Bladder Cancer

Condition

What is Bladder Cancer?

Bladder cancer is a type of genitourinary cancer that starts in the bladder and makes up approximately 5% of all new cancer cases in the U.S. Most cases of bladder cancer start in the cells that line the insides of your bladder. If untreated, bladder cancer can quickly spread to other areas of the body, limiting your treatment options.

Mercy is a leader in diagnosing and treating genitourinary cancers, including bladder cancers. Our team of cancer specialists will pinpoint the cause of your symptoms and develop a unique treatment plan for relief. 

Types of Bladder Cancer

There are numerous types of bladder cancer that are categorized depending on where it formed, in addition to other factors. According to the American Cancer Society, bladder cancers may be described as invasive or non-invasive based on whether they have spread into the bladder wall. 

  • Non-invasive bladder cancer - cells are found in the inner layer of cells but have not grown into the deeper layers.
  • Invasive bladder cancer - cells that have grown into the deeper layers of the bladder wall, making them more likely to spread and more difficult to treat.  

Bladder cancer is also divided into two subtypes:  papillary carcinomas and flat carcinomas, based on how they grow.

Urothelial Carcinoma

Also referred to as transitional cell carcinoma (TCC), urothelial carcinoma is the most common type of bladder cancer. TCC is a papillary or flat tumor that grows into the deeper layers of the bladder. 

Other Types of Bladder Cancer

There are additional types of bladder cancer, yet they are very rare. Other bladder cancer types include the following.

  • Squamous cell carcinoma. Squamous cell carcinoma makes up only about 1 - 2% of all bladder cancers in the US and is almost always invasive. It develops in the bladder lining in response to chronic irritation and inflammation, often the result of an infection.
  • Adenocarcinoma. Adenocarcinoma makes up about 1% of all bladder cancers and almost all cases of adenocarcinoma in the bladder are invasive.
  • Small cell carcinoma. Small cell carcinoma begins in the neuroendocrine cells and makes up less than 1% of all bladder cancers in the US. It typically grows very quickly but can be treated effectively with chemotherapy.
  • Sarcoma. Bladder sarcomas start in the muscle layer of the bladder wall and tend to form in openings between the ureters and the urethra. However, they can also develop in the bladder itself. Bladder sarcomas are the most common kind of genitourinary sarcomas.

Bladder Cancer Causes & Risk Factors

Although all of the causes of bladder cancer are unknown, researchers do know that some cases are related to gene mutations that occur during a person's lifetime. Additional risks for bladder cancer may include the following factors.

The risk of developing bladder cancer increases with age. It typically occurs more in individuals over the age of 55 and less in individuals under the age of 40. Additionally, bladder cancer is far more common in men than in women. In fact, men develop bladder cancer at about four times the rate of women.  

People who smoke or have a history of heavy smoking develop bladder cancer at more than three times the rate of those who don't smoke or use tobacco products.

People who work with certain industrial chemicals or in environments where harmful substances are present may be at greater risk. Radon and asbestos are two of the known chemical substances known to cause cancer in humans. If you’ve received prior radiation therapy or chemotherapy, you may also be at greater risk—especially if you’ve received radiation directly to the pelvic area or had sustained use of chemo.

If you have a history of developing bladder infections, bladder stones, kidney stones or have prolonged bladder irritation, you may be at greater risk of developing bladder cancer. Additionally, having cancer in any area of the urinary tract can increase your chances of developing cancer again. In fact, bladder cancer has a very high recurrence rate.

Having Cowden syndrome, Lynch syndrome or other genetic syndromes can increase your risk of developing bladder cancer at some point in your lifetime. 

Risk Factors for Bladder Cancer

Mercy’s Dr. Gautum Agarwal discusses risk factors and common causes of bladder cancer.

Bladder Cancer Signs & Symptoms

As with most genitourinary cancers, the earlier bladder cancer is found, the more successful treatment is likely to be. In about 90% of cases, one of the first signs of bladder cancer is blood in the urine. Additional signs of bladder cancer can include:

  • Pain or burning during urination
  • Having to urinate more often
  • Difficulty urinating, including a slow or weak stream
  • Pelvic or back pain

Advanced Bladder Cancer Symptoms

Symptoms of more advanced bladder cancer can include:

  • Lower back pain on one side
  • Weight loss or sudden loss of appetite
  • Inability to pass urine
  • Chronic bone pain
  • Swelling of the feet and/or ankles

It’s not unusual for people showing signs of bladder cancer to assume their symptoms are not cancerous. That’s because common symptoms are often similar to other medical conditions, such as a urinary tract infection or an overactive bladder. If you notice any changes in your urination habits or see blood in your urine, talk to your Mercy doctor immediately.

Diagnosing & Treating Bladder Cancer

Mercy’s cancer specialists will create an individualized treatment plan based on your needs and condition. Using a combination of proven screening tools and testing procedures, your Mercy doctor will diagnose your cancer and discuss the next steps with you. 

