Bladder Cancer

Bladder cancer occurs when the cells in the bladder—like the cells in other parts of your body—grow and divide abnormally. If a normal cell collects too many genetic errors, it can turn into a cancer cell. As the cancer cell grows and divides, it will begin to form a tumor. A tumor is a lump or mass of tissue caused by cells growing out of control. Cancer happens when these abnormal cells keep multiplying and can spread to other parts of the body. This can cause bleeding or may affect how your bladder functions. 

Your bladder is an important bodily organ that stores urine until it is passed through a small tube called the urethra, the tube that carries urine out of your body. The bladder has 4 separate layers:

1. The inside layer is the bladder lining.
2. Next to that is connective tissue (that also has nerves and blood vessels).
3. The third layer is the bladder muscle, which expands and contracts while storing urine and during urination.
4. The outside layer is made up of fatty tissue.  

There are some risk factors for bladder cancer that you cannot control. These include: 

• Being assigned male at birth
• Getting older
• Family history of bladder cancer
• Birth defects in the bladder or urinary tract 

Other risk factors include: 

• Smoking
• Exposure to chemicals at work or in the environment
• Bladder irritation caused by:
• Kidney and bladder stones
• Inflammation and infections
• Long-term catheter use
• Having had pelvic radiation to treat another type of cancer 

Some common symptoms of bladder cancer include:

• Blood in your urine
• Pain when you urinate
• Having to urinate more often than usual

However, these symptoms can also be signs of bladder problems that aren’t cancerous, such as infection or an overactive bladder. If you have these symptoms, make sure to see your doctor. 

Diagnosis

The process of finding out if you have bladder cancer and learning as much as possible about it is called diagnosis and staging. A complete diagnosis usually takes more than one doctor’s visit. It may involve radiology scans, blood tests, and a bladder biopsy. Your doctor will work with a team to figure out if you have cancer. They will also determine the type and subtype of your cancer cells, known as the pathology, and if and where it has spread.  

Your healthcare team will want a detailed medical history if they suspect bladder cancer. They will then order tests to learn as much as they can about your bladder cancer. This process may include:  

Physical exam – The exam will include questions about your medical history and any symptoms you may be experiencing.

Imaging (scans) – Scans provide a picture of the bladder and other areas. They are used to look for tumors or abnormal cells. They help determine the extent or spread of the cancer.

Blood work – Your care team may send blood samples to a lab to check blood counts and kidney function.

Cystoscopy Procedure – Your doctor may also send you to a urologist for a cystoscopy (sis-TOS-kuh-pee). This procedure allows your doctor to see and examine the inside of your bladder. During the procedure: 

• Your doctor will insert a scope into your urethra.  
• Your doctor will fill your bladder with a sterile solution.
• Your doctor will remove a small piece of bladder tissue. This is called a biopsy. The tissue is sent to a pathologist, who will examine it under a microscope to see if there are any cancer cells. 

From the biopsy, more information is gathered to determine the best treatment. This includes the type, grade, and stage of bladder cancer.

For more details about cystoscopy procedures, watch the video Having a Cystoscopy from our friends at Cancer Research UK.

Type

The results of the biopsy will help your doctor know what type of bladder cancer you have. This tells you and your healthcare team where the cancer started: 

• Urothelial (transitional cell) – most common bladder cancer that starts in the cells that line the bladder and urethra
• Squamous cell carcinoma
• Adenocarcinoma
• Other less common cancers 

Grade

The grade describes what the cancer cells look like when viewed by a pathologist:

Low grade: less likely to come back
High grade: more likely to come back

Staging 

The stage of the bladder cancer tells you and your health care team how far the cancer has spread. Bladder cancer can be non muscle invasive (Stages 0-1) or muscle invasive (Stages 2-4).

Your care team is made up of doctors, nurses, and other health professionals who work together to support your health. They help explain what’s happening in your body, guide your treatment, and answer any questions you and your family may have.

