Many times, people who have bladder cancer find out about it because of blood in their urine (hematuria). This can happen because of a urinary tract infection or other problems.
Bladder cancer starts in cells that line the inside of the bladder. It can grow into and destroy healthy tissue and spread to other parts of the body. The stage and grade of the cancer determines treatment.
The DNA in cells in the bladder can mutate, disabling their functions and allowing them to grow out of control. Most of these mutated cells die or are attacked by the body’s immune system. But sometimes they escape detection, continue to grow and form a tumor in the bladder. Most of the time, these cancers start in cells on the surface of the urothelium (the layer that lines the inner wall of the bladder). But cancer can also begin in cells deep within the urothelium. These are referred to as invasive cancers. Bladder cancer can also spread to other parts of the body, such as nearby lymph nodes or, rarely, to distant sites.
Several factors increase a person’s risk of getting bladder cancer. These include smoking and workplace exposure to carcinogens. Being male and over age 55 also increases your risk. People who have a family history of the disease also have a higher risk. This is because they may have been exposed to the same carcinogens that their family members were. Having changes in certain genes — like GSTM1 or NAT2 — that make it harder for the body to break down some toxins also increases your chance of getting the disease.
Chronic bladder irritation is another major risk factor for bladder cancer. This can happen from having repeated urinary infections, kidney or bladder stones or having a previous urothelial cancer. People who have a history of bladder inflammation or who have received chemotherapy or radiation to the pelvis for other cancers are also at a higher risk.
Other risk factors for bladder cancer are a history of inflammatory conditions in the bladder, such as polyps or diverticula; a personal or family history of other gynecologic or colorectal cancers; and certain genetic mutations. Some of these include having a mutation in the p16 gene, which is associated with cancers of the pancreas and breast; having a mutation in the BRCA1 or BRCA2 genes, which are linked to hereditary breast and ovarian cancers; and having the condition Cowden disease, caused by a mutation in the PTEN gene.
In the early stages, bladder cancer often causes few or no symptoms. But as the cancer gets bigger and moves deeper into the wall of the bladder, it may cause pain or blood in the urine. In women, bleeding in the urine (called haematuria) can sometimes be mistaken for a urinary tract infection or for postmenopausal uterine bleeding.
Symptoms that may be caused by bladder cancer include blood in the urine, painful or difficult urination, and weight loss. If you have these symptoms, talk with your doctor. They will ask you when they started and how often you have them. They will most likely ask you to give a urine sample as a first step in diagnosing what is causing them.
The first treatment for bladder cancer is usually surgery to remove the tumor. It is important to tell your doctor if you have any blood in your urine (called hematuria). He or she will test your urine to see if there is any cancer in it. If there is, your doctor will probably also use other tests to find out how far the cancer has spread (the stage).
Bladder cancer can also grow into other structures in the body that surround the bladder, such as the ureters (the tubes that carry urine from the kidneys to the bladder), urethra (the tube that carries urine from the bladder to the outside of the body) and lymph nodes near the bladder. If the cancer is found in these other structures, it is called advanced bladder cancer. The chance of survival is much lower if the cancer has spread when it is diagnosed than if it is still in the bladder.
Your doctor will suggest a treatment plan based on the type of bladder cancer you have and how advanced it is. For example, if the cancer is still in the inner layer of the bladder, your doctor may recommend radiation therapy. This is a treatment that uses high-energy x-rays to kill cancer cells or keep them from growing. It can be done in addition to surgery or as the only treatment for some types of bladder cancer.
Depending on your symptoms, doctor will do one or more tests to find out if you have bladder cancer and how far it has spread (stage). Doctors use many different tests and tools to make a diagnosis and plan treatment. Some of these tests may be repeated during and after treatment to see if the cancer is responding to the treatment.
Your doctor will ask you about your past health and your symptoms, and do a physical exam. If your doctor suspects bladder cancer, they will order an imaging test or tests to look for a tumor in your bladder and for signs the cancer has spread.
