Most bladder cancers are superficial and have a good outcome when detected and treated early. The earliest warning sign is usually bleeding in the urine (Hematuria)

What is the Bladder?

The bladder is a hollow organ in the lower abdomen.  It stores urine.  The bladder has a muscular wall that is lined with several layers of transitional cells.

The most common type of bladder cancer arises from these transitional cells.

How do I know if I have Bladder cancer?

Common symptoms of bladder cancer include:

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

When symptoms occur, they are not sure signs of bladder cancer.  Infections, benign tumors, bladder stones, or other problems may also cause them.  Only a doctor can make a diagnosis.  (People with symptoms like these generally see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.)  It is important to see a doctor so that any illness can be diagnosed and treated as early as possible.

How is Bladder Cancer diagnosed?

To find if the cause of symptoms could be due to bladder cancer, the doctor asks about the patient’s medical history and does a physical exam.  The physical will include a rectal or vaginal exam that allows the doctor to check for tumors that can be felt.  In addition, urine samples are sent to the laboratory for testing to check for blood and cancer cells.

A telescope to look directly into the bladder called a cystoscope is inserted through the natural urine passage into the bladder to examine for cancer. This procedure may be done with local or general anesthesia. Samples of bladder tissue may be obtained through this tube.  A pathologist then examines the sample under a microscope.  The removal of tissue to look for bladder cancer cells is called a biopsy.  In many cases, performing a biopsy is the only sure way to tell whether bladder cancer is present.

Once bladder cancer is diagnosed, the doctor will want to learn the grade of the bladder cancer and the stage, or extent, of the disease.  Grade is important because it tells how closely the bladder cancer resembles normal tissue and suggests how fast the cancer is likely to grow.  Low-grade bladder cancers more closely resemble normal tissue and are likely to grow and spread more slowly than high-grade cancers.

Staging is a careful attempt to find out whether the bladder cancer has spread and, if so, what parts of the body are affected.  The stage of bladder cancer may be determined at the time of diagnosis, or it may be necessary to perform additional tests.  Such tests may include imaging tests - CT scan, MRI, sonogram, IVP, bone scan, or chest x-ray.

How is bladder Cancer staged?

Bladder cancer that is confined to the lining of the bladder is called superficial bladder cancer. It is common for superficial bladder cancer to recur after treatment. If this happens, most often it recurs as another superficial bladder cancer. 

In some cases, bladder cancer that begins in the transitional cells spreads through the inner lining of the bladder and invades the muscular wall of the bladder.  This is known as invasive bladder cancer.  Invasive bladder cancer may grow through the bladder wall and spread to nearby organs. 

Bladder cancer cells may also be found in the lymph nodes surrounding the bladder.  If the bladder cancer has reached these nodes, it may mean that bladder cancer cells have spread to other lymph nodes and to distant organs, such as the lungs.  The cancer cells in the new tumor are still bladder cancer cells.  The new tumor is called metastatic bladder cancer rather than lung cancer because it has the same kind of abnormal cells that were found in the bladder.

How is Bladder Cancer treated?

Treatment for bladder cancer depends on the stage of the disease (how deeply, the cancer has invaded the bladder wall), the grade of the bladder cancer, the patient’s general health, and other factors.  The doctors develop a treatment plan to fit each patient’s needs.  Depending on its stage and grade, bladder cancer may be treated with surgery, radiation therapy, chemotherapy, or biological therapy.  Doctors may recommend one treatment method or a combination of methods.  It is important for patients to discuss the treatment plan with their doctors.

Surgery
This is the commonest and an effective form of treatment for bladder cancer. 

Trans urethral resection of bladder tumor (TURBT).
Early (superficial) bladder cancer may be treated at the time of diagnosis through a procedure called Trans urethral resection of bladder tumor (TURBT). This is a minimally invasive, endoscopic procedure without any wounds. During TURBT, the doctor inserts a telescope into the bladder through the urethra. Through this, another instrument called a resectoscope that holds a small wire loop on the end is manipulated to remove the bladder cancer or to burn away bladder cancer cells with an electric current. This procedure is done under general or regional anesthesia and requires hospital stay.

Radical Cystectomy
Surgery to remove part or the entire bladder is called cystectomy. This surgery is reserved for bladder cancer that has invaded the muscle wall, or when superficial bladder cancer involves a large part of the bladder.

Radical cystectomy removes the entire bladder, nearby lymph nodes, and any surrounding organs that contain cancerous cells.  In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. When the bladder must be removed, the doctor creates another way for urine to leave the body.  A part of the small or large intestine may be used to make a new replacement bladder called a neobladder inside the body.  Urine collects there instead of emptying into a bag.

In some cases, patients may have part of the bladder removed in an operation called partial cystectomy.  This type of surgery may be done when a patient has a low-grade bladder cancer that has invaded the wall of the bladder but is limited to one area of the organ.  Because most of the bladder remains intact, a patient urinates normally after recovering from this surgery.

Radiotherapy
In radiotherapy, high-energy rays are used to kill bladder cancer cells.  Like surgery, radiation therapy is local therapy; it affects bladder cancer cells only in the treated area.  Sometimes, radiation is given after surgery or along with anticancer drugs.  When bladder cancer has spread to other organs, radiation therapy may be used to relieve symptoms caused by the cancer.

Chemotherapy
Toxic drugs can be used to kill cancer cells.  The doctor may use one drug or a combination of drugs.  Chemotherapy may be used alone or after TURBT with fulguration of superficial bladder cancer. 

In a treatment called intravesical chemotherapy, anticancer drugs are placed in the bladder through a tube called a catheter, which is inserted through the urethra.  When given in this way, the anticancer drugs, which remain in the bladder for several hours, affect mainly the cells in the bladder.  The treatment is usually done once a week for several weeks.  Sometimes, the treatments continue once or several times a month for up to a year. 

Chemotherapy also may be used to help control the disease when bladder cancer cells have deeply invaded the bladder or spread to lymph nodes or other organs.  In this case, the anticancer drugs are usually given by injection into a vein (IV); some may be given by mouth.  This form of chemotherapy 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: a treatment period followed by a recovery period, and so on.  Chemotherapy may be used alone or in combination with surgery or radiation therapy.

Intravesical BCG
 This is a form of Biological Therapy using live-attenuated BCG bacteria stimulate the immune system to attack the bladder cancer cells. The bacteria are administered into the bladder the same way as intravesical chemotherapy agents. It is extremely effective especially against multiple bladder cancer foci, recurrent bladder cancers and carcinoma-in-situ (CIS).

What are the possible causes of Bladder Cancer and can I prevent it?

At this time, the causes of bladder cancer are not fully understood.  It is clear, however, that this disease is not contagious; no one can “catch” cancer from another person.

Men are affected by bladder cancer about three times as often as women.  Most bladder cancers occur after the age of 40, but the disease can also develop in younger people.

Known and possible risk factors for bladder cancer include:

• Smoking. 
  This is a major risk factor.  Cigarette smokers develop bladder cancer tow to three times more often than do nonsmokers.  Quitting smoking reduces the risk of bladder cancer, lung cancer, and several other types of cancer, as well as a number of other diseases.
• Occupational risk. 
  Workers in some occupations are at higher risk of getting bladder cancer because of exposure to carcinogens in the workplace.  Increased risk is seen in people in the rubber, chemical, and leather industries, as well as in hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.

People who think they may be at risk for developing bladder cancer should discuss this concern with their doctor.  The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.