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Bladder Cancer Symptoms, Stages, Treatments ( courtecy;-
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Most bladder cancers are detected at early stages when the
tumor has not spread outside the bladder and treatments are successful.
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What Is Bladder Cancer?
Bladder cancer is the
growth of abnormal or cancerous cells on the inner lining of the bladder wall.
Most bladder cancers are detected at early stages when the tumor has not spread
outside the bladder and treatments are successful.
Bladder Cancer Symptoms: Blood in Urine
(Hematuria)
One sign of
bladder cancer is blood in the urine, also known as hematuria. Blood in the
urine does not always mean bladder cancer. Hematuria is most often caused by
other conditions like trauma, infection, blood disorders, kidney problems,
exercise, or certain medications. Blood in the urine may be seen by the naked
eye (gross hematuria) or only detected on urine testing (microscopic
hematuria). The urine may be discolored and appear brownish or darker than
usual or, rarely, bright red in color.
Bladder Cancer Symptoms: Bladder Changes
Bladder cancer
sometimes causes changes in bladder habits like having to urinate more often or
feeling an urgent need to urinate without producing urine. Another symptom of
bladder cancer is pain or burning during urination without evidence of a
urinary tract infection. These symptoms of bladder problems, like bleeding, are
usually caused by conditions other than cancer. Bladder cancer tends to cause
no symptoms until it reaches an advanced stage that is difficult to cure.
Possible Causes of Bladder Cancer: Smoking
Smoking is the
greatest known risk factor for bladder cancer; smokers are four times more
likely to get bladder cancer than nonsmokers. Harmful chemicals from cigarette
smoke enter the bloodstream in the lungs and are ultimately filtered by the
kidneys into the urine. This leads to a concentration of harmful chemicals
inside the bladder. Experts believe that smoking causes about half of all
bladder cancers in men and women.
Possible Causes of Bladder Cancer: Chemical
Exposure
Exposure to
certain chemicals on the job can increase risk of bladder cancer. Occupations
that may involve exposure to cancer-causing chemicals include metal workers,
hairdressers, and mechanics. Organic chemicals called aromatic amines are
especially associated with bladder cancer and are used in the dye industry.
Those working with dyes, metal workers, or in the manufacturing of leather,
textiles, rubber, or paint should be sure to follow recommended safety
protocols. Smoking increases the risk even more for these workers.
Who is at Risk for Bladder Cancer?
Bladder cancer
can affect anyone, but certain groups are at greater risk. Men are three times
more likely than women to get bladder cancer. Around 90% of cases occur in
people over age 55, and whites are twice as likely as African Americans to
develop the condition.
Other factors
that increase the risk of getting bladder cancer include a family history of
the condition and previous cancer treatment. Birth defects involving the
bladder increase the risk of bladder cancer. When people are born with a
visible or invisible defect that connects their bladder with another organ in
the abdomen, this leaves the bladder prone to frequent infection. This
increases the bladder’s susceptibility to cellular abnormalities that can lead
to cancer. Chronic bladder inflammation (frequent bladder infections, bladder
stones, and other urinary tract problems that irritate the bladder) increase
the risk of developing bladder cancer.
Bladder Cancer Diagnosis: Testing
There is no
single lab test that can specifically screen for and diagnose bladder cancer,
even though urine tests may suggest that cancer is present. If a cancer is
present, several tests may be abnormal, including urine cytology and tests for
tumor marker proteins.
Cystoscopy
A type of
endoscopy, cystoscopy, is a procedure that allows visualization of the inside
of the bladder through a thin, lighted tube that contains a camera. The
instrument can also take small samples (biopsies) if abnormal areas are seen. A
tissue biopsy is the most reliable way to diagnose bladder cancer.
Urinalysis and Urine Cytology
An analysis of
the urine is a very useful test in the diagnosis of and screening for many
diseases and conditions. The urinalysis will detect any abnormalities in the
urine such as blood, protein, and sugar (glucose). A urine cytology is the
examination of urine under a microscope while looking for abnormal cells that
might indicate bladder cancer.