These tests include an ultrasound, a CT scan and a urine test. For a CT scan, you lie on an examination table while the scanner takes pictures of your body from many angles. It takes about 30-45 minutes. It’s important to tell your doctor if you have a pacemaker or other metal implant in your body before having a CT scan.
A urinalysis or cytology test is a simple blood test that checks the cells in a sample of your urine for signs of cancer and to check for a urinary tract infection. The test can also show if you have hematuria (blood in the urine).
If a urinalysis or cytology screen is abnormal, doctors will do a procedure called cystoscopy. During this test, the doctor will insert a long tube with a camera into the urethra and into your bladder to check for abnormal areas and collect a tissue sample (biopsy). They may also use this test to remove small tumours and check them under a microscope. If the doctor thinks you might have a high risk of bladder cancer, they may also do a test called fluorescence cystoscopy. This test uses a special dye to show any unusual areas in your bladder.
A radioisotope bone scan or x-rays can help doctors find out if the cancer has spread to your bones. They will usually be done along with a CT or MRI scan.
The cancer care team will make a treatment plan based on the stage and grade of your bladder cancer, and other factors, such as your general health and preferences. The team will also discuss how the treatments may affect your quality of life and how likely you are to have side effects. Your doctor will explain the options and help you decide which is best for you.
Some of the same tests used to diagnose your cancer will be used to find out how well it is responding to treatment. These are called follow-up or surveillance tests. Your doctor will repeat these tests at regular intervals to check for changes in your cancer or possible new symptoms.
Your doctor may recommend a test to look for a gene change that can help predict how your cancer might respond to treatment. These are called molecular markers. The type of marker your doctor uses depends on the type of cancer you have and its stage.
A CT scan is an imaging test that takes a series of detailed pictures of areas inside the body from many different angles using a computer linked to a machine that makes x-rays. A contrast dye is injected into a vein, and the x-rays are taken as the dye moves through your kidneys, ureters, and bladder.
You might have a specialized CT scan, called a CT urogram, which is done to better see the inside of your urinary tract and identify any tumors. This test combines the CT scan with a procedure to drain the bladder and ureters, and then fill the bladder with a special liquid to help your doctor get a more accurate picture of your kidneys and ureters.
Your doctor might give you chemotherapy before surgery to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. This is called preoperative or neoadjuvant therapy.
After surgery, you might have chemotherapy or radiation therapy to kill any remaining cancer cells and reduce the chance of the cancer coming back. These are called adjuvant therapies.
Symptoms of Bladder Cancer can be similar to signs of other diseases and infections. So if you have them, see your doctor right away.
These tests can help your doctor find out if the tumor is in the lining of your bladder or has spread to the muscle layer of your bladder wall. This is called staging.
Almost 80 percent of people with bladder cancer have blood in their urine, or haematuria. It may be visible to the naked eye (gross hematuria) or it may only be seen with a special test, called urinalysis. The bleeding may come and go, and it often does not cause any pain. But if you have pain or other symptoms, see your doctor right away.
This symptom is usually the first sign of bladder cancer that people have, but it isn’t always taken seriously enough. The reason is that it’s far more common for bladder cancer to be caused by something else, like a urinary tract infection (UTI), bladder stones or an enlarged prostate gland (in men).
People who have bladder cancer often experience pain when they urinate, especially when it is very difficult to urinate. This is because the cancer causes the urethra (the tube that carries pee out of the body) to stretch and tear, which can cause it to feel painful.
The other problem is that the bladder cancer can grow into or spread (metastasize) to the tissue that lines the inside of the bladder and urethra. If it does this, the lining can become irritated and red, which also feels painful.
Sometimes, cancer can even grow into the muscles that surround the bladder and urethra. This can lead to pain when you urinate, or it may cause the bladder muscle to swell up (tumour invading the surrounding tissue).
Cancer that has spread to the bones can cause back pain, which might be there all the time or it might get worse at night. The cancer can put pressure on the spinal cord, which stops it from working properly.
