Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Treatment
Coping
As many as 53,000 American men are diagnosed with bladder cancer each year, while over 10,000 are expected to die as a result of the malignancy.
Verywell / Ellen Lindner
By far the most common bladder cancer in the United States istransitional cell carcinoma (TCC), also known as urothelial carcinoma.This type is limited to the innermost lining of the bladder (known as the transitional epithelium). Because the transitional epithelium is only a few cells thick, catching cancer at this early stage—when it is considered non-invasive—translates to high rates of treatment success.
While 70% of bladder cancers are confined to the transitional epithelium, others will penetrate deeper into the bladder wall.Those that involve the underlying layer of cells, called the lamina propria, are referred to as non-muscle invasive carcinoma. Those that penetrate even deeper into the muscles of the bladder wall are classified as invasive carcinomas.
Once cancer spreads (metastasizes) beyond the confines of the bladder—most of often to lymph nodes, bones, lungs, liver, or peritoneum—it becomes more difficult to treat and control.
In addition to TCC, other, less common types of bladder cancer include adenocarcinomas, small cell carcinomas, and sarcomas. These types are considered uncommon and each account for 1% or less of all U.S. cases.
Bladder cancer is often painless. The most significant sign of malignancy is urinary bleeding, either overt (known asgross hematuria) or detected with blood or imaging tests (microscopic hematuria).The bleeding may be consistent or intermittent. While blood in urine may be distressing, it is neither diagnostic of cancer nor predictive of the severity of a malignancy.
Thesigns and symptoms of bladder cancercan vary based on the size and location of the tumor as well as the stage of the disease. In addition to bleeding, other symptoms may include:
Like any cancer, bladder cancer is due to mutated cells that proliferate and form a tumor—in this case, in the bladder. For reasons not entirely understood, bladder cancer affects men three to four times more often than women, with nine out of 10 cases occurring over age 55.The disease is more common in white than black men.
The exact cause of one’s bladder cancer is not always certain, but there arecontributing factorsthat healthcare providers can point to.
Beyond male gender, race, and older age,cigarette smokingremains the most significant risk factor for bladder cancer. Because many of thecarcinogensfound in cigarettes are expelled from the body in urine, the persistent exposure to these compounds candouble your riskof bladder cancer compared to non-smokers.Moreover, the risk increases in relation to the number of cigarettes you smoke.
Other factors may include:
Certain genetic mutations (particularly the FGFR3, RB1, HRAS, TP53, and TSC1 mutations) may furtherpredispose you to bladder cancer.
Family history may also play a role. Rare inheritable genetic disorders like Lynch syndrome (associated with colorectal cancer),Cowden disease(linked to thyroid and breast cancer), andretinoblastoma(an eye cancer) may potentially increase your risk of bladder cancer.
To this end, the diagnosis relies heavily on the exclusion of all other causes before more invasive investigations begin. This may include a digital rectal exam andprostate-specific antigen (PSA) testto rule out prostate problems. Imaging tests such as X-rays andcomputed tomography (CT)may be used to exclude kidney stones, bladder stones, and urinary tract disorders.
While urinary cytology (the microscopic evaluation of urine to check for cancer cells) may provide evidence of cancer, the test is often inaccurate if the tumor is small and non-invasive.
The same applies to newer options called the bladder tumor antigen (BTA) and nuclear matrix protein 22 (NMP) tests, both of which are more likely to detect larger, more advanced tumors.As such, these tests are more useful in monitoring a diagnosed malignancy than establishing the initial diagnosis.
Definitive Diagnosis
The gold standard for diagnosis of bladder cancer iscystoscopy.The direct viewing technique is performed underlocal anesthesiato numb the urethra (the tube through which urine exits the body).
The cystoscope is comprised of either a 2.9-millimeter or 4.0-millimeter tube that is inserted into the urethra to get an up-close view of the internal structure of the bladder. Tiny instruments can also be fed through the scope to obtain tissue samples for evaluation in the lab.
While cystoscopy can offer definitive evidence of bladder cancer, additional tests such as abone scan, liver function tests, and CT scans of the chest, pelvis, and abdomen may be used to establish if and how far the cancer has spread.
Disease Staging
Based on a review of the test result, a specialist known as a urologic oncologist will stage the cancer. Cancer staging is used to determine the appropriate course of treatment depending on the characteristics of the tumor. It can also help predict the likely outcome (prognosis) of the disease.
The staging is classified based on the type and location of the tumor as follows:
If the lymph nodes are involved, “N+” is tagged onto the end of the tumor stage (for example, T3N+). If cancer has metastasized to the lymph nodes and distant organs, “N+M1” is tagged to the end of the tumor stage.
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Ta, Tis, and T1 tumors
The mainstay of treatment of Ta, Tis, and T1 cancers is the surgical removal of visible tumors.The procedure, known astransurethral resection of the bladder tumor (TURBT), is performed undergeneralorregional anesthesiausing a specially equipped cystoscope. The urologist may also place you on a course of chemotherapy to kill all remaining cancer cells. Mitomycin C is a commonly used chemotherapeutic agent.
If the cancer is likely to recur (such as can occur with stage Tis tumors),immunotherapymay be used to help boost the body’s tumor-fighting cells. TheBacillus Calmette-Guerin (BCