Bladder Cancer Basics

Bladder cancer: what it is 1,2

Bladder cancer is an uncontrolled, rapid growth of abnormal cells in the bladder. The disease usually begins in the lining of the bladder; however, cancerous cells may spread into the muscular wall of the bladder. Invasive bladder cancer may spread to nearby or distant lymph nodes, other areas of the urinary system, organs in the pelvis, or other organs in the body, such as the liver and lungs.

bladder cancer can be found more easily using Blue Light Cystoscopy with Cysview

Reproduced from Bladder Cancer: A Patient-Friendly Guide to Understanding Your Diagnosis and Treatment Options. Copyright © 2017 David Pulver

Common signs

Common signs 3,4

The most common sign of bladder cancer is painless, but visible blood in the urine (hematuria). Though, not all blood in urine means bladder cancer is present. You need to see a urologist to be sure.

Other common symptoms of bladder cancer include:

  • Irritation or pain during urination (dysuria)
  • Urinating small amounts frequently
  • Feeling the constant need to urinate
  • Trouble urinating or having a weak urine stream

If you experience any of these symptoms, contact your doctor. There’s a high likelihood that they are symptoms of a less severe bladder condition than cancer. But don’t ignore them. You need a healthcare professional to identify the cause to know whether you should see a urologist or not.

Don’t ignore symptoms. Only a healthcare professional can advise you whether to see a urologist or not.

In 2015, there were more than 708,000 Americans living with bladder cancer. Each year, there are tens of thousands of new cases diagnosed. In 2018, there were an additional 81,190 new cases (about 62,380 in men and 18,810 in women).5, 6

  • 9 out of 10 people with bladder cancer are over the age of 55.6
  • 1 in 27 chance a man has of developing bladder cancer. For women, the chance is 1 in 89.6
  • Fourth most common cancer in men, but it is less common in women.1
  • The rates of new bladder cancer cases and of cancer deaths have been dropping slightly in women in recent years.6
  • In men, incidence rates have been decreasing and death rates have been stable.6

Early detection is key to increasing survival rates.

Variations in bladder cancer

Variations in bladder cancer 1,7

All bladder cancer is not the same. Bladder cancer can differ in type, size, shape and depth. Urologists use a stage and grade classification system to identify and distinguish the different kinds of bladder cancer. This information also helps the doctor decide the best treatment options for bladder cancer patients.

  • The stage is determined by how far the cancer has gone into the bladder wall and if any has spread to nearby tissues and/or other organs.

    The higher the stage the further the tumor has grown away from its original site on the surface. The following are the stages for bladder tumors:

    • T0: No tumor
    • Ta: Papillary tumor without invading the bladder wall
    • TIS (CIS): Carcinoma in situ (non-invasive flat high-grade (G3) cancer)
    • T1: Tumor invades the connective tissue under the surface lining
    • T2: Tumor invades the muscle layer
    • T3: Tumor penetrates the bladder wall and invades the surrounding fat layer
    • T4: Tumor invades other organs (i.e., prostate, uterus, vagina, pelvic wall)
  • The grade depends on how the cancer cells look under a microscope compared to healthy cells. The difference in appearance helps doctors predict how likely the tumor is to return (recurrence) or continue to grow and spread (progression).

    Grade is expressed as a number between 1 (low) and 3 (high, i.e. G3); the higher the number the less the tumor resembles a normal cell. Your doctor may refer to the tumor simply as low-grade or high-grade.

Bladder cancer is classified into two types, depending on the depth of invasion in the bladder wall:

  • Non-muscle invasive bladder cancer (NMIBC) is in the inner layer of cells and has not gone deeper. These cancers are the most common (70% of all bladder cancer cases) and include the subtypes Ta, carcinoma in situ (CIS) and T1 lesions.
  • Muscle invasive bladder cancer is when the cancer has penetrated deeper layers of the bladder wall. These cancers are harder to treat and are more likely to spread to other organs. These cancers include the subtypes T2, T3 and T4.

 

Stages of Bladder Cancer

Reproduced from Nature Reviews Disease Primers. 2017; Sanli O, Dobruch J, Knowles M.A, Burger M, Alemozaffar M, Nielsen M.E, Lotan Y.