If you have blood in your urine, the doctor will do one or more tests to find out what is causing it. The tests might include a urinalysis, which checks for infection, and a special test that looks for cancer cells in the urine (urine cytology). The doctor might also do a computed tomography (CT) scan or an ultrasound of your kidney, ureters and bladder. They might also do a magnetic resonance imaging (MRI) scan, which produces pictures of your organs using radio waves and a large magnet.
Frequent urination is one of the more common Bladder Cancer symptoms. It means you have to pee more often, usually several times throughout the day and night. If it’s bothering you, we recommend chatting with your doctor to find out what’s causing it. It’s important to remember that it’s not always the cause of something serious, like bladder cancer. For example, it could be caused by drinking too much fluid or a urinary tract infection.
Urine is a waste product that your body gets rid of to eliminate toxins and other unwanted materials. Normally, you should pee about seven to eight times a day. If you’re feeling the need to pee more than that, or if you wake up multiple times in the middle of the night to pee, then it might be time to see your doctor.
If your doctor thinks there is a reason for your frequent urination, they may order tests to figure out what’s causing it. These can include a urinalysis, urine culture, blood work and imaging of your bladder.
These tests can also determine the stage of your cancer. They can help your doctor plan your treatment. If they discover that the cancer is only in the bladder lining and hasn’t spread, it will be stage T1. If they find that the cancer has spread to the bladder wall or muscles, it will be in a higher stage.
A bladder tumor can also cause painful urination. This is known as dysuria. Pain can be felt at the start of urination, or it might happen after you’ve already emptied your bladder. It can be a sharp pain or it might feel like a burning sensation. It can be in the bladder or in the urethra.
Having pain when you’re going to pee can be very disruptive. It can prevent you from being able to sleep or even go about your daily routines. It’s important to talk to your doctor if you’re having this symptom, but don’t panic. Many other things can cause it, including a UTI or an enlarged prostate (in men).
Having pain or a feeling that you have to urinate right away, even though your bladder is not full, could be a sign of Bladder Cancer. It’s important to talk to your doctor about any unusual symptoms. They’ll ask you about your health history and do a physical exam. Your doctor may also ask for a urine sample to test for cancer.
When a person has bladder cancer, their bladder can sometimes fill up with blood, and this makes it painful to urinate. Depending on the type of cancer, the blood can be clear or rusty to dark red in color. The blood may appear on a regular basis or it might come and go over time. It is very important to tell your doctor if you notice any blood in the urine, even if it only happens occasionally.
If the bladder cancer is caught in its early stages, it can be treated very effectively. However, it is very difficult to detect at later stages, when it has spread beyond the lining of the bladder. Cancer cells can spread to nearby organs and lymph nodes. They can also move into the bones. If the cancer spreads to the spine, it can cause back pain and make it hard to walk.
Symptoms of bladder cancer can vary from person to person, and they can also be caused by other health conditions. So it’s important to talk with your doctor if you have any concerns.
If you are diagnosed with bladder cancer, your doctor will use medical tests to find out the stage of your disease. The staging system your doctor uses depends on the type of cancer you have and where it first formed. The doctor will describe the stage of your cancer in your pathology report.
Back pain is very common and can be caused by many things. It may be due to lifting a heavy object, moving suddenly or sitting in the same position for a long time. It may also be a result of muscle spasms or a sprain/tear in the ligaments and muscles supporting the back. It can also be a symptom of a tumour in the bladder or a condition such as a herniated disk.
A doctor can usually tell from a physical examination whether the back pain is acute or chronic. The doctor will also be able to determine the cause of the pain. They will refer you to specialists if necessary. These include orthopedic surgeons, neurologists and rheumatologists. In some cases, doctors may prescribe steroid injections (epidural steroids) or anti-inflammatory medications. These may reduce inflammation in the back and ease the irritation of nerve roots.
If the pain is from a herniated disk, your doctor may suggest traction to stretch the spine. This helps to push the herniated disc back into place and relieves pain, but only for a short period of time.
Most people who have back pain recover without the need for surgery. If the pain persists, the doctor can prescribe physical therapy. This includes exercises, stretches and strengthening of the stomach and back muscles. It can also involve a technique called cognitive behavioral therapy, which helps the patient develop new ways of thinking. This can reduce the amount of painkillers needed and prevent back pain from recurring.
Very rarely, back pain can be a sign of bladder cancer. However, it is important to get any kind of pain checked out by a doctor because other health conditions can also cause these symptoms. Having a family history of bladder cancer is the biggest risk factor. Other factors include smoking, being exposed to certain chemicals in the workplace and drinking well water that has been contaminated with arsenic. Having diabetes or taking some kinds of chemotherapy drugs can also increase the risk. The most important thing is to see a doctor if you have blood in the urine, painful urination or back pain. They will be able to investigate the more common causes of these symptoms first, but if they are not found, they can arrange for tests like an ultrasound or CT scan to check for a possible tumor in the bladder.
Many people have treatment to help lower the chance that their cancer will come back. This includes chemotherapy, radiation therapy, and immunotherapy.
Chemotherapy uses drugs to kill cancer cells or stop them from growing. It’s often given through a tube inserted into the bladder (called a catheter).
People with intermediate risk of recurrence might have intravesical Bacillus Calmette-Guerin (BCG) or intravesical chemotherapy with mitomycin, epirubicin, or gemcitabine. They may also have regular cystoscopies to look for new tumors.
Chemotherapy (also called chemo) uses drugs to destroy cancer cells and stop them from growing. It can be given alone or with other treatment types. For example, it might be given through a tube that is put into your bladder (intravesical). Or it might be used to help make radiation more effective. It might also be given as a pill or injected into a vein.
Your doctor will give you a ‘prognosis’, which is his or her opinion of how likely it is that the cancer will return and how likely it is to get worse. It is based on the type of cancer and its stage, as well as your age and general health. Everyone is different, so it is important to discuss your prognosis with your doctor.
The stage of your cancer is a good guide to how serious it is and what treatment might be needed. Your doctor will use the TNM system, which describes how far the cancer has spread, to work out your stage. It may be written as stage I, II, III, or IV in your pathology report or elsewhere.
If your cancer is in the early stages, you might be able to have surgery to remove the tumor and reduce the chance of it coming back. This is called transurethral resection of the bladder tumor (TURBT). A biopsy might also be done to check whether or not the tumor has spread to the muscle layer. This is usually done during a cystoscopy. The doctor inserts a thin, tube-like instrument into your bladder through the urethra. Some fluid is added to fill the bladder, and the doctor then uses a camera to look at the inside of the bladder.
A second procedure, fulguration, involves using an electrical current to burn away any areas of the tumor that are still left in the bladder. If your tumor is in the later stages, you might be offered chemotherapy after TURBT to lower the risk of it coming back. You might also be offered other treatment options such as chemoradiation or radical cystectomy (removal of the bladder), depending on your risk.
Using a machine that focuses beams of radiation to the tumor, radiotherapy can kill cancer cells and prevent them from growing. Radiation is often used as part of a combination treatment called trimodal therapy, along with surgery and chemotherapy. It is also a main treatment for some muscle-invasive bladder cancers, or when a person cannot have surgery.
Your doctor will consider how you want to be treated and what your goals are. They may talk with you about the pros and cons of different treatments, so that you can make the best decision for you. They will use information about your type of cancer, its stage, and grade, and your general health to decide what is right for you.
For non-muscle-invasive cancer that has not grown beyond the bladder wall (T1a and T2a), surgery or intravesical therapy with a weakened live bacteria called bacillus Calmette-Guerin (BCG) might be enough to keep it from coming back. But if the cancer grows or if it comes back after BCG, you might need a cystectomy or other treatment to remove all the parts of your bladder.