Bladder Cancer Diagnosis: Imaging
Intravenous Pyelogram
An intravenous
pyelogram is an X-ray test with contrast material (dye) to show the uterus,
kidneys, and bladder. When testing for bladder cancer, the dye highlights the
organs of the urinary tract allowing physicians to spot potential
cancer-specific abnormalities.
CT Scans and MRI
CT scans and
MRI are often used to identify tumors and trace metastasized cancers as they
spread to other organ systems. A CT scan provides a three-dimensional view of
the bladder, the rest of the urinary tract, and the pelvis to look for masses
and other abnormalities. CT scans are often used in conjunction with Positron
emission tomography (PET) to highlight cells with high metabolic rates.
“Hot spots” of cells with abnormally high metabolism may indicate the presence
of cancer and require further investigation.
Bone Scan
If a tumor is
found in the bladder a bone scan may be performed to determine whether the
cancer has spread to the bones. A bone scan involves having a small dose of a
radioactive substance injected into the veins. A full body scan will show any
areas where the cancer may have affected the skeletal system.
ypes of Bladder Cancer
Bladder cancers
are named for the specific type of cell that becomes cancerous. Most bladder
cancers are transitional cell carcinomas, named for the cells that line the
bladder. Other less common types of bladder cancer are squamous cell carcinoma
and adenocarcinoma.
Transitional Cell Carcinoma
Bladder cancer
that begins inside the innermost tissue layer of the bladder, the transitional
epithelium, is known as transitional cell carcinoma. This type of lining cell
is are able to stretch when the bladder is full and shrink when it is emptied.
Most bladder cancers begin in the transitional epithelium.
There are two
types of transitional cell carcinoma, low-grade and high-grade. Low-grade
transitional cell carcinoma tends to come back after treatment, but rarely
spreads into the muscle layer of the bladder or to other parts of the body.
High-grade transitional cell carcinoma also tends to come back after treatment
and will often spread into the muscle layer of the bladder, other parts of the
body, and the lymph nodes. High-grade diseases cause most bladder cancer
deaths.
Squamous Cell Carcinoma
Squamous cells
are thin, flat cells that may lead to bladder cancer after irritation or
long-term infection.
Adenocarcinoma
Adenocarcinoma
cancers emerge from glandular cells in the lining of the bladder.
Adenocarcinoma is a very rare form of bladder cancer.
Stages of Bladder Cancer
Cancer staging
is typically determined by the extent to which a cancer has grown or spread. A
staging system is a way for professionals to specifically describe how much a
cancer has progressed. Typically, the TNM system is used for bladder cancer and
represents the following:
·
T describes how far the main tumor has grown
·
N reveals any cancer spread to lymph nodes near the bladder
·
M reveals whether the cancer has spread (metastasized) to other
locations away from the bladder.
Bladder Cancer Stages
Stage 0a (Ta,
N0, M0): The cancer is non-invasive papillary carcinoma and has not invaded the
connective tissue or bladder wall muscle.
Stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only.
Stage I (T1, N0, M0): Tumor has spread onto the bladder wall.
Stage II (T2, N0, M0): Tumor has penetrated the inner wall and is present in muscle of the bladder wall.
Stage III (T3, N0, M0): Tumor has spread through the bladder to fat around the bladder.
Stage IV applies to one of the following: (T4, N0, M0): Tumor has grown through the bladder wall and into the pelvic or abdominal wall.
Any T, N1, M0: The tumor has spread to the nearby lymph nodes. Any T, any N, M1: The tumor has spread to distant lymph nodes or to sites such as bones, liver, or lungs.
Stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only.
Stage I (T1, N0, M0): Tumor has spread onto the bladder wall.
Stage II (T2, N0, M0): Tumor has penetrated the inner wall and is present in muscle of the bladder wall.
Stage III (T3, N0, M0): Tumor has spread through the bladder to fat around the bladder.
Stage IV applies to one of the following: (T4, N0, M0): Tumor has grown through the bladder wall and into the pelvic or abdominal wall.
Any T, N1, M0: The tumor has spread to the nearby lymph nodes. Any T, any N, M1: The tumor has spread to distant lymph nodes or to sites such as bones, liver, or lungs.
Bladder Cancer Treatment: Surgery
Transurethral Resection
Early stage
cancers are most commonly treated by transurethral surgery. An instrument
(resectoscope) with a small wire loop is inserted through the urethra and into
the bladder. The loop removes a tumor by cutting or burning it with electrical
current, allowing it to be extracted from the bladder.
Partial and Radical Cystectomy
Partial
cystectomy includes the removal of part of the bladder. This operation is
usually for low-grade tumors that have invaded the bladder wall but are limited
to a small area of the bladder. In a radical cystectomy, the entire bladder is
removed, as well as its surrounding lymph nodes and other areas that contain
cancerous cells. If the cancer has metastasized outside of the bladder and into
neighboring tissue, other organs may also be removed such as the uterus and
ovaries in women and the prostate in men.
Bladder Cancer Treatment: Urinary Diversion
After Surgery
When the entire
bladder is removed the surgeon will create an alternate way for urine to be
stored and passed. This procedure is called urinary diversion. Depending on
preference, a bag can either be placed inside or outside of the body to collect
urine. Non-continent urinary diversion is when a urostomy bag is placed outside
the body, worn under the clothes. Continent urinary diversion consists of a
pouch, made from intestinal tissue, inside the body to hold urine. In a newly
introduced surgical procedure, the insertion of an artificial bladder has also
been successful for some patients.
Bladder Cancer Treatment: Chemotherapy
Chemotherapy is
given in some cases before surgery to shrink bladder cancer tumors. It can also
be used after surgery to destroy any remaining tumor cells. Chemotherapy may be
given intravenously or administered directly into the bladder (intravesical
chemotherapy). Intravesical chemotherapy is effective in decreasing the
recurrence rate of superficial bladder cancers on a short-term basis, but not
effective against bladder cancer that has already invaded the muscular walls.
Systemic or intravenous chemotherapy is required when the cancer has deeply
penetrated the bladder, lymph nodes, or other organs.
Chemotherapy Side Effects
Side effects
vary from patient to patient. Common side effects of systemic chemotherapy
include the following:
·
Nausea and vomiting
·
Loss of appetite
·
Hair loss
·
Sores on the inside of the mouth or in the digestive tract
·
Feeling tired or lacking energy
·
Increased susceptibility to infection
·
Easy bruising or bleeding
·
Numbness or tingling in the hands or feet
Bladder Cancer Treatment: Immunotherapy
Immunotherapy
involves the administration of helpful bacteria through a catheter into the
bladder to trigger the immune system to attack both the bacteria and the cancer
cells. Immunotherapy is only given in stages Ta, T1, and CIS (carcinoma in
situ) bladder cancers. Bacillus Calmette-Guerin (BCG) is a type of bacteria
used in this therapy. Intravesical BCG treatment is given once a week and can
be used after surgery to lower the chance of tumor recurrence. Immunotherapy
side effects can include irritation of the bladder, minor bleeding in the
bladder, and flu-like symptoms.
Bladder Cancer Treatment: Radiation
What is Radiation?
Radiation
therapy is the use of painless, invisible, high-energy radiation that can kill
both healthy and cancerous cells. Radiation can be used as an alternative
approach or in addition to chemotherapy or surgery to destroy cancer cells.
External Radiation
External
radiation is produced by a machine outside the body. The machine aims a
concentrated beam of radiation at the tumor. External radiation is typically
given five days a week for five to seven weeks.
