What is Bladder Cancer?
The bladder is a hollow, flexible pouch in your pelvis. Its main job is to store urine before it leaves your body. Your kidneys make pee. Tubes called ureters carry the pee from your kidneys to your bladder. When you use the bathroom, the muscles in your bladder push the urine out through a tube called the urethra. You get bladder cancer when cells inside of it grow out of control. Over time, a tumour forms. At the diagnosis, 75% of bladder cancers are just superficial and doesn't infiltrate the bladder wall. In the remaining 25% it has already spread to nearby fat and tissue. In severe cases, it can spread to distant parts of your body, including your lymph nodes, bones, lungs, or liver. Bladder cancer is rare. It accounts for just 5% of all new cancers in the U.S. The 5-year survival rate for bladder cancer is about 77%. That means that about 7 out of 10 people who are diagnosed with the disease will still be alive 5 years later. But that's just an estimate. Your outcome is based on your unique situation. That includes things like your age, overall health, how early the cancer was found, and how well it responds to treatment.
What Causes It?
Doctors aren't sure. But they do know that several things increase your risk for the disease. They include:
Genetic makeup, race, and family history. Bladder cancer is most common in white men over age 40. If you or someone in your immediate family (parents or siblings) has had cancer of the bladder or the urinary tract before, you're more likely to get it.
Chronic bladder inflammation. If you have bladder infections that keep coming back or another condition that causes your bladder to be irritated for long periods of time, you stand a better chance of getting bladder cancer.
Smoking . Every time you inhale tobacco fumes, you're taking in all kinds of harmful chemicals. Over time, these build up in your bladder. You may pee some of them out. But they can still damage the lining of your bladder and put you at risk for cancer.
Working around harmful chemicals. People who work in certain industries (painters, machinists, printers, hairdressers, and truck drivers, among others) may be exposed to harmful chemicals for long periods of time. This can increase their risk of disease.
Taking certain diabetes medications. If you've taken pioglitazone (Actos) for more than a year, you may stand a greater chance of getting bladder cancer. Other diabetes meds that contain pioglitazone (Actoplus Met and Duetact) can also raise your risk.
Prior chemo or radiation treatment. If you've had radiation therapy to your pelvis, you're more likely to develop bladder cancer. The same is true if you've taken the chemo medication cyclophosphamide(Cytoxan) for a long time.
The most common -- and often, the first -- symptom is blood in your urine. It may be just a little, or it can be enough to change the color of your pee. It may turn orange, pink, or darker red. You may see blood one day, but not the next. If you have bladder cancer, the blood eventually comes back. In some cases, you can't see blood in your urine. Your doctor or lab tech will only see it under a microscope. Make an appointment if you have any of these other symptoms:
- You have to pee more often than usual
- Your urine changes color
- It hurts or burns when you pee
- You feel like you have to pee -- even if your bladder's not full
- You can't pee, or you pee very little
If you notice any of these things, call your doctor, but don't panic. Having these symptoms doesn't mean you have cancer. You could have a urinary tract infection, bladder infection, or some other less serious condition. Once bladder cancer starts to spread, you may notice that:
- You can't pee, even when you feel like you have to
- Your lower back hurts
- You're losing weight without trying
- You're not as hungry as usual
- You have swollen feet
- Your bones hurt
- You often feel extremely tired or weak
Again, see your doctor if any of these things happen to you. They could also signal that you have something other than bladder cancer. o find out whether you have bladder cancer, the first thing your doctor probably will do is a complete medical history. He'll ask you about your overall health, as well as anything that increases your risk, like having a family member who had bladder cancer. Next, he'll probably do physical exam. This may include a pelvic exam (for women) or a digital rectal exam (DRE). In this procedure, your doctor will put on a glove and insert one finger into your rectum. This will allow him to feel a tumor in your bladder. It'll also give him an idea of how big it is or whether it has spread. If your doctor finds something that's not normal, he'll order lab tests. He might also send you to see a urologist. That's a doctor who focuses on diseases affecting the urinary system (kidneys, bladder, etc.) and male reproductive system. Your urologist may run the following tests to get a better idea of what's going on:
When you pee in a cup at your doctor's office, there are a number of things he and other health professionals can look for:
- Urinalysis. Your doctor will check to see if there's any blood, or other substances, in your urine.
- Urine cytology. Your doctor will use a microscope to check your urine for cancer cells.
- Urine culture. Your doctor will send your urine to a lab. After a few days, lab technicians will check to see what kinds of germs grow in it. These results will tell your doctor if you have a bladder infection.
- Urine tumor marker tests. These look for substances that are released by bladder cancer cells. Your doctor may use one or more of these along with a urine cytology to see if you have the disease.
Your doctor will place a cystoscope through the opening of your urethra -- the duct that you pee through -- and into your bladder. The cytoscope is a thin tube with a light and video camera on the end. Your doctor will inject salt water through the tube and into your bladder. This will allow him to see the inner lining of your bladder with the camera. He may give you medicine to numb your urethra and bladder. If the procedure is done in the operating room, you'll be given anesthesia so you won't be awake.
These use X-rays, magnetic fields, sound waves, or radioactive substances to create pictures of what's happening inside your body. Here are just a few of the imaging tests your doctor may use to see if you have bladder cancer:
- Ultrasound. Sound waves create pictures of your urinary tract. It allows your doctor to see how big a bladder tumor is.
- Contrast enhanced CT scan. This will give your doctor an image of your kidney, bladder, and ureters (tubes that carry pee from your kidneys to your bladder). It'll show tumors in your urinary tract. It can also show lymph nodes that contain cancer.
- MRI. This test uses radio waves and sound magnets to create images of your urinary tract.
- Chest X-ray. If cancer in your bladder spread to your lungs, this test will allow your doctor to see it.
- Bone scan. Cancer that has spread from your bladder to your bones will be visible through this scan.
Bladder cancer, like other cancers, is measured in stages. The stages describe how far your cancer has spread. This key piece of information will help you and your doctor choose the best treatment for your unique case. There are two types of stages for bladder cancer -- the clinical stage and the pathologic stage. The clinical stage is your doctor's informed opinion of how far your cancer has spread. This is based on results of a number of tests, including physical exams, imaging tests like MRIs or CT scans, and biopsies. Your doctor will use this information to plan your treatment. The pathologic stage is something your doctor determines after surgery to remove the cancer. He'll look at previous test results. He'll also examine what he found during surgery to give you an idea of how far your cancer has spread.
What Do Different Bladder Cancer Stages Mean?
The American Joint Committee on Cancer (AJCC) created a method of staging cancer called the TNM system. It's used to describe how far the disease has spread. It's based on the following three key pieces of information:
- T (Tumor) -- This measures how far the main tumor has grown through the bladder and whether it has spread into nearby tissues.
- N (Lymph Nodes) -- These are groups of cells that fight disease. "N" is used to describe whether cancer has spread into your lymph nodes.
- M (Metastasized) -- Doctors use this to describe whether the disease has spread into organs or lymph nodes that aren't near the bladder.
Your doctor will assign a number or letter after T, N, and M. The higher the number, the more the cancer has spread. Once he's determined your T, N, and M stages, your doctor will use this information to give you an overall cancer stage. These range from 0 to the Roman numeral IV. Here's what each stage means:
Stage 0: The cancer has only grown into the center of your bladder. It hasn't spread into the tissues or muscle of your bladder wall itself. It hasn't spread to your lymph nodes or other organs, either.
Stage I: The cancer has grown into the lining of your bladder, but not the muscle of your bladder wall. Nor has it spread to your lymph nodes or distant organs.
Stage II: The cancer has grown through the connective tissue in your bladder and into your muscle.
Stage III: Cancer is now in the layer of fatty tissue that surrounds your bladder. It may also be in your prostate, uterus, or vagina. But it hasn't spread to nearby lymph nodes or to distant organs.
Stage IV: This may include any of the following:
- The cancer has spread from your bladder into your pelvic or abdominal wall. But it hasn't spread to lymph nodes or distant organs.
- The cancer has spread to nearby lymph nodes. But it hasn't reached distant organs.
- Cancer is now in your lymph nodes or distant sites like your bones, liver, or lungs.
The more information you have about the stage of your bladder cancer, the better able you'll be to choose the right treatment option for you.
If you have bladder cancer, there are several available treatment options. Your doctor will help you decide which treatment is best for you and this will depend on a number of things. These include your age, how much the cancer has spread (doctors call this your cancer"stage"), and any other health conditions you have.
Trans-Urethral Resection of Bladder Tumor
Transurethral resection of bladder tumor (TURBT) is the most common surgery for bladder cancer that's in the early stages. This procedure is done in a hospital. Your doctor will put an instrument called a resectoscope into your bladder through your urethra. That's the tube that urine flows through when you go to the bathroom. The resectoscope has a wire loop at the end. Your doctor will use it to remove abnormal tissues or tumors. The main goal of TURBT is to stage the tumour (to see how deep the tumour infiltrate the bladder wall) and differentiate between superficial and infiltrating bladder cancer. The other objective is to completely remove the tumour as curative intent.
In this type of surgery, your doctor removes part of your bladder (a partial cystectomy) or all of it (a radical cystectomy). If cancer has spread to the muscle layer of your bladder and is still small, your doctor may be able to perform a partial cystectomy. But most people who have cancer that has grown into the muscle of the bladder will need a more extensive surgery instead. If the cancer is large or has spread to more than one part of your bladder, your doctor will likely remove the entire organ and the nearby lymph nodes. This is a radical cystectomy. For both of these procedures, you'll be given medicationso that you won't be awake. You may have to stay in the hospital for up to a week afterward. Usually, you can go back to your normal routine in a few weeks.
This treatment is also used for early-stage cancers. Your doctor uses a catheter to inject a liquid medication right into your bladder. He'll choose between two different types of medications -- immunotherapy or chemotherapy ("chemo").
- Immunotherapy. In this method, your body's own immune system attacks the cancer cells. Your doctor will inject a germ called Bacillus Calmette-Guerin (BCG) into your bladder through a catheter. This germ is related to the one that causes tuberculosis. This draws your body's immune cells to your bladder. There, they're activated by the BCG and begin to fight the cancer cells. Your doctor may start this treatment a few weeks after you have a TURBT.
- Intravesical chemotherapy ("chemo"). If your doctor and you decide on this treatment, he'll inject cancer-fighting medications into your bladder through a catheter. The chemo works to kill the harmful cells.
If you have metastatic bladder cancer, your doctor is likely to give you a combination of treatments to fight the disease. Most people need more than one approach to get rid of all the cancer cells, especially because the disease has spread to different parts of the body. Many people with bladder cancer need surgery. But in most cases of metastatic bladder cancer, surgery can't remove all of the disease. So you'll need other treatments along with, or instead of, an operation. These could include chemotherapy, radiation, and immunotherapy.
Chemotherapy Before Surgery
You will most likely get chemotherapy first, before your operation. It can help shrink tumors, which makes them easier to remove and makes surgery safer. This also makes it less likely that the cancer will come back.