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Tulane Cancer Center ~ Bladder Cancer

Bladder cancer is a term for any number of malignant cell growths in the urinary bladder - typically in the inner lining cells. Blood in the urine, frequent urination, and pain during urination are common symptoms.

Bladder Carcinoma

Bladder carcinoma is a type of bladder cancer originating the cells lining the inside wall of the bladder. The most common type of bladder cancer in the US, a transitional cell carcinoma bladder tumor can originate in similar cells lining the inside of the urethra or ureters.

How is bladder cancer diagnosed?

To diagnose bladder cancer, your doctor will:

  • Ask about your medical history and do a physical exam, including a vaginal or rectal exam.
  • Test your urine to look for blood or abnormal cells.

Have a cystoscopy test that lets your doctor look into your bladder with a thin, lighted viewing tool. Small tissue samples are taken and looked at under a microscope to find out if there.

Types of Bladder Cancer

Bladder cancers are divided into several types based how their cells look under a microscope. Different types can respond differently to treatments such as radiation and chemotherapy.

Transitional cell (urothelial) carcinoma
This is by far the most common type of bladder cancer. About 95% of bladder cancers are this type. The cells from transitional cell carcinomas look like the urothelial cells that line the inside of the bladder.

Urothelial cells also line other parts of the urinary tract, such as the lining of the kidneys (called the renal pelvis), the ureters, and the urethra, so transitional cell cancers can also occur in these places. In fact, patients with bladder cancer sometimes have other tumors in the lining of the kidneys, ureters, or urethra. If someone has a cancer in one part of their urinary system, the entire urinary tract needs to be checked for tumors.

Bladder cancers are often described based on how far they have invaded into the wall of the bladder:

  • Non-invasive bladder cancers are still in the inner layer of cells (the transitional epithelium) but have not grown into the deeper layers.
  • Invasive cancers grow into the lamina propria or even deeper into the muscle layer. Invasive cancers are more likely to spread and are harder to treat.

Symptoms may include:

  • Blood in your urine
  • A frequent urge to urinate
  • Pain when you urinate
  • Low back pain

Risk factors for developing bladder cancer include smoking and exposure to certain chemicals in the workplace. People with a family history of bladder cancer or who are older, white, or male have a higher risk.

Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and biologic therapy. Biologic therapy boosts your body's own ability to fight cancer.

Diagnosis

If you have symptoms that suggest bladder cancer, contact your physician. You may have one or more of the following tests performed:

  • Urine tests: The lab checks your urine for blood, cancer cells, and other signs of disease.
  • Cystoscopy: Your doctor uses a thin, lighted tube (a cystoscope) to look directly into your bladder. It may be done at your doctor’s office. This test can be uncomfortable because the doctor will insert the cystoscope into the bladder through your urethra. You may need local anesthesia for this test.
  • Biopsy: Your doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present.
  • For a small number of patients, the doctor removes the entire area with cancer during the biopsy. For these patients, bladder cancer is diagnosed and treated at the same time.

Bladder Tumors are often GRADED to determine how fast the tumor is likely to grow.

  • A sample of tissue may be taken from the bladder. If cancer cells are found in the tissue, the pathologist studies the sample under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal bladder tissue.
  • Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Treatment

Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.

 

Stage 0 and I Treatments

  1. Surgery to remove the tumor without removing the rest of the bladder
  2. Chemotherapy or immunotherapy placed directly into the bladder

Stage II and III treatments:

  1. Surgery to remove the entire bladder (radical cystectomy) and nearby lymph nodes
  2. Surgery to remove only part of the bladder, followed by radiation and chemotherapy
  3. Chemotherapy to shrink the tumor before surgery
  4. A combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery)

Surgery

Surgery for bladder cancer includes:

  • Transurethral resection of the bladder (TURB): Cancerous bladder tissue is removed through the urethra.
  • Partial or complete removal of the bladder: Many people with stage II or III bladder cancer may need to have their bladder removed (radical cystectomy). Sometimes only part of the bladder is removed. Radiation and chemotherapy is usually given after this surgery.

Chemotherapy

  • Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
  • For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
  • A Foley catheter can be used to deliver the medication into the bladder. Common side effects include bladder wall irritation and pain when urinating.
  • For more advanced stages (II-IV), chemotherapy is usually given by vein (intravenously).

Helpful Links:

www.cancer.org/cancer/bladdercancer/
www.cancer.gov/cancertopics/types/bladder‎
www.bladdercancer-info.com/
www.urologyhealth.org/urology/index
www.cancer.net
www.bcan.org
www.bladdercancercarcinoma.com