Internal Radiation
Internal
radiation consists of inserting a small pellet of radioactive material inside
the bladder. The treatment lasts several days and patients are required to stay
in the hospital until the pellet is removed.
Radiation Side Effects
Radiation
therapy also has side effects, which can include fatigue, nausea, skin
irritation, pain with urination, and diarrhea.
Alternative Treatments for Bladder Cancer
There are no
alternative or complementary therapies that have been shown to prevent or cure
bladder cancer. Ongoing research studies are examining the role of green tea or
broccoli sprouts as potential complementary treatments.
Bladder Cancer Survival Rates and Prognosis
Bladder Cancer Survival Rates
As with most
cancers, survival rates are dependent upon the stage or extent of spread of the
cancer when it is found. About 50% of bladder cancers are detected when the
tumor is limited to the inner lining of the bladder, and 5-year survival rates
for this early stage of cancer are nearly 100%. Cancers that have spread
further typically have lower survival rates. Today the relative survival rates
for all stages of bladder cancer are 77% at 5 years, 70% at 10 years, and 65%
at 15 years.
Bladder Cancer Prognosis
The outlook for
bladder cancer patients depends on the stage of cancer at the time of
diagnosis. Patients with metastatic bladder cancer that has spread to other
organs have an average life expectancy of 12 to 18 months. Recurrent cancer
suggests a more aggressive type and a negative outlook for long-term survival
for patients with advanced stage bladder cancer.
Sex After Bladder Cancer Treatment
The surgery for
bladder cancer can damage nerves in the pelvis, making sex difficult.
Changes for Men
Some men may
have trouble getting an erection, but in younger men, this may improve over
time. Semen cannot be produced if the surgery involved removal of the prostate
gland and seminal vesicles.
Changes for Women
In women, the
uterus, ovaries, and part of the vagina are removed during radical cystectomy.
This permanently stops menstruation and prohibits all future pregnancies.
Women who undergo surgery for bladder cancer may also find that sex is less
comfortable, and achieving orgasms may be difficult.
Bladder Cancer Prevention
There is no
known way to prevent bladder cancer, but it is always advisable to follow a
healthy lifestyle. Stop smoking and limit alcohol consumption to 1 to 2 drinks
a day. A healthy diet contains lots of fruits, vegetables, whole grains, and
correct portion sizes of lean meats. Regular exercise and having checkups can
also help you support your health and provide peace of mind. Avoid unsafe
chemical exposures and keep protected if working with chemicals.
New and Experimental Treatments for Bladder
Cancer
New treatments
are being investigated for bladder cancer. These include photodynamic therapy,
gene therapy, and targeted therapy. Clinical trials are available to test some
of these or other new therapies.
Photodynamic Therapy
Photodynamic
therapy uses a laser light and chemicals to kills cancer cells and shrink
tumors. A few days before treatment, the patient is given light-sensitive
compounds intravenously that sensitizes cancer cells to the light rays emitted
by a laser. A small scope with a laser is then introduced into the bladder
through the urethra and is aimed at the tumor.
Gene Therapy
Gene therapy
refers to the introduction of cells with laboratory-altered DNA into the body
in order to prevent the mutation and spread of cancerous cells or to attack
cancerous cells and tumors by cutting off blood supply or causing internal
cellular death to targeted cancer cells. Gene therapy often requires the use of
a patient’s blood or bone marrow may in order to perform the procedure.
Experimental in nature, gene therapy is a newly emerging procedure with a
growing research base. Some scientists believe gene therapy may be the best way
to find a cure for cancer.
Targeted Therapy
Targeted
therapies are directed at limiting growth of cancer cells. Targeted therapy
uses drugs to interfere with specific molecules involved in carcinogenesis and
tumor growth.
Reviewed by Melissa Conrad Stöppler, MD on Saturday, July 16, 2016
Bladder Cancer Symptoms, Stages, Treatments
This tool does not provide medical advice
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