About Bladder Cancer

 

What is Bladder Cancer?

Bladder cancer is a common form of cancer that occurs in the bladder, an organ in the lower abdomen that holds urine. The American Cancer Society estimates that over 83,000 new cases of bladder cancer will be diagnosed in the U.S. in 2021.
 

Bladder cancer forms when DNA (the material in cells that makes up genes and controls how cells work) in the bladder mutate, disabling the functions that control cell growth. These mutated cells typically die or are attacked by the immune system. However, some mutated cells may escape and grow out of control, creating a tumor inside the bladder.
 

Bladder cancer usually begins in the urothelial cells that line the inside of your bladder. This is where tumors usually develop. However, some tumors may grow into deeper bladder layers. 
 

There are three main types of bladder cancer:    

  • Urothelial carcinoma. Urothelial carcinoma, also called transitional cell carcinoma or TCC, accounts for the vast majority of bladder cancers. This type of bladder cancer starts in the urothelial cells in the urinary tract. 

  • Squamous cell carcinoma. The second most common type of bladder cancer, squamous cell carcinoma, begins in squamous cells – thin, flat cells that may form in the bladder after long-term irritation or infection.

  • Adenocarcinoma. This type accounts for a small percentage of bladder cancers and develops from mucus-secreting glands known as glandular cells.
     

Bladder cancer can be described as:

  • Superficial bladder cancer – affects the cells of the lining in the bladder only.

  • Invasive bladder cancer –has spread through the lining of the bladder to the muscle wall, other organs, or lymph nodes.
     

Do you suspect you are at risk for bladder cancer? The START Center for Cancer Care can provide state-of-the-art treatments for detecting and conquering bladder cancer. Read more details below, and visit our START Center services page for additional information.
 

What Causes Bladder Cancer

 

Researchers do not know what exactly causes bladder cancer. Changes in the DNA inside normal healthy bladder cells can cause them to grow and form cancers. DNA is the chemical compound that makes up our genes. The genes that help cells grow, divide, and stay alive are known as oncogenes. The genes that help control cell division, repair mistakes in DNA, or cause cells to die at the right time are known as tumor suppressor genes. Mutations in these genes can potentially lead to cancer.

How do I know if I have Bladder Cancer?

 

Many people with bladder cancer do not exhibit symptoms. A bladder cancer diagnosis is often made when red blood cells are detected in a urine test (urinalysis). Urologists are generally the doctors who diagnose and treat bladder cancer. Their specialty is the urinary tract, which includes the bladder, kidneys, ureters, and urethra.

Common Symptoms of Bladder Cancer


Blood in the urine

In many cases, blood in the urine (known as hematuria) is an early sign of bladder cancer. The blood may change the color of the urine to pink, orange, or dark red. The color of the urine could even be normal, and small amounts of blood may be discovered during the urine test (urinalysis). Blood may be there one day and gone the next. The urine could remain clear for months. However, if the patient has bladder cancer, the blood will eventually reappear.
 

The early stages of bladder cancer often cause bleeding but with very little pain or discomfort. It’s important to note that blood in the urine does not always indicate that you have bladder cancer. More often than not, it’s caused by benign tumors, an infection, bladder stones, or another non-cancerous ailment. It’s still critical to be seen by a doctor if you have blood in the urine.

Bladder habit changes

While bladder symptoms are more often the result of conditions unrelated to cancer, bladder cancer may cause changes to bladder habits, including:

•    Needing to urinate with little or no results
•    Having to urinate more than usual
•    Painful urination

UTI-like symptoms

Bladder cancer is sometimes mistaken for a Urinary Tract Infection (UTI) because they share many of the same symptoms. Patients with UTI experience increased frequency of urination, pain with urination, and difficulty urinating. If you have experienced any urinary problems, or if antibiotics do not seem to be helping your UTI symptoms, speak with your doctor.

Decreased appetite

Loss of appetite is a common symptom of bladder cancer. If the cancer has spread, you may experience weight loss, fatigue, and weakness. There are many other conditions that can affect your appetite, so don’t assume it is cancer. But be sure to speak with your physician if the problem persists. 

Advanced symptoms

Bladder cancer is advanced when the tumor has grown past the bladder lining and surrounding layers of tissue and muscle. During this stage, the cancer could have spread to other parts of the body. Symptoms of advanced bladder cancer include:

  • Urination problems

  • Lower back pain

  • Weight loss or loss of appetite

  • Fatigue

  • Feeling weak

  • Swollen feet
     

Sometimes by the time symptoms of bladder cancer are noticed, the cancer has already spread to other parts of the body. The symptoms will then depend on where it has spread. For instance, cancer that has spread to the lungs may cause shortness of breath or a cough. Talk with your doctor if you are concerned about any changes you are experiencing. You can use our online form to request an appointment at the START Center. We will ask how long and how often you have had these symptoms. This information can help us formulate a diagnosis. 
 

