Bladder Cancer

Signs and Symptoms

The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas.

Cancer only in cells in the lining of the bladder is called superficial bladder cancer. This type of bladder cancer often comes back after treatment, but it does not tend to progress. If the tumor recurs, the disease often recurs as another superficial cancer in the bladder. Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina in women or the prostate gland in men. It also may spread to other parts of the body.

When bladder cancer spreads outside the bladder, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, cancer cells may have spread to other lymph nodes or other organs, such as the lungs, liver or bones.

When cancer spreads or metastasizes from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if bladder cancer spreads to the lungs, the cancer cells in the lungs are actually bladder cancer cells. The disease is metastatic bladder cancer, not lung cancer. It is treated as bladder cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" disease.

Fortunately, the majority of bladder cancers do not grow rapidly and can be treated without major surgery. Thus, most patients with bladder cancer are not at risk of developing a cancer that will spread and become life threatening. Early detection is vital; it allows the prompt treatment that gives patients the best chance for a favorable outlook.

Common symptoms of bladder cancer include:

• Blood in the urine, making the urine slightly rusty to deep red
• Pain during urination
• Frequent urination, or feeling the need to urinate without results

These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones or other problems also can cause these symptoms.

Diagnosis

If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:

• Physical exam: The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
• Urine tests: The laboratory checks the urine for blood, cancer cells and other signs of disease.
• Intravenous pyelogram: The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
• Cystoscopy: The doctor uses a thin, lighted tube, called a cystoscope, to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient usually does not need anesthesia for this procedure.

Treatment

People with bladder cancer have many treatment options, including surgery, radiation therapy, chemotherapy or biological therapy. Some patients may receive a combination of therapies.

Surgery

Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. Your doctor can explain each type of surgery and discuss which is most suitable for you.

• Transurethral resection: The doctor may treat early or superficial bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and burn away any remaining cancer cells with an electric current, called fulguration. You may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy. (See below.)
• Radical cystectomy: For invasive bladder cancer, the most common type of surgery is radical cystectomy. Your doctor also may choose this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed.
• Segmental cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.

Radiation therapy

Radiation therapy, also called radiotherapy, uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area. A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

Doctors use external radiation therapy to treat bladder cancer. A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated five days a week for five to seven weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Your doctor may use one drug or a combination of drugs.

If you have superficial bladder cancer, your doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. A tube or catheter is inserted through the urethra and puts liquid drugs in the bladder. The drugs remain in the bladder for several hours. They mainly affect cells in the bladder. Usually, patients have this treatment once a week for several weeks. Sometimes, treatments continue once or several times a month for up to a year.

If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, your doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.

You may have chemotherapy alone or combined with surgery, radiation therapy or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic or at your doctor's office. Depending on which drugs are given and your general health, you may need a short hospital stay.

Biological therapy

Biologic therapy, also called immunotherapy, uses the body's natural ability or immune system to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. Drugs are delivered directly into the bladder using a catheter. This helps prevent the cancer from coming back.