Your bladder is a balloon-shaped, muscular organ located in your pelvis. The function of the bladder is to hold urine produced from the kidneys. The bladder stores the urine until it is expelled through the urethra.
A bladder tumor is when abnormal cells grow on or through the bladder wall. These tumors can be benign (noncancerous) or malignant (cancerous).
Typically, early bladder cancer has few symptoms. The most common symptom is hematuria (blood in your urine that may be only visible by microscope). Other possible symptoms include:
- Abdominal or pelvic pain
- Painful urination
- Urinary frequency and/or urgency
- Urine leakage (incontinence)
- Weight loss
All of these symptoms may be related to other medical diagnoses as well. It is important to seek evaluation from a medical provider who can help determine what the true diagnosis is.
Per the National Cancer Institute, in 2013, about 55,000 men and 18,000 women will be diagnosed with bladder cancer in the United States. Most will be more than 70 years old. More than nine out of 10 Americans with bladder cancer have a type called transitional cell cancer (TCC).
There are three layers of the bladder; each has its own function. Depending on where the abnormal cells grow on these layers, this is the type of or name given to the cancer.
- The inner layer, or lining, has transitional cells on the surface that stretch when your bladder fills with urine and shrink when you empty your bladder.
- The middle layer is muscle tissue. It assists you when you are emptying your bladder by squeezing the urine out.
- The outer layer covers the bladder and is composed of blood vessels, fibrous tissue and fat.
Types of Bladder Cancer
- Transitional Cell Carcinoma (TCC): This cancer begins in the innermost tissue layers of the bladder. The cancer cells can stretch and shrink depending on if the bladder is full or empty. Most bladder cancers are TCC type. This can also be called Urothelial Carcinoma. There are two subtypes:
- Papillary Carcinoma: This grows out of the inner lining toward the center of the bladder and has fingerlike projections. Typically, this type of cancer does not invade the deeper layers of the bladder.
- Flat Carcinoma: This grows on the surface of the inner bladder wall; it does not have fingerlike projections growing toward the center of the bladder, but is flat. Many times you may hear “Carcinoma in situ” for this type of bladder cancer.
- Squamous Cell Carcinoma: This cancer forms in the squamous cells and are flat in appearance.
- Adenocarcinoma: This cancer forms in the glandular/secretory cells of the bladder. This accounts for 1 percent to 2 percent of bladder cancers in the U.S.
- Small-cell carcinoma is extremely rare, accounting for fewer than 1 percent of all bladder cancers diagnosed in the United States. This type of bladder cancer begins in neuroendocrine cells, which are similar to nerves.
- Sarcoma is another very rare type of bladder cancer that begins in the muscle layer of the bladder wall.
Staging of Bladder Cancer
Once bladder cancer has been diagnosed, it is given a stage which describes how aggressive it is and helps your provider determine what treatment plan is best for you.
- Stage O: The cancer cells are only present on the inner lining of the bladder and have not invaded the connective tissue or muscle of the bladder wall. There has been no spreading to lymph nodes or outside sites.
- Stage 1: The cancer cells have grown into and under the lining of the bladder wall. There has been no spreading to lymph nodes or outside sites.
- Stage 2: The cancer cells have grown into the muscle layer of the bladder. There has been no spreading to lymph nodes or outside sites.
- Stage 3: The cancer cells have grown outside of the bladder walls and into surrounding tissues.
- Stage 4: The cancer cells have grown outside of the bladder walls and have spread to other sites.
The treatment of bladder cancer depends on the grade and stage of the cancer cells. Your provider will recommend the best treatment plan for you after testing, biopsy results and a complete review of your medical history.
A biologic liquid that contains weakened bacteria called BCG (Bacillus Calmette-Guérin) is instilled into the bladder by a urethral catheter. This treatment is typically given for superficial bladder cancers once a week for six weeks. This bacteria helps the body’s natural defenses kill the cancer cells in the bladder and helps to prevent them from coming back.
Bladder chemotherapy can be administered directly into the bladder by a urethral catheter. This works directly on the tissues to kill the cancer cells.
Surgery is an option for most people with bladder cancer. Below is a listing of surgical treatments per the National Cancer Institute with details about each of them.
Transurethral Resection (TUR)
The doctor uses a cystoscope to treat early bladder cancer (Stage 0 or Stage 1). No incision (cut) into your body is needed, but general anesthesia is usually given. The doctor inserts the cystoscope into the bladder through your urethra. The cutting tool is slipped through the cystoscope. A small wire loop at the end of the tool removes the cancer and burns away remaining cancer cells with an electric current.
TUR may need to be repeated. Also, bladder-instilled chemotherapy or biological therapy may be given after this type of surgery. For a few days after TUR, you may have some blood in your urine and difficulty or pain when passing urine. Otherwise, TUR generally causes few problems.
The surgeon makes an incision into your body to remove the cancer from your bladder.
Part of the bladder (called a partial cystectomy)
For some people with a single, small tumor in the bladder, the surgeon does not remove the entire bladder. The surgeon removes the tumor, the part of the bladder containing the tumor, and nearby lymph nodes. After part of the bladder is removed, you may not be able to hold as much urine in your bladder as before surgery. You may need to empty your bladder more often. This problem usually gets better with time.
All of the bladder (called a radical cystectomy)
For bladder cancer that has invaded the muscle layer (Stage 2 or some Stage 3), the most common type of surgery is radical cystectomy. The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra.
In addition, the surgeon usually removes the prostate from a man and may remove the uterus and ovaries from a woman. Other nearby tissues may also be removed. When the entire bladder is removed, the surgeon makes another way for urine to be collected from the kidneys and stored. You may wear a flat bag outside the body under your clothes, or the surgeon may use part of your intestine to create a pouch inside the body. Another option is a neo-bladder, or portion of your intestine that is reconfigured to create a new bladder that is reattached to your ureters and urethra in an attempt to restore a more normal urinary function. Your provider will discuss the best option for your case prior to surgery.
When the prostate or uterus is removed, a man can no longer father a child and a woman can no longer get pregnant. Men may be unable to have intercourse after surgery, and if the surgeon removes part of a woman’s vagina, intercourse may be difficult.
Robot-assisted Laparoscopic Cystectomy
This procedure spares vital nerves and muscle tissue while the bladder is removed and a alternative way for urine to be collected from the kidneys is created. Learn about robot-assisted laparoscopic cystectomy.
Radiation Therapy can sometimes be used with intravenous chemotherapy in patients with invasive cancer. It uses high-energy beams to shrink or kill the cancer cells. Internal or external radiation or a combination may be used to treat the cancer cells. Learn more about radiation therapy at the Regional Cancer Center at Memorial.
Chemotherapy is where one or more drugs kill the cancer cells, either through injection into the urethra and bladder (intravesical) or by absorption into the blood by taking a pill or having it delivered into a vein (intravenous). Intravenous is usually indicated in preparation for surgery, or when the cancer has spread beyond the bladder.