Bladder Cancer Symptoms, Stages, Treatments

Bladder cancer is the unregulated growth of abnormal bladder 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 when treatments are most successful.

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 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. In some people, bladder cancer tends to cause no symptoms until it reaches an advanced stage that is difficult to cure.

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.

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.

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.

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.

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.

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.

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

The following is an example of bladder cancer stages and the TNM system:

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.

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.

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.

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

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.

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.

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. Consult your doctor before starting any such "therapies".

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. 

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.

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 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.