Key members of a treatment team for bladder cancer can include: 

• urologist
• urology nurses
• wound/ostomy nurse
• medical oncologist
• oncology nurse
• radiologist
• palliative care specialist
• dietician
• social worker
• financial counselor

Learning about your treatment options will help you and your healthcare team with shared decision-making. Treatment for bladder cancer may involve a combination of treatments. And your treatment will be based on whether you have non-muscle invasive or muscle-invasive bladder cancer. Talk to your doctor about the risks and benefits of each type of treatment to determine which is best for you. 

Shared decision-making - means that doctors and patients work together to make healthcare decisions. The doctor shares information about the options, and the patient shares what matters most to them. Together, they decide what care is best.

If you or someone you know might need a urostomy, check out this blog on ostomy awareness. It shares helpful tips and real stories from others who've been through it. Find more information here.   

TURBT Procedure

If you have bladder cancer, your urologist will perform a surgical procedure called a transurethral resection of bladder tumor (TURBT). This is the most common way to remove early-stage tumors. For the procedure: 

• You may be given anesthesia.
• Your urologist will insert a scope through the urethra into the bladder. This part is very similar to a cystoscopy.
• Your urologist will remove any abnormal looking tissue using the scope’s wire loop.
• A pathologist will look at this tissue under a microscope to learn more about the abnormal tissue. 

A Healthy Lifestyle

Be sure to talk to your healthcare team about exercise, diet, and nutritional supplements. It is not yet known if these can help reduce the risk of your cancer returning or spreading. Eating a good diet, not smoking, being active, and staying at a healthy weight are good for your heart and overall health. 

Scanxiety

Having to go for repeat testing or needing repeat surgeries can cause anxiety, sadness, depression, or frustration. These follow-up tests can also cause a great deal of stress. Follow-up cystoscopies may cause pain and discomfort, which can cause even more anxiety. Patients have nicknamed these feelings scanxiety.
 

Emotional Support

Whether you have cancer or someone close to you has bladder cancer, it can be very helpful to talk with others in a similar situation who will understand what you are going through. Support from others who understand can help improve your ability to cope and feel more in control over your situation. It can also give you a sense of hope. 

Survivorship

Cancer survivorship doesn’t begin when treatment ends. It starts at the time of your diagnosis. You can think of survivorship as having 2 parts:
 

From diagnosis through the end of treatment

During this time, your focus will be on learning more about the type of bladder cancer you have, your treatment options, and making treatment decisions that are right for you. Survivorship will also be about learning the best way to manage and cope with short-term symptoms or side effects that you have from your cancer or its treatments. 

After treatment ends

During this time, your focus will be on adjusting to life after your initial treatment is over. At this time, your focus will be on understanding when you need to see your doctor for follow-up visits, managing any long-term side effects of your cancer and its treatments, and — for many patients — learning how your new bladder works. 

Managing long-term side effects both physical and emotional is an important part of recovery. Changes like adjusted urination habits can bring frustration. It may take time to ease back into daily routines. Support is available to help you manage these changes and take care of your overall well-being. 

The Bladder Cancer Advocacy Network (BCAN) provides support through their Survivor to Survivor program. The program provides support and information on coping with side effects to women and men at all stages of survivorship.

Survivorship Care Planning

A survivorship care plan is a document that includes information about the treatments you have received and the follow-up care you need. Having a survivorship care plan can help you keep track of all the treatments you’ve had, your test results, and when to follow up with your cancer care team. It can also help you keep copies of all medical records and insurance payments in one place. Because some types of bladder cancer have a high risk of coming back, these follow-up tests are very important.

You will also want to:

• Know what symptoms might suggest your bladder cancer has returned or spread so you can tell your healthcare team about them as soon as possible.
• Talk to your care team about your risk for other types of cancers.
• Talk to your care team about exercise, diet, and nutritional supplements. It is not known if they can reduce the risk of a recurrence.
• Keep copies of all your medical records and insurance payments.