Cancer of the Bladder
In this condition factsheet:
Diagnosing Cancer of the Bladder
To diagnose bladder cancer, your doctor will review your medical history, including information about past employment, possible exposure to chemicals, and lifestyle habits such as smoking. Your doctor will then do a physical exam and will probably perform a vaginal and/or rectal examination to rule out other possible causes of the symptoms.
Blood tests are done to check for kidney function, and urine is checked for blood or cancer cells. Next, a cystoscopy is performed. A doctor inserts a thin tube called a cystoscope through the urethra (the tube that carries urine from the bladder to outside the body during urination) and into the bladder.
The cystoscope allows the doctor to look inside the bladder for any abnormalities, and to take a tiny sample of tissue (a biopsy), which will be checked for cancer cells. If you have a cystoscopy, your doctor may give you either a local or general anesthetic.
Once a diagnosis of cancer is made, the stage of the cancer (how far it has advanced) is determined. Some of the following tests might be done:
- CT or CAT scans (computed tomography) show any tumours or abnormalities in the urinary tract area (this includes the bladder, kidneys, urethra, and ureters).
- MRIs (magnetic resonance imaging), more sophisticated than CT scans, show any irregularities in the bladder or urinary tract area.
- IVP (intravenous pyelogram or intravenous pyelography) involves injection of dye into the bloodstream (which becomes concentrated in the urine), at which point X-rays are taken. The X-rays follow the urinary path and show any obstructions or abnormalities.
- Bone scans determine if the cancer has spread to the bones.
- Chest X-rays show if the cancer has spread to the lungs.
Treating and Preventing Cancer of the Bladder
Like most cancers, bladder cancer can be treated by surgery, radiotherapy, chemotherapy, or a combination of therapies. The choice of treatment depends on the location and the staging of the cancer.
When bladder cancer is caught early, a transurethral resection (TUR) can be done. Using a cystoscope, the doctor uses a special tool to burn away the cancerous cells inside the bladder. The advantage of this treatment is that the bladder stays intact and people can still urinate normally after the procedure.
Surgery to remove the bladder is called a cystectomy. If the cancer has invaded through the bladder wall, or if it covers a large portion of the bladder, surgeons generally choose this surgery over TUR.
In women, removing the bladder usually involves also removing the uterus (hysterectomy), fallopian tubes, ovaries, and part of the vagina. If the woman is young, the ovaries might be left intact so that she won't have early menopause. For men, the prostate and the seminal vesicles (the glands that produce semen) must usually be removed along with the bladder.
Occasionally, an operation called a segmental cystectomy may be performed if the cancer is limited to a small part of the bladder wall. This surgery doesn't remove the entire bladder, so people can still urinate normally afterward.
There are two types of radiotherapy used to treat bladder cancer: internal and external.
External radiotherapy aims radiation directly at the cancer cells in the bladder. It may be done prior to surgery to shrink the size of the tumour, or after the surgery along with chemotherapy.
Internal radiotherapy is done by inserting radiation implants directly into the bladder. This treatment requires a hospital stay. Visitors might not be allowed - this is to avoid exposing them to the radiation coming from the person being treated. Once the implants are removed, no more radiation is released and the person can return home from the hospital.
Some people receive both internal and external radiation.
The side effects of radiotherapy are usually temporary, and they include:
- red, dry skin at the radiation site
- decreased appetite
- vaginal dryness (for women)
- difficulty having erection (for men)
Chemotherapy can be used alone or in combination with surgery and/or radiotherapy. It's available as a general treatment (usually given intravenously) or a local one.
Local chemotherapy (intravesical therapy) involves putting chemotherapy medications directly into the bladder for several hours at a time. The greatest advantage to intravesical treatment is that there are fewer side effects since the medications are not given systemically (throughout the body). This approach is usually reserved for superficial tumours removed during a cystoscopy, both to treat tiny amounts of tumour left behind or to prevent recurrence after successful removal.
General, or systemic, chemotherapy circulates throughout the body, so more of the body systems are affected by the treatment. This approach is used if the cancer has spread and can't be reached by the local (intravesical) approach.
Side effects from chemotherapy include:
- nausea and vomiting
- hair loss
- mouth sores
- increased risk of infection
The prognosis (outlook) for bladder cancer is good. The sooner the cancer is discovered, the better the chances of survival. The five-year survival rate can be as high as 94% if the cancer is detected early. However, this drops dramatically once the cancer has spread to other areas of the body.
If bladder cancer does return, it most often happens within the first year or two after treatment, so good follow-up is essential. This involves cystoscopies and urine tests at least every three months for a couple of years, then less frequent ongoing monitoring.
While some of the risk factors for bladder cancer can't be avoided (age and gender, for example), there are some precautions that can be taken to help avoid developing it. For those who work with high-risk chemicals, it's important to have urine tests as part of general annual physical examinations. Any unusual bladder symptoms should be checked by a doctor immediately.
Since smoking is a known risk factor for getting bladder cancer, smokers should try to quit or ask their doctor about ways to quit.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.