nodes or other parts of the body.

Bladder Cancer Treatment

Generally, the options are surgery, chemotherapy, immunotherapy or biological therapy and radiation therapy or a combination of treatments. Treatment choice depends on the stage and grade of the tumor, where it is located, whether it has spread, where it has spread and your general health and age.

• Non-muscle invasive stages A, in-situ, and 1 tumors can be removed without skin incisions by resection or laser ablation via a cystoscope. After resection of the tumors, chemotherapy or immunotherapy will be given directly into the bladder to destroy residual tumor cells at the surgical site and circulating cells, to prevent new tumors and disease recurrence. Frequent and lifelong follow-up will be necessary due to the high frequency of local recurrence and progression.
• Invasive bladder cancers (stages 2 – 4) spread when some of the cancer cells break away from the original tumor and travel through the blood vessels and the lymph nodes to the liver, lungs and bones (metastases). They require more aggressive treatments such as removal of the bladder, prostate in men, and female reproductive structures in women. A urinary diversion is usually necessary with these procedures. Combined multi-modal therapy with tumor resection, radiation and chemotherapy is also another option with less effective cancer control but may be appropriate for some people.

The urologists at Erlanger Urology are world-class bladder cancer specialists with expertise in state-of-the-art treatments. They work with a team including radiologists and oncologists to provide you with personalized care. 

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