What is bladder cancer?
Bladder cancer is cancer in the cells that line the bladder. These cells are called urothelial cells and can also be found in the kidneys and ureters connecting the kidney and bladder.
There are three different kinds of bladder cancer, including urothelial carcinoma (also known as transitional cell carcinoma), squamous cell carcinoma, and adenocarcinoma. While urothelial carcinoma is the most common form of bladder cancer, squamous cell carcinoma and adenocarcinoma are relatively rare.
What are the symptoms of bladder cancer?
The symptoms of bladder cancer can be similar to other urological conditions, so it’s important to discuss any symptoms you find worrisome with your provider so that further evaluation can be done.
Typically, the symptoms of bladder cancer include frequent urination, blood in urine (hematuria), back pain, and painful urination.
What are the risk factors for bladder cancer?
Certain risk factors can increase your chances of being diagnosed with bladder cancer. These factors include:
- Smoking
- Chemical exposure, specifically arsenic or the chemicals used to make rubber, leather, dyes, or paints
- Being over the age of 55
- Chronic bladder infections, cystitis, or inflammation caused by the parasite known as schistosomiasis (rare in the U.S.)
- Family history of bladder cancer or Lynch syndrome
- Previous cancer treatments, including treatment with cyclophosphamide or radiation to the pelvic region
- Being born a male
How is bladder cancer diagnosed?
Like many cancers, bladder cancer is often diagnosed after a series of tests. These tests can include a variety of imaging, including CT and x-ray, and laboratory tests, such as urine cytology.
Additional testing can also include the use of a small tube called a cystoscope to view the inside of the bladder. By inserting it through your urethra and into the bladder, your urologist can check the structure of the bladder and identify any signs of the disease. This is called a cystoscopy and can be performed in a hospital or clinic setting.
A biopsy may also be done at the time of the cystoscopy, allowing the urologist to collect a sample of the cells within the bladder for additional testing.
After a bladder cancer diagnosis has been established, the cancer is staged on a scale from 0 to IV, with the lowest stages indicating the cancer is confined to the bladder and the higher stages indicating that the cancer has spread or metastasized outside of the bladder. Additionally, bladder cancer is also assigned a grade. The grade of the cancer indicates how the cells collected look under a microscope. In bladder cancer, there are two separate grades: low-grade and high-grade.
A low-grade bladder cancer typically grows slower and is not as likely to infiltrate the bladder wall. In contrast, a high-grade bladder cancer can grow rapidly and is more likely to metastasize outside of the bladder.
How is bladder cancer treated?
When it comes to the treatment of bladder cancer, options for treatment are very dependent upon not only the stage of the cancer but also the grade of it and the overall health of an individual. Like many cancers, surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy (or a combination of all) are often the course of treatment for bladder cancer.
A surgical approach to the treatment of bladder cancer can offer several different procedures.
A transurethral resection of bladder tumor (TURBT) is used to not only diagnose bladder cancer but also to treat it. This procedure involves the surgeon using an electric wire loop inside a cystoscope within the bladder to burn away the cancer. With the cystoscope inserted through the urethra, no incisions are made and chemotherapy can also be injected while the cystoscope is in place.
A cystectomy is a surgery to remove the bladder through an incision made in the lower abdomen. This can be a full (radical) or partial removal of the bladder, depending upon the diagnosis and size of the tumor. This surgery also varies upon gender, with men typically also having their prostate and seminal vesicles removed. In contrast, women with a radical cystectomy might also have their uterus and ovaries removed. With the removal of the bladder, reconstruction for the elimination of urine will be necessary, and your surgeon can offer options that best fit your lifestyle and diagnosis.
Since bladder cancer can often recur following treatment, it’s extremely important that you follow the guidelines established by your provider for ongoing care. To review the options available to you and your diagnosis, you can reach The Iowa Clinic Urology department at 515.875.9800.