Bladder cancer starts in the urothelial cells of the bladder. Most bladder cancers are treatable if diagnosed early. It may come back even after successful treatment. Hence, patients need follow-up tests for years after bladder cancer treatment.
The bladder is located in the lower abdomen. It is a muscular-hollow organ that stores urine.
What are the signs and symptoms?
The common symptoms are blood in the urine (hematuria), lower back pain, frequent and painful urination.
What are the diagnostic tests for bladder cancer?
- Urine cytology test helps determine the presence of tumor cells in the urine under a microscope.
- Cystoscopy is a crucial diagnostic procedure for bladder cancer. A thin, lighted, flexible tube (cystoscope) allows the doctor to detect growths in the bladder.
- Biopsy or Transurethral resection of bladder tumor (TURBT) involves the removal of a small amount of tissue for lab examination. It helps determine the type of tumor, location, and additional microscopic cancerous changes or carcinoma in situ (CIS).
- Computed tomography (CT or CAT) scan clicks images from different angles. A computer creates a detailed, 3-dimensional image that indicates abnormalities or tumors.
- Magnetic resonance imaging (MRI) produces detailed body images using magnetic fields. MRI can identify the tumor size, enlarged lymph nodes, and cancer spread.
- Positron emission tomography (PET) or PET-CT scan is PET combined with a CT scan. It produces the images of organs and tissues using a radioactive substance.
- Ultrasound creates a picture of the internal organs using sound waves to locate a tumor.
How advanced is my bladder cancer?
Stage 0a:
The cancer is on the surface of the bladder’s inner lining.
Stage 0is:
A flat tumor or carcinoma in situ (CIS) on the bladder’s inner lining. It can cause muscle-invasive disease.
Stage I:
The cancer is in the bladder’s inner lining and the lamina propria.
Stage II:
Spread into the bladder muscle wall.
Stage III:
Spread into the muscle wall to the fatty layer of tissue near bladder, prostate (in men), the uterus – vagina (in women) and to the regional lymph nodes.
Stage IV:
Spread into the pelvic or abdominal wall. Also into the lymph nodes outside the pelvis and other body parts.
What are the suitable treatment options?
Surgery
Surgery removes the tumor and surrounding healthy tissues on the basis of the stage and grade of the disease.
- Transurethral bladder tumor resection (TURBT)
It helps in diagnosis, staging, and treatment. A surgeon puts a cystoscope into the bladder through the urethra to remove the tumor.
TURBT may eliminate non-muscle-invasive bladder cancer. Additional treatments such as bladder removal or radiation therapy are helpful for muscle-invasive bladder cancer.
It removes the whole bladder, surrounding tissues and organs. The prostate and part of the urethra are also removed in males. The uterus, fallopian tubes, ovaries, and part of the vagina are removed in females.
This surgery can be done with a large incision (open cystectomy) or using cameras (laparoscopic cystectomy) with or without a robot (robotic cystectomy).
It involves the removal of only part of the bladder. However, it is not for muscle-invasive disease.
- Pelvic lymph node dissection
It removes the lymph nodes in the pelvis. It is an accurate way to detect cancer spread.
The common side effects are infection, blood clot, bleeding, erectile dysfunction, nerve damage, urine leakage and fatigue (tiredness).
Chemotherapy
Chemo drugs kill cancer cells by curbing growth, division, and production. Chemotherapy has a specific number of cycles for a set period. It uses a single drug or a combination of drugs.
There are two types of chemotherapy for bladder cancer.
Intravesical or local chemotherapy: Chemo drugs are put into the bladder through a catheter. It only destroys superficial tumor cells. It doesn’t work if cancer has spread to other organs.
Systemic chemotherapy: The drug travels to cells through the blood. It is useful for advanced bladder cancer, both muscle-invasive localized and metastatic diseases.
The common side effects are fatigue, infection, body pain, blood clots, bleeding, appetite loss, abnormal taste (dysgeusia), nausea, diarrhea (dysentery), vomiting (emesis) and hair loss.
Immunotherapy or biologic therapy
It boosts the body’s natural defenses to curb cancer. The two types of immunotherapies are local and systematic.
The common side effects are fatigue, excessive itching, rash, flu-like symptoms, thyroid gland malfunction, hormonal changes, weight changes, diarrhea, and inflammation.
Targeted therapy
It targets cancer-specific genes, proteins, or tissue that help cancer grow. It blocks the cancer spread to minimize the healthy cell damage.
The common side effects are neutropenia, nausea, diarrhea, fatigue, hair loss, anemia, vomiting, constipation, appetite loss, rash, and abdominal pain.
Radiation therapy
It involves high-energy x-rays to eliminate cancer cells. The most common radiation treatment type is external-beam radiation therapy. It has a specific number of treatments over a set period.
It is not a primary treatment for bladder cancer. Radiation in combination with systemic chemotherapy works well. Those who cannot receive chemotherapy might receive radiation alone.
The side effects are fatigue, skin reactions, diarrhea, bladder irritation, frequent urination, and bleeding from the bladder or rectum.
Most side effects will go away soon after treatment ends.
What are the alternative treatment options?
The alternative viable options may or may not be standard treatment. It includes vitamins, herbs, and diet. Some of these may be useful. A few may be harmful. Discuss with the doctor about other suitable treatment alternatives.
What to expect after treatment?
You may have fear of cancer recurrence. Visit your doctor every three months after the treatment ends. Do not skip follow-up visits. Your doctors will ask you about new symptoms. A physical examination and diagnostic tests may help to check recurrence.
For the first year, the follow-up visits may be every three months. After the first year, follow-up visits might be every six months, and then at once a year after five years.
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