Muscle-invasive cancer that has spread beyond the bladder wall into the muscle tissue (T3a and T3b) is harder to treat. Your doctor might suggest a more extensive TURBT, followed by chemoradiation to try to shrink the cancer and keep it from returning. It might be combined with the immunotherapy drug pembrolizumab (Keytruda), or with nivolumab (Opdivo), especially if your cancer is high-grade or has come back after surgery.
It is possible for cancer to come back (recur) even after treatment, and your doctor will likely give you follow-up tests to look for it. These will include urine tests and imaging tests like CT scans or magnetic resonance imaging (MRI). They might also recommend other medicines, such as the chemo drugs cisplatin and fluorouracil or the immunotherapy drug pembrolizumab. You might also want to take part in a clinical trial of a new treatment. See the booklet Recurrent Bladder Cancer for more information.
The surgeon removes as much of the tumor as possible through a procedure called TURBT. This is usually done using a tube (catheter) inserted through the urethra. The doctor may also take a sample of tissue from the bladder (biopsy) for testing. Often, doctors will use a drug before surgery to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy.
If the cancer is muscle-invasive and has spread from the bladder to other parts of the body, doctors may need to remove the entire bladder. This is called a radical cystectomy. It can be done through an incision on your lower abdomen or by a robot, which uses arms that hold a camera and surgical tools. Robotic surgery can be less invasive and result in quicker recovery times.
Nonmuscle-invasive bladder cancer, which has not spread to other parts of the body, can often be treated with a more extensive TURBT followed by radiation and chemotherapy. This is known as bladder-preserving trimodality therapy. Your doctor might add a drug to the chemo, such as the immunotherapy drugs pembrolizumab (Keytruda) or enfortumab vedotin (Padcev). These are antibodies that are linked to medicines, which target and attack specific cancer cells without harming healthy cells.
People with NMIBC are at higher risk of the cancer returning after treatment. Close follow-up is needed, with cystoscopy every 3 months for at least a couple of years to look for new tumors.
The surgery and chemo used for the initial treatment of the cancer will cause side effects. These might include pain in your belly or pelvis, and blood in the urine. Some of these side effects will go away after the treatments end. But others might be permanent.
Your doctor will talk to you about when to have follow-up appointments, which might be more often in the first months and years after your active treatment ends, and then less often as time goes by. During these visits, your doctor will check your health and answer any questions you have. They will also give you a physical exam and do blood and urine tests. They might also have a CT scan of your bladder and abdomen.
There are several drugs that can help your immune system find and fight cancer cells. These are called immunotherapy drugs. There is a lot of research being done to find better ways to use immunotherapy to treat different types of cancer.
There is a possibility that your cancer may come back (recur). If this happens, it is important to talk with your health care team right away. The team will recheck the tumor with cystoscopy and TURBT and do imaging tests to see how the treatment is working. A recurrence can be treated the same as the original cancer or may require more treatment, including chemotherapy or surgery with or without radiation and/or immunotherapy.
Bladder cancer can start in the transitional epithelial cells that line the bladder or in squamous cells, which are thin, flat cells in the lining of the bladder. It can also start in glandular cells that make mucus and other substances in the bladder or in muscle tissue.
The stage of bladder cancer tells how aggressive the cancer is and how far it has spread from where it started in the bladder. Your doctor will describe the stage of your cancer using a system called TNM (tumor, node, metastasis). Your pathology report will include this staging information.
You and your doctor will decide what treatment is best for you. The type of treatment will depend on the stage and grade of the cancer, your overall health, and your preferences. Your doctor will discuss all of your options, including how long you might have to be in treatment.
Your doctor may suggest a second opinion. You will need to bring important medical test results and reports to the new doctor to share with them before they can give you a recommendation.
If you have non-muscle invasive bladder cancer that comes back, you can try more treatments, such as a combination of chemotherapy with or without immunotherapy and/or radiation therapy or cystectomy. You can also ask about clinical trials that are looking at other ways to treat bladder cancer.
