Bladder Cancer Overview

November 12, 2021
Bladder Cancer Overview

Written by Patti Shelton, MD 

 

Bladder cancer usually begins in the lining of the bladder, but can also originate from glands, nerves, or muscles of the bladder. In most cases, it’s very treatable when caught at an early stage. However, it can come back later, so continued monitoring is needed once treatment is complete.

What are the symptoms of bladder cancer?

Possible symptoms of bladder cancer include:

  • Excessively frequent urination
      • Urinary urgency – feeling like you really need to go right away, but then not much urine comes out
      • Pain when urinating
      • Blood in the urine – this may cause the urine to look red or brown, but sometimes there’s only a microscopic amount of blood detected on a lab test
      • Pain in the pelvic area or lower back

    Similar symptoms can also be caused by other more common conditions, such as a bladder infection. Testing will be needed to determine what’s causing your symptoms.

    What causes bladder cancer?

    It’s often impossible to say what has caused a specific case of cancer. However, certain factors do increase your risk of getting bladder cancer, including:

    • Demographics. Men are at a higher risk than women, and the risk also increases as you age. Most people with bladder cancer are 55 or older.
    • Smoking. Certain chemicals found in cigarette smoke accumulate in the bladder and can cause cancer.
    • Chemical exposures. The specific chemicals implicated are generally industrial ones, which are involved in manufacturing.
    • Chronic bladder irritation. People who have very frequent bladder infections have a higher risk for bladder cancer.
    • Previous treatment for another cancer. The treatments used for certain other cancers, including specific types of chemotherapy as well as radiation, can sometimes lead to bladder cancer later on.
    • Family history. As with most types of cancers, if you have a relative who’s had bladder cancer, you’re more likely to get it yourself.

    To reduce your risk of bladder cancer, you can quit smoking, closely follow the safety precautions for any chemical that you’re using, and eat a healthy diet.

    How is bladder cancer diagnosed?

    If you’re having symptoms that might indicate bladder cancer, then your doctor will do some tests to look for the cause of your symptoms. These include:

    • Urine tests. You urinate into a cup, and then various tests are run on the sample. This is the least invasive type of testing, and is often the first step.
    • Imaging. This generally involves an X-ray or a CT scan. Often, dye will be injected into a vein to help the doctor visualize particular structures.
    • Cystoscopy. This involves putting a long flexible tube with a camera up through the urethra, which is the tube that carries urine from the bladder out of the body. (Don’t worry, you will get medications to stay comfortable during this procedure!) The doctor can look for cancer in the bladder, and if there’s a concerning area, can take a biopsy to check for cancer.

    If these tests show that you do have bladder cancer, then the next step is called staging. This allows your doctors to determine how big your cancer is and whether it has spread to other parts of the body, so that they can choose the right treatment plan. This generally involves having one or a few imaging tests, which may include:

    • CT scan
    • MRI
    • PET scan
    • Chest X-ray
    • Bone scan

    Your doctor will use all of this information, as well as results from testing the tissue sample from your biopsy, to determine what specific type of bladder cancer you have and whether it has spread to other parts of the body. 

    How is bladder cancer treated?

    Your personal treatment plan depends on the type of bladder cancer that you have and how advanced it is. Some of the treatment options may include:

    • Surgery. This could range from removing the cancer during a cystoscopy (the procedure with the long flexible tube) to removing the whole bladder, sometimes along with other organs next to it. If your bladder is removed, then a new bladder-like pouch can be surgically constructed from a piece of your intestine.
    • Chemotherapy. This may be placed directly into the bladder through a tube, or it may be injected into the whole body through a vein.
    • Radiation. People who get radiation treatment almost always get chemotherapy too. Some people have radiation plus chemotherapy instead of having surgery at all. Others are able to have a less invasive surgery (removing just the cancer instead of the whole bladder), combined with radiation and chemotherapy.
    • Immunotherapy. This is a newer type of cancer treatment, which stimulates the body’s own immune system to destroy cancer cells. Like chemotherapy, it may be placed directly into the bladder or given to the whole body through a vein.
    • Clinical trials. Some people who have a more aggressive type of cancer, or whose cancer doesn’t respond to the usual treatment, might opt to get an experimental treatment in a research study called a clinical trial. This isn’t right for everyone, but certain patients might have this option.

    The specifics of each treatment plan are very individualized. Please discuss your treatment plan with your care team. Ask why they are recommending certain treatment options, and what the other options might be. Remember that you are ultimately in charge of your own cancer treatment, and you have the right to make your own decisions.

    Even if it’s successfully treated, bladder cancer can come back. You will need to be monitored for a few years following your treatment. This usually means having a cystoscopy periodically, so your doctor can see any possible cancer growing back in your bladder. The specific timing of this can vary, but it’s commonly done every three to six months for the first few years, tapering off after that if no cancer is found. Other tests, such as urine testing, may also be done. 

     

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