How to Test for Bladder Cancer 

Bladder cancer is often diagnosed in its early stages and is typically diagnosed by the following diagnostic imaging and labs.

One of the most common ways to check for bladder cancer is through a test known as a cystoscopy. This procedure may be used to remove tissue samples from the bladder or to remove tumors from the surface of the bladder wall.

During this test, medicines known as porphyrins are inserted into the bladder. These drugs are then absorbed by cancer cells, which causes them to glow beneath a blue light. This process allows your Mercy doctor to pinpoint cancer cells in the bladder that may have been missed during the routine white light cystoscopy.

urinalysis is a simple test that checks for blood and other substances in the urine. Usually, when blood is found in the urine, it’s a sign of less severe problems, such as an infection. A urinalysis can detect changes to the urine untraceable to the human eye, which may catch harmful diseases, such as bladder cancer, in their early stages.

X-rays and CT scans are two examples of imaging tests your Mercy doctor may recommend to see if your bladder cancer has spread to other parts of the body. Images may be taken of your upper or lower urinary tract, which includes your kidneys, ureters and urethra. Based on the results of the test, a biopsy may be needed to confirm any findings. 

Bladder Cancer Prevention

Bladder cancer cannot be completely prevented. However, there are steps you can take to reduce the risk factors that are within your control. Preventive factors include:

  • Avoiding tobacco products
  • Limiting exposure to workplace chemicals known to cause bladder cancer, such as asbestos and radon
  • Drinking water to stay hydrated

Bladder Cancer Treatment Options

Treatment for bladder cancer generally involves surgery. Additional treatments, such as radiation therapy and chemotherapy, may be given either before or after surgery to help with your recovery. No matter what stage your bladder cancer is in, Mercy will help develop a treatment plan that’s right for you. 

Depending on the stage of your bladder cancer, surgical cancer treatments may be the first option. Surgical treatments for bladder cancer include transurethral resection (TURBT), cystectomy and bladder reconstruction surgery.
 

Transurethral Resection of Bladder Tumor (TURBT)

Minimally invasive by nature, a TURBT is a procedure that kills cancer cells by using an electric current or laser. During a TURBT, a thin cystoscope also known as a resectoscope is put through your urethra into your bladder. The resectoscope removes any abnormal tissues or tumors. Since TURBT requires no incisions, it’s usually performed as an outpatient procedure.


Most people who have bladder cancer only need TURBT treatment. Once the cancer is removed, patients will need occasional cystoscopy exams to make sure the tumor has not returned.
 

Cystectomy


Commonly used for more advanced bladder cancers, a cystectomy is a surgical procedure that involves the removal of part or all of the bladder.

  • Partial cystectomy - a partial cystectomy. removes only the infected part of your bladder.
  • Radical cystectomy - a radical cystectomy removes your entire bladder. If your bladder is removed completely, your doctor will also perform a type of surgery called urinary diversion. This allows urine to leave your body through a replacement bladder or an opening made in the abdominal wall.


Treatment for Bladder Cancer in Men

Men who need to have a radical cystectomy will usually have their prostate and seminal vesicles removed. This means they’ll no longer be able to produce the fluid needed to make semen. If you’re concerned about having children after your surgery, talk to your Mercy physician about your options.


Treatment for Bladder Cancer in Women

Women who undergo a radical cystectomy may also have their ovaries and uterus removed. Given the average age of menopause onset, treatment is much less likely to impact female fertility, since bladder cancer typically occurs in people over 55. However, if you're a woman who develops bladder cancer before menopause onset and you want to have children, talk to your Mercy doctor about what treatment options are available.

Your Mercy doctor may recommend radiation therapy before surgery to shrink your tumor or after surgery to eliminate any remaining cancer cells. Radiotherapy is also recommended for patients who are not candidates for surgery. You’ll want to review the possible side effects with your Mercy doctor before deciding if radiation therapy is right for you. 

Bladder cancer treatment plans may include chemotherapy if your cancer has spread to the lymph nodes or other distant parts of your body. It also may be used in combination with surgery and radiation therapy to increase effectiveness. In some cases, flushing the bladder with chemo drugs after the surgical removal of tumor(s) may reduce the risk of cancer recurring. Chemotherapy drugs can be delivered directly into the bladder, given in pill form or administered with an IV.

Also known as biological therapy, immunotherapy is the use of certain drugs that allow a person’s immune system to recognize and fight cancer cells in the body. Currently, BCG is the most effective biologic drug used to treat bladder cancer and prevent it from returning. Bacillus Calmette-Guérin (BCG) is a type of bacteria closely related to the one that causes tuberculosis. The BCG vaccine is a live bacteria instilled into the bladder. Designed to recruit immune cells, it attacks harmful cancer cells. 

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