About half of all bladder cancers are first found while the cancer is still confined to the inner layer of the bladder wall. About one in three bladder cancers has invaded into deeper layers but are still only in the bladder. In most of the remaining cases, the cancer has spread to nearby tissue or lymph nodes outside the bladder. Rarely (in about 4% of cases), it has spread to distant parts of the body.6

Diagnosing bladder cancer

Diagnosing bladder cancer8

To diagnose bladder cancer based on urinary symptoms, physicians will compile a medical history and perform urine tests and cultures to check for the presence of blood, infection and other abnormal cells.

If tests show suspicious or positive bladder cancer findings, a urologist will perform a cystoscopy to look directly into a patient’s bladder. This initial cystoscopy may be performed in the doctor’s office or in a clinic where the patient is awake with moderate sedation and/or pain management; or it may be done in the operating room (OR) where the patient is asleep under anesthesia. If done outside an OR and suspicious lesions are found, the patient will then be referred for a cystoscopy in an OR.

Regardless of whether the OR procedure is the initial or subsequent cystoscopy, it is in the OR under general anesthesia that suspicious tissue will be removed for further testing. The removed tissue is sent to the lab to be biopsied for histological confirmation and final diagnosis, which includes the disease’s stage and grade.

Other tests that can provide additional information on staging include:

  • CT urogram scan or MRI to determine if the cancer has spread to the lymph nodes, lungs, liver or other abdominal organs.
  • Chest X-ray to determine if the cancer has spread to the lungs.
  • Bone scan to determine if the cancer has spread to the bones.
  • An intravenous pyelogram (IVP), also called an intravenous urogram (IVU) to detect urinary tract tumors.

Bladder cancer treatment

Bladder cancer treatment9

Bladder cancer is a very treatable cancer. Depending on the stage and grade of bladder cancer, treatment options may include:

  • Surgery to remove the cancer (used in more than 90% of patients)
    • For non-muscle invasive bladder cancer, the surgery performed is called a transurethral resection of the bladder tumor (TURBT).
      • The urologist performs the TURBT through a cystoscope that either illuminates inside the bladder with white light alone or also has the ability to shine blue light as well.
      • With the availability of blue light, the procedure becomes a Blue Light Cystoscopy with Cysview®.
      • Cysview causes bladder cancer to glow bright pink under blue light. Cysview is the only FDA-approved product on the market for the improved detection of bladder cancer using blue light technology.
    • For muscle invasive bladder cancer, the urologist usually performs a procedure called a cystectomy, which means bladder removal.
      • There are different types of bladder removal surgeries depending on the extent of the disease and if a new bladder can be created from GI tract tissue.
  • Adjuvant treatments
    • Chemotherapy destroys cancer cells using medicines (may be given before or after surgery).
    • Immunotherapy causes the body’s natural defenses – the immune system – to attack bladder cancer cells.
    • Radiation therapy destroys cancer cells using high-dose X-rays or other high-energy rays; may be given before or after surgery and may be given at the same time as chemotherapy.

1 American Cancer Society. Bladder Cancer. PDF Source. Accessed March 2019.
2 Bladder Cancer Advocacy Network. What is Bladder Cancer? BCAN.org. Accessed March 2019.
3 American Cancer Society. Signs and Symptoms of Bladder Cancer. Cancer.org. Accessed March 2019.
4 Bladder Cancer Advocacy Network. Signs and Risk Factors. BCAN.org. Accessed March 2019.
5 National Cancer Institute. SEER Stat Facts: Bladder Cancer 2017. seer.cancer.gov. Accessed March 2019.
6 American Cancer Society. Key Statistics for Bladder Cancer. Cancer.org. Accessed March 2019.
7 Bladder Cancer Advocacy Network. Types, Stages & Grades. BCAN.org. Accessed March 2019.
8 American Cancer Society. Tests for Bladder Cancer. Cancer.org. Accessed March 2019.
9 American Cancer Society. Treating Bladder Cancer. PDF Source. Accessed March 2019.