What Is the Best Way to Treat Bladder Cancer?

 

There are a number of ways to treat bladder cancer, including:

Surgery.

Surgical approaches to bladder cancer include:

  • Transurethral resection of the bladder tumor (TURBT): The most common type of bladder cancer surgery, TURBT is used to treat early-stage cancer that has not spread into the muscle. A cystoscope is inserted through the urethra and into the bladder to remove tumors. The tumors are sent to a lab to be examined.

  • Partial cystectomy (segmental cystectomy): The area of cancer and a small surrounding area are removed. Some lymph nodes may be removed. This surgery is used for cancer that has invaded the bladder wall.

  • Radical cystectomy: With this surgery, the entire bladder and any organs or lymph nodes affected are removed. Men might need the prostate and seminal vesicles removed, while women may need their uterus, cervix, ovaries, and part of the vagina removed. This will require an alternate route for urine to leave the body.

  • Robotic radical cystectomy: Uses 3D magnification, robotic technology, and small instruments to enhance a surgeon’s skills when removing a bladder.

  • Incontinent diversion (urostomy): This makes a new opening for urination with a bag worn outside of the body to store urine.

  • Continent urinary diversion: This creates a new bladder so you can control when urine leaves your body. A bag is not needed.

Immunotherapy

Immunotherapy stimulates the body’s defenses to attack and eliminate cancer cells. There are two main types of immunotherapy for treating bladder cancer:

Checkpoint inhibitors: These drugs work by blocking checkpoint proteins from binding with their partner proteins, allowing the immune cells (T cells) to attack tumors. The drugs block the interaction of a molecule (PD-1) on the immune cells with a molecule (PD-L1) on cancer cells. Examples of checkpoint inhibitor drugs include Keytruda, Libtayo, and Opdivo.

Cancer vaccines: These are given to help treat bladder and other cancers by boosting the immune system. The Bacillus Calmette–Guérin (BCG) vaccine is approved to treat bladder cancer. This vaccine involves live bacteria injected into the bladder in an effort to attract immune cells, which then may attack cancer cells.

Immunotherapy may not be recommended for everyone, and responses to the treatment may vary. Immunotherapy may be used in combination with surgery or chemotherapy.

Chemotherapy

Chemotherapy kills cancer cells wherever they are in the body. Chemotherapy may be administered before or after surgery. You could receive chemotherapy as the main treatment, especially if the cancer has spread and surgery is not an option.

The main types of chemotherapy for bladder cancer include:

 

Intravesical Chemotherapy: For intravesical chemotherapy, the chemo drug is put directly into the bladder. This type of chemotherapy is used for cancer that is only in the lining of the bladder. 

Systemic Chemotherapy: When chemotherapy drugs are administered in pill form or injected into a vein or muscle, the drugs enter the bloodstream and travel throughout the entire body. This is known as systemic chemotherapy, and it can affect cancer cells anywhere in the body.
 

Common chemotherapy drugs used for treating bladder cancer include:

  • Vinblastine

  • Methotrexate

  • Cyclophosphamide

  • Carboplatin

  • Ifosfamide

  • Gemcitabine

  • Doxorubicin

  • Cisplatin
     

Many of these chemotherapy drugs are used in tandem with one another. Side effects from chemotherapy drugs may include:

  • Nausea

  • Vomiting

  • Loss of appetite

  • Loss of hair

  • Fatigue from anemia

  • Vulnerability to infections

  • Ulcers in the mouth
     

Radiation Therapy

Radiation is an invisible high-energy ray that kills both cancer cells and normal cells. Like surgery, radiation therapy is a local treatment used to eradicate cancer that can be contained within the radiation field. Newer radiation treatments are able to focus radiation more on the cancer cells and not kill as many normal cells. Radiation may be given for muscle-invasive bladder cancers and is often used as an alternative approach to or in addition to surgery. 
 

The following two types of radiation therapy can be used. 
 

External radiation: External radiation is produced by a machine outside of the body. The machine shoots a beam of radiation directly at the tumor. External radiation therapy is typically spread out in short treatments five days a week for up to 7 weeks. Spreading it out helps protect the healthy tissues by lowering the dose of each treatment. 

Internal radiation: Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material. This is administered through a variety of techniques. One way involves placing a small pellet of radioactive material inside the bladder. When the treatment is completed, the pellet is removed. The duration of the treatment varies, as does the length of time the radiation is left in the bladder.  
 

It’s worth noting that bladder cancer has one of the highest recurrence rates among the most common cancers. This means it is likely to come back even after treatment. Some individuals may battle bladder cancer for many years. Even when the cancer is removed, patients routinely have follow-up appointments for 5-10 years to make sure it has not returned. Bladder cancer can have a long-term physical and psychological impact.
 

