Bladder Cancer
What is Bladder Cancer?
The bladder is a hollow organ in the lower abdomen that stores urine. Bladder cancer occurs when cells in the bladder start to grow out of control. Most bladder cancers are urothelial carcinomas.
Urothelial carcinoma is cancer that begins in urothelial cells, which are found in the lining of the bladder and some other organs.
Other ways to describe bladder cancer:
Nonmuscle-invasive bladder cancer is contained completely in the bladder and hasn’t penetrated into the muscle wall of the bladder. Approximately 75% of bladder cancers are nonmuscle-invasive.
Muscle-invasive bladder cancer is cancer that has grown into the muscle wall of the bladder or beyond it.
Metastatic bladder cancer is cancer that has spread from the bladder to other parts of the body such as lymph nodes, bone or other organs.
Common Symptoms
The most common symptom is blood in the urine (called hematuria). This often changes the colour of urine to pink, red or dark marooon. Sometimes, the amount of blood in the urine is so tiny that it can only be detected by urine tests.
Other common symptoms of bladder cancer may include:
a need to urinate more often than usual (frequent urination)
an intense need to urinate (urgent urination)
burning or pain during urination
trouble urinating
low back pain or pain in the pelvis
Check with your health care provider if you are concerned about any of these symptoms. It’s possible other conditions could be the cause of these symptoms.
Diagnosis
Tests used to diagnose bladder cancer:
Urine Cytology: A sample of urine is examined under a microscope to see if any cancer cells are present.
Cystoscopy: A thin flexible camera is inserted through the urethra into the bladder, so that a urologist can examine the lining of the bladder for tumours.
TURBT (Transurethral Resection of Bladder Tumour): A surgical procedure using a cystoscope through the urethra to remove tumours and nearby samples of bladder muscle. The material removed is sent to a lab for analysis to help determine the stage and grade of the bladder cancer.
Scans: CT, MRI or ultrasound scans may be used to help detect cancer and to help with staging the the cancer.
Treatment
Surgery is the main treatment for bladder cancer. Along with surgery, other treatments such as chemotherapy or radiation may also be given.
TURBT (Transurethral Resection of Bladder Tumour): Once the bladder has healed from the diagnostic TURBT, additional TURBTs may be performed on nonmuscle-invasive tumours if they are aggressive.
Treatment with BCG: For specific types of nonmuscle-invasive cancers, a drug called BCG may be inserted into the bladder once a week for six weeks. BCG is a weakened form of Tuberculosis mycobacterium and it stimulates immune responses to destroy the cancer cells. Maintenance treatments of BCG may be prescribed to reduce the risk of the tumour recurring.
Treatment with Mitomycin C: Mitomycin C is a liquid chemotherapy solution that may be given at the time of a TURBT for specific types of nomuscle-invasive cancers
Partial cystectomy: Surgery to remove part of the bladder. This may be done in some cases of muscle-invasive cancer where the cancer is limited to one area of the bladder. Very specific criteria are required for a partial cystectomy to be offered.
Radical cystectomy with urinary diversion: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when muscle-invasive bladder cancer is present, or when certain types of nonmuscle-invasive bladder cancer recur. When the bladder is removed, a new method is created for urine to drain from the kidneys to outside the body (called diversion).
Other Resources
Canadian Urological Association: Bladder Tumours Brochure