Bladder Cancer
When you’re diagnosed with bladder cancer, you need expert care. At Owensboro Health, you can find it close to home. As an accredited Comprehensive Community Cancer Program, we offer nearly all the same options and technology you’d find at an academic medical center. Our care team will work together across many fields of medicine to develop a treatment plan that’s personalized to you — designed around your specific condition, personal preferences and treatment goals. And you can count on us to treat your bladder cancer holistically, caring not only for your physical health, but your mental and emotional health, too.
What is Bladder Cancer?
Bladder cancer develops when cells in the bladder — a hollow organ in the lower pelvis which holds urine — begin to grow out of control. The bladder wall has several layers, each made up different kinds of cells. Most cancers start in the innermost lining of the bladder wall, called the urothelium or transitional epithelium. And if cancer grows into deeper layers of the bladder wall, it becomes harder to treat.
Bladder Cancer Symptoms
Often, bladder cancer is found early because it causes blood in the urine. Blood in the urine doesn’t necessarily mean you have bladder cancer, though: It’s more commonly caused by something like an infection or kidney stones. Still, it’s one of the most common symptoms of the disease.
Other bladder cancer symptoms include changes in urination, such as:
- Frequent need to go at night
- Increased need to go
- Pain or burning
- Trouble urinating altogether
- Urgent need to go, even if your bladder isn’t full
- Weak urine stream
Bladder Cancer Risk Factors
A risk factor is something that raises your risk for developing a certain type of cancer. Some, like those related to genetics, you can’t change. But others, like risk factors related to lifestyle, you can.
One example of a bladder cancer risk factor you can’t change is gender. Men are much more likely to develop bladder cancer than women. In fact, it’s the fourth most common cancer in men.
Other risk factors for bladder cancer include:
- Being of certain racial and ethnic backgrounds (white people, for example, are about twice as likely to develop bladder cancer as African Americans and Hispanics, and Asian Americans and Native Americans have slightly lower rates)
- Being older than 55
- Drinking water contaminated with arsenic
- Exposure to certain industrial chemicals, like aromatic amines sometimes used in the dye industry
- Having a personal or family history of bladder cancer
- Having chronic bladder irritation or infections
- Not drinking enough water
- Smoking
- Taking certain medicines or dietary supplements, such as the diabetes medicine pioglitazone (Actos®) and supplements with aristolochic acid
Bladder Cancer Types
If you have bladder cancer, it’s most likely a urothelial carcinoma, which is cancer that starts in the urothelial cells that line the inside of the bladder.
But other, less common types of bladder cancer include:
- Adenocarcinoma
- Sarcoma
- Small cell carcinoma
- Squamous cell carcinoma
Bladder cancers are also sometimes divided into two subtypes — papillary and flat — depending on how they grow. In addition, they can be described as either non-muscle invasive or muscle invasive depending on whether they’ve spread into the muscle wall of the bladder.
Diagnosing Bladder Cancer
Bladder cancer is most often found when someone experiences symptoms, like blood in the urine. If we suspect bladder cancer, we’ll most likely perform certain tests, including a physical exam and a digital rectal exam.
We may also may order certain lab tests, such as:
- Urinalysis, which checks for blood and other substances in your urine
- Urine culture, which checks the urine to see if an infection is causing your symptoms
- Urine cytology, which checks for cancerous or pre-cancerous cells in your urine
In addition, we’ll likely recommend a cystoscopy, which looks for abnormal cells using a long, flexible tube with a small camera on the end. A cystoscopy is one of the most common ways we check for bladder cancer.
If a cystoscopy identifies cancerous cells, we’ll biopsy the cells using a transurethral resection of bladder tumor (TURBT), also known as a transurethral resection (TUR). This procedure lets us remove the tumor and some of the bladder muscle around it. If cancer is found, the test can also show if it’s invaded the bladder’s muscle.
We also may use imaging tests to diagnose bladder cancer. Some of these include:
- CT scan
- Intravenous pyelogram (IVP) or retrograde pyelogram
- MRI
- Ultrasound
Treating Bladder Cancer
Our comprehensive cancer care team will develop a treatment plan that’s tailored to you, taking into account your specific diagnosis, overall health and personal treatment goals. Your care team may include a medical oncologist, radiation oncologist, surgical oncologist and urologist, but you may consult with others during treatment, as well, such as dietitians, counselors and nurse practitioners.
Surgery, alone or in combination with other therapies, is the most common treatment for bladder cancer. Early-stage bladder cancers can often be removed, but new cancers may form over time. For this reason, we monitor patients with bladder cancer long after treatment ends.
Surgery for bladder cancer may include:
- Cystectomy. Typically used when bladder cancer has spread, this procedure can either be partial, with only some of the bladder removed, or radical, with the entire bladder and nearby lymph nodes removed. A radical cystectomy also removes the prostate and seminal vesicles in men. In women, it also removes the ovaries, fallopian tubes, uterus, cervix and a small part of the vagina.
- TURBT. Although often used to diagnose bladder cancer, it’s also the most common treatment for bladder cancers that haven’t spread.
Other treatments for bladder cancer include:
- Chemotherapy. Chemotherapy for bladder cancer is ether delivered into the bladder, via intravesical therapy, or systemically, through the vein or muscle.
- Immunotherapy. This type of therapy is often used to treat early-stage bladder cancers.
- Intravesical therapy. Used mainly for early-stage bladder cancers that are still in or very close to the inner lining of the bladder wall, this therapy involves a liquid drug inserted into the bladder. Chemotherapy, immunotherapy and targeted therapy drugs may be delivered this way.
- Radiation therapy. This treatment may be recommended after surgery to kill any remaining cancer cells.
- Targeted therapy. Bladder cancer cells may contain fibroblast growth factor receptors (FGFR), a group of proteins that can help them grow. Your doctor may recommend drugs, called FGFR inhibitors, that target cells with FGFR gene changes.