The START Center is a research facility. Our oncologists are international cancer research leaders and conduct Phase I clinical trials for anti-cancer medications. Phase I trials are the first round of trials for new drugs that are tested by a particular group of participants. If you are interested in learning more about Phase I trials, use our online form to speak with a doctor that can assess if this is something that would be right for you.
 

 

What Puts Me at Risk for Bladder Cancer?

A risk factor is something that increases your chance of developing a disease. Some factors that increase the risk of bladder cancer include:

 

Smoking 

While the exact causes of bladder cancer are unknown, smoking is known to be a leading risk factor. Smokers are approximately four times more likely to get bladder cancer than non-smokers. Chemicals in tobacco are carried from the lungs to the bloodstream, then filtered by the kidneys into the urine. This puts harmful chemicals in the bladder, damaging cells. This damage could lead to cancer.

 

Chemical exposure 

Certain jobs that expose you to cancer-causing chemicals may increase your risk for bladder cancer. If you work with dyes, rubber, textiles, paints, or leather, make sure you follow all safety protocols to reduce contact with chemicals.

 

If you work in any of the following industries, you are more likely to develop bladder cancer: 

  • Rubber, chemical, textile, or leather industries

  • Hairdressing

  • Machine work

  • Metalwork

  • Painting

  • Commercial truck driving

  • Dry cleaning

  • Printing

 

Medications 

Certain drugs have been linked to bladder cancer. Some studies have shown that taking the diabetes medication pioglitazone (Actos) for more than a year could increase the risk of developing bladder cancer. Cancer treatments, including the chemotherapy drug Cytoxan and radiation therapy, might also increase the risk of cancer.

 

Chronic bladder inflammation  

A history of this condition raises your risk.

 

Family history 

If you have a family history of bladder cancer, you might be at an increased risk for it. This could be due to genetics or environmental factors like being exposed to cigarette smoke.

 

Gender 

Bladder cancer affects more men than women. Men are about three times more likely to get bladder cancer at some point in their life.

 

Age 

Bladder cancer tends to occur in older people. Approximately 9 out of 10 people with bladder cancer are 55 or older (73 is the average age of people who develop it).

 

Race and ethnicity 

Bladder cancer is most prevalent in Caucasians. African Americans and Hispanics are less likely to have it. Asian Americans and American Indians have the lowest rates of occurrence.

 

How Can I Prevent Bladder Cancer?

If you have risk factors for bladder cancer, there are things you can do to lower your risk, including:

Quit smoking. Cigarette smokers are two to three times more likely to develop bladder cancer. Quitting smoking is one of the most important things you can do for prevention.

Ready to stop smoking? Try these resources.

Help! I Want to Quit Smoking! | American Heart Association
Help for Cravings and Tough Situations While You're Quitting Tobacco (cancer.org)

 

Avoid harmful chemicals. Following safety procedures when working with hazardous chemicals is an important aspect of bladder cancer prevention since substances used in dye, textile, rubber, leather, and trucking industries might cause harm to the bladder. 


Some studies have indicated that consuming high amounts of arsenic in drinking water is linked to a greater risk of bladder cancer. Researchers are not exactly sure why exposure to this element is related to cancer. 

Drink water and stay hydrated. Drinking a lot of water could dilute harmful substances in your urine and flush them out of your bladder. While there is no conclusive evidence demonstrating that drinking water reduces the risk of bladder, some researchers believe it may help.
 

Eat fruits and vegetables. Some studies have suggested that a diet high in fruits and vegetables might help protect against bladder cancer. Cruciferous vegetables like broccoli, cabbage, and cauliflower, especially have been linked to a reduction in the risk of developing cancer.
 

Tell your doctor about all symptoms. You have the greatest chance of surviving when the cancer is in its early stages. The sooner your doctor makes a diagnosis and begins treatment, the better.
 

How to Prepare for your Appointment

It’s important to prepare for your first appointment with an oncologist, or cancer doctor. Listed below are some helpful tips for how to prepare:

•    Bring your health insurance card and medical records if you have not arranged for them to be delivered.
•    Bring a list of all the medications you take.
•    Bring a list of your allergies.
•    Arrive 30 minutes before your appointment time so you can fill out the required paperwork. 
•    Write down everything that comes to mind. This will help you get your thoughts in order so you can have questions to ask your doctor.
•    Ask a friend or loved one to come with you to the appointment. They can help listen to what the doctor says and take notes.
•    Educate yourself before the appointment. Visit a reliable cancer website, such as the American Cancer Society, and read about bladder cancer and its treatment options. When you come to your appointment with some knowledge, you will be able to better understand what the doctor tells you.

Contact Us

You likely have questions. Many of them. Perhaps you’re worried about yourself, or about someone else in your family. The START Center is here for you. You can speak to us in person, or you can schedule a telemed visit. Our compassionate START physicians have your best interests at heart. Complete our contact form online or call us at one of our locations today.

 

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