What is bladder cancer?

One way to discuss bladder cancer is to describe the kind of cells it starts in.

The bladder wall is made up of many layers of cells. It has an outer layer of muscle cells and an inner lining layer of transitional cells. Bladder cancer can affect any one or all of these cells (and layers). These are the 3 types of cells that most commonly become bladder cancer:

• Urothelial cells or transitional cells. These cells make up the tissue that lines the inside of the bladder. This tissue is called the urothelium. Cancer that starts here is called urothelial carcinoma or transitional cell carcinoma (TCC). This is, by far, the most common type of bladder cancer.
• Squamous cells. These look like cells from the surface of the skin. They can start in the bladder if there’s a lot of inflammation. Over time, they can become cancer. This type is rare, causing less than 1 in 50 of all bladder cancers.
• Cells that make up glands. This type of bladder cancer is called adenocarcinoma. It’s very rare. Only about 1 in 100 people with bladder cancer have this type.

In rare cases, other cancers can start in the bladder. These include lymphoma, sarcoma, and small cell carcinoma.

Who is at risk for bladder cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.

The risk factors for bladder cancer include:

• Smoking tobacco
• Having a Caucasian ethnic background
• Being a man
• Older age
• Exposure to certain chemicals and dyes
• Chronic bladder problems
• Taking certain medicines and supplements
• History of bladder cancer yourself or in your family
• Certain genetic syndromes
• Past cancer treatment with certain kinds of chemo or radiation to your pelvis
• High levels of arsenic in your drinking water

Talk with your healthcare provider about your risk factors for bladder cancer and what you can do about them.

Can bladder cancer be prevented?

There is no sure way to prevent bladder cancer. But some risk factors can be controlled to help reduce your risk. Don’t smoke and limit exposure and protect yourself from chemicals. It may also help to drink a lot of water and eat a healthy diet with lots of fruits and vegetables.

Are there screening tests for bladder cancer?

There are no regular screening tests for bladder cancer. Screening tests are done to check for disease in people who don’t have symptoms.

People at high risk, such as those who have had bladder before, may be screened with cystoscopy. This is a test that lets the doctor look inside the bladder using a thin tube that’s put in through the urethra. Urine tests can also be done to look for blood or abnormal cells.

What are the symptoms of bladder cancer?

Common symptoms of bladder cancer include:

• Blood in your urine. Blood is often the first sign of bladder cancer. The color of urine may be pink or deep red, depending on the amount of blood. You may have clots of blood in the urine.
• Change in urinary habits. This can include urinating more often than normal. You may feel an urgent need to urinate, have trouble urinating, or have a weak stream of urine. You may have burning or pain when urinating.

Many of these may be caused by other health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is bladder cancer diagnosed?

Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. Your provider will do a physical exam. This may include a rectal or vaginal exam. They may do this to check for the tumors that may be large enough to feel.

You may also have one or more of these tests:

• Urinalysis and urine culture
• Urine cytology test
• Urine tests for bladder cancer tumor markers
• Cystoscopy
• Intravenous pyelogram (IVP)
• Bladder biopsy

After a diagnosis of bladder cancer, you’ll likely need other tests. These help your healthcare providers learn more about cancer. They can help determine the stage of cancer. The stage is how much and how far cancer has spread (metastasized) in your body. It is one of the most important things to know when deciding how to treat cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

How is bladder cancer treated?

Your treatment choices depend on the type of bladder cancer you have, test results, and the stage of cancer. The goal of treatment may be to cure you, control cancer, or to help ease problems caused by cancer. Talk with your healthcare team about your treatment choices, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just one treatment or a combination of treatments.

Bladder cancer may be treated with:

• Surgery
• Intravesical therapy
• Chemotherapy (chemo)
• Radiation therapy
• Immunotherapy
• Targeted therapy

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects?

Cancer treatments such as chemotherapy and radiation can damage normal cells. This can cause side effects like hair loss, mouth sores, and vomiting.

Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Coping with bladder cancer

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.
• Ask your healthcare team or social worker for help.
• Speak with a counselor.
• Talk with a spiritual advisor, such as a minister or rabbi.
• Ask your healthcare team about medicines for depression or anxiety.
• Keep socially active.
• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.
• Drink plenty of water, fruit juices, and other liquids.
• Keep physically active.
• Rest as much as needed.
• Talk with your healthcare team about ways to manage treatment side effects.
• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse
• Signs of an infection, such as a fever
• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for, and when to call. Know how to get help after office hours and on weekends and holidays.

Key points about bladder cancer

• Bladder cancer most often starts in the cells that make up the inside lining of the bladder. From the lining it can spread deeper into the other layers of the bladder wall.
• Common symptoms include having blood in your urine and a change in your urinary habits.
• A diagnosis is made with a physical exam that may include a rectal or vaginal exam. You may also need tests such as a urine test, bladder biopsy, or cystoscopy.
• Bladder cancer may be treated with surgery, intravesical therapy, chemo, radiation therapy, immunotherapy, and targeted therapy.
• Treatment side effects can include hair loss, mouth sores, skin changes, and vomiting. Talk with your healthcare provider about any side effects and ways to manage them.