Bladder cancer one of the most common forms of cancer, but doesn’t get much attention. It typically begins in the inner lining of the bladder, the organ that stores urine after it passes from the kidneys. Most bladder cancers are caught early, when treatments are highly successful and the disease has not spread beyond the bladder. But bladder cancer tends to come back, so regular check-ups are important.
Blood in Urine
Blood in the urine can be a sign of bladder cancer, either visible to the eye or picked up by routine testing. The urine may look darker than usual, brownish, or (rarely) bright red. Most commonly, blood in the urine is not caused by cancer, but by other causes. These include exercise, trauma, infections, blood or kidney disorders, or drugs, such as blood thinners.
Bladder symptoms are more likely to come from conditions other than cancer. But bladder cancer can sometimes cause changes to bladder habits, including:
- Needing to go, with little or no results
- Having to go more often than usual
- Painful urination
- Difficulty urinating
Urinary tract infections or bladder stones can cause similar symptoms, but require different treatments.
Although the exact causes of bladder cancer remain unknown, smoking is the leading risk factor. Smokers are about four times more likely to get bladder cancer than people who have never smoked. Chemicals in tobacco smoke are carried from the lungs to the bloodstream, then filtered by the kidneys into urine. This concentrates harmful chemicals in the bladder, where they damage cells that can give rise to cancer.
Research suggests that certain jobs may increase your risk for bladder cancer. Metal workers, mechanics, and hairdressers are among those who may be exposed to cancer-causing chemicals. If you work with dyes, or in the making of rubber, textiles, leather, or paints, be sure to follow safety procedures to reduce contact with dangerous chemicals. Smoking further increases risk from chemical exposure.
These factors put you at greater risk:
- Gender: Men are three times more likely to get bladder cancer.
- Age: Nine out of 10 cases occur over age 55.
- Race: Whites have twice the risk of African-Americans.
Other factors at play include a family history of bladder cancer, previous cancer treatment, certain birth defects of the bladder, and chronic bladder irritation.
There’s no routine test for bladder cancer. But if you’re at high risk or have symptoms, your doctor may first order a urine test. If needed, a procedure called cystoscopy lets your doctor see inside the bladder with a slender lighted tube with a camera on the end. The cystoscope can be used to remove small tissue samples (a biopsy) to be examined under a microscope. A biopsy is the best way to diagnose cancer.
If cancer is found, imaging tests can show whether it has spread beyond the bladder. An intravenous pyelogram uses dye to outline the kidneys, bladder, and ureters, the tubes that carry urine to the bladder. CT and MRI scans give more detailed images of these, and can show the lymph nodes nearby. An ultrasound uses sound waves, instead of radiation, to produce images. Additional imaging tests look for cancer in the lungs and bone.
Types of Bladder Cancer
The main types of bladder cancer are named for the type of cells that become cancerous. The most common is transitional cell carcinoma, which begins in the cells that line the inside of the bladder. Squamous cell carcinoma and adenocarcinoma are much less common.
Stages of Bladder Cancer
Stage 0: Cancer stays in the inner lining.
Stage I: Cancer has spread to the bladder wall.
II: Cancer has reached the muscle of the bladder wall.
III: Cancer has spread to fatty tissue around the bladder.
Stage IV: Cancer has spread to the pelvic or abdominal wall, lymph nodes, or distant sites such as bone, liver, or lungs.
Transurethral surgery is most often done for early-stage cancers. If cancer has invaded more of the bladder, the surgeon will most likely perform either a partial cystectomy, or a radical cystectomy, to remove the entire bladder. For men, the prostate and urethra may also be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may also be removed.
These drugs may be given before surgery to shrink tumors, making them easier to remove. Chemotherapy is also used to destroy any cancer cells left after surgery and to lower the chances that the cancer will return. Hair loss, nausea, loss of appetite, and fatigue are common side effects. The drugs can be given by vein or directly into the bladder.
Immunotherapy treatments help your body’s immune system attack bladder cancer cells. One treatment, called Bacillus Calmette-Guerin therapy, sends helpful bacteria through a catheter directly to your bladder. Another kind of treatment, called immune checkpoint inhibitors, makes it easier for the immune system to overcome the defenses of cancer cells. These drugs are primarily for advanced cancers and are given by IV about every 2-3 weeks. Flu-like symptoms are a common side effect of these treatments.
Radiation uses invisible, high-energy beams, like X-rays, to kill cancer cells and shrink tumors. It’s most often given from outside the body by machine. Radiation is often used in tandem with other treatments, such as chemotherapy and surgery. For people who can’t undergo surgery, it may be the main treatment. Side effects can include nausea, fatigue, skin irritation, diarrhea, and pain when urinating.
Survival rates are closely tied to the stage at diagnosis. About half of bladder cancers are caught when the disease is confined to the inner lining of the bladder. Nearly 96% of these people will live at least five years, compared to people without bladder cancer. The more advanced the cancer, the lower this figure becomes. But keep in mind that these rates are based on people diagnosed from 2006 to 2012. The treatments and outlook may be better for cancers diagnosed today. And each person’s case is different.
Living With Bladder Cancer
Cancer is a life-changing experience. And although there’s no surefire way of preventing a recurrence, you can take steps to feel and stay healthy. Eating plenty of fruits, veggies, and whole grains. If you smoke, stop. Limit alcohol to one or two drinks a day, if you drink. Daily exercise and regular checkups will also support your health and give you peace of mind.
Watch this video on bladder cancer: