What is Bladder Cancer?

Cancer is the growth of abnormal cells which can grow together to form masses called tumors. When the bladder is affected by cancer, it usually begins in the cells that line the bladder. The cancer cells grow into a tumor and can invade and damage normal organs and tissues. Bladder cancer is more common in people over age 60.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of bladder cancer. We provide supportive programs with specially trained staff including dietitians, social workers, genetic counselors, nurse navigators, financial counselors and psychologists. Plus, we are active in bladder cancer clinical trial enrollment and membership.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Bladder cancer symptoms usually start subtly, including:

• Blood in the urine
• Frequent or urgent urination
• Difficulty urinating or inability to urinate
• Pain or burning during urination
• Back or pelvic pain

Diagnosis

To determine if someone has bladder cancer, we ask about medical history and do a physical exam, including a vaginal and/or rectal exam. We also use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Urine test: To look for cancer cells.

Cystoscopy: During this test, a narrow tube is inserted through the urethra. A small sample of the cells in the bladder may be collected to check for cancer.

Contrast-enhanced CT Scan: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the bladder visible to X-rays. Computers capture the images and produce a highly detailed view of the urinary tract and bladder.

Causes

There are a number of genetic, lifestyle and environmental factors that can increase the risk of bladder cancer, including:

• Smoking. People who smoke are more likely than nonsmokers to get bladder cancer.
• Workplace exposure to chemical carcinogens.
• Exposure to medications like cyclophosphamide used to treat cancer and other conditions.

Risk Factors

Risk factors that can contribute to bladder cancer include:

Age: Bladder cancer is rarely found in people under age 40.

Being male: Men are more likely to develop bladder cancer than women.

Being white: Whites have a greater risk of developing bladder cancer than people of other races.

Chronic bladder inflammation: Long-term use of catheters can cause chronic bladder infections, which can increase the risk of bladder cancer.

Exposure to certain chemicals: Exposure to arsenic and being around chemicals used to manufacture dye, rubber, leather, textiles and paint can increase the risk of developing bladder cancer.

Family history: People with family members who have bladder cancer are at higher risk.

Parasitic infection: The parasitic infection schistosomiasis, prevalent in tropical and subtropical areas, is associated with bladder cancer.

Previous cancer treatment: Some cancer treatments, such as radiation of the pelvis, and some cancer drugs can increase the risk of bladder cancer.

Prevention 

While some risk factors like age and heredity cannot be controlled, there are ways you can help to prevent bladder cancer:

Don’t smoke: Smoking is thought to be a factor in about half of all bladder cancers.

Practice good heart health: Eat a healthy low-fat diet that includes plenty of fruit and vegetables, exercise daily and drink plenty of fluids.

Avoid exposure to chemicals: Avoid exposure to industrial chemicals and make sure your drinking water is free from toxic chemicals like arsenic.

Prognosis

Prognosis depends upon how the bladder cancer stage at diagnosis, including the size of the tumor and the extent of spread. If diagnosed early, prognosis is good for patients with bladder cancer. Bladder cancer can come back or recur, which makes regular follow-up with your physician important.

Treatment and Recovery

Bladder cancer treatment depends upon the location and size of the cancer and the extent to which the cancer has spread. Sometimes, multiple types of treatments are necessary, including:

Surgery

Surgery can include removal of the bladder cancer or partial or total removal of the bladder.

• Transurethral bladder tumor resection (TURBT): In this procedure, a tube is inserted through the urethra and into the bladder to biopsy the tumor or remove it.
• Cystectomy: In this procedure, a portion of the bladder (partial cystectomy) is removed or the total bladder (radical cystectomy) is removed. During radical cystectomy, nearby tissues and organs may also be removed, including the prostate and urethra in men, or the uterus, fallopian tubes, ovaries and part of the vagina in women. Lymph nodes in the pelvis may also be removed. This surgery can be performed through an incision in the abdominal wall. In some cases, cystectomy can be performed by laparoscopic and robotic surgery in which instruments and camera arms are placed through several small abdominal incisions, which makes recovery faster. When the bladder is removed, the surgeon will create a new pathway for the urine out of the body. Sometimes the surgeon can create a neobladder from part of the intestine, and connect the neobladder to the urethra to enable normal urination.

Intravesical therapy

With this procedure, a medication is put directly into the bladder via a catheter in order to treat bladder cancer that is in the lining of the bladder. The drug can affect the lining of the bladder without having major effects in other parts of the body. Drugs can include chemotherapy or immunotherapy.

Chemotherapy

Chemotherapy uses special drugs designed to kill cancer cells. Chemotherapy can be administered intravesically directly to the bladder, or it can be given as a pill or injected into the bloodstream.

Immunotherapy and Targeted Agents

Medications that target proteins or receptors may re-start the immune system and allow the immune system to attack the bladder cancer cells.

Radiation therapy

Radiation uses high-energy radiation to kill cancer cells. Radioactive beams form outside the body are directed specifically to the site of the cancer. Most often radiation treatments are given five days a week for several weeks.

Complications

Bladder cancer may recur, so follow-up care for years after successful treatment is important. The risk of recurrence varies with the type, size and extent to which the cancer has spread. It is very important to take all medication as directed. Side effects should be reported as soon as possible. Your doctor and nurses can try several options if there are side effects or if you have trouble tolerating the medications.

Some treatments for bladder cancer result in alternative ways of eliminating urine form the body. That can mean an internal pouch is emptied via a catheter, or an external bag to collect urine is changed. Other complications, which can be treated, include sexual dysfunction and body image changes:

For men: Certain medications and procedures can change the ability to obtain or maintain an erection. Surgical procedures that remove the seminal vesicles and prostate affect semen production and may result in a dry ejaculate. Some changes may improve over time and should be discussed with your healthcare provider.

For women: Radiation and surgery may result in changes to the vagina and other structures. More difficult and painful intercourse or changes in sexual desire may result and should be discussed with your healthcare provider

Emotional support is important for anyone who has bladder cancer. Family and friends, support groups and counselors can help.