Visual Guide to Bladder Cancer

Cancer is the growth of abnormal cells in the body. Bladder cancer 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 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 (though they don't cause urine in the blood by themselves).  

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.

Anyone can get bladder cancer, but 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. 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.An intravenous pyelogram uses dye to outline the kidneys, bladder, and ureters, the tubes that carry urine to the bladder.

The main types of bladder cancer are named for the type of cells that become cancerous. The most common is urothelial carcinoma (also called transitional cell carcinoma), which begins in the cells that line the inside of the bladder.

Squamous cell carcinoma and adenocarcinoma are much less common.

Stage 0: Cancer stays in the inner lining.
Stage I: Cancer has spread to the bladder wall.
Stage II: Cancer has reached the muscle of the bladder wall.
Stage III: Cancer has spread to fatty tissue around the bladder and possibly certain nearby lymph nodes. It may also have spread to the prostate in men or the uterus or vagina in women.
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 likely perform a total cystectomy, removing the entire bladder and nearby lymph nodes.  For men, the prostate and seminal vesicles may also be removed.. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may also be removed.

If your entire bladder must be removed, your surgeon will construct another means of storing and passing urine. A piece of your intestine may be used to create a tube that allows urine to flow into an external urostomy bag. In some cases, an internal reservoir -- drained via a catheter -- can be constructed. Newer surgeries offer the possibility of normal urination through the creation of a new bladder (neobladder) also using intestine. This allows urination in the normal way without a catheter or urine bag,

Chemotherapy involves drugs designed to kill cancer cells. 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.

This type of treatment stimulates your immune system to identify and attack cancer cells. One treatment, bacillus Calmette-Guerin (BCG) therapy, sends in helpful bacteria through a catheter directly to your bladder that trigger the immune system. BCG is used for cancers that haven't spread. Another type of therapy, immune checkpoint inhibitors, targets certain proteins on cancer cells.

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.

These newer drugs target cancer differently than other treatments like chemotherapy do. FGFRs (fibroblast growth factor receptors) are proteins on bladder cancer cells. They can turn faulty and feed cancer growth. FGFR inhibitors block that action. They are tablets you take by mouth. Their use is reserved for metastatic/advanced bladder cancer. Some people with advanced cancer who have not been helped by other treatments may respond to FGFR inhibitors.

Currently, no complementary treatments are known to treat or prevent bladder cancer, but research is ongoing. Studies are looking at whether extracts of green tea, pomegranate, or broccoli sprouts may help in treating people with bladder cancer

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. About 96% of these people will live at least 5 years, compared to people without bladder cancer. But only 5 out of 100 people whose bladder cancer was found after it spread to distant spots are alive 5 years after diagnosis.
 

Surgery can damage sensitive nerves, making sex more difficult. Some men may have trouble having an erection, though for younger patients, this often improves over time. When the prostate gland and seminal vesicles are removed, semen can no longer be made. Women may also have trouble with orgasm, and may find sex less comfortable. Be sure to discuss treatment options with your doctor.

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, whole grains, and keeping to modest portions of lean meat is a great start. If you smoke, stop. Limit alcohol to one drink a day for women and up to two drinks a day for men. Daily exercise and regular checkups will also support your health and give you peace of mind.

Several new treatments may prove useful in treating bladder cancer. Photodynamic therapy, used in early stage cancers, uses a laser light to activate a chemical that kills cancer cells. Some gene therapies use lab-created viruses to fight cancer. And targeted therapies aim to control the growth of cancer cells. You may be eligible to participate in a clinical trial of these or other cutting-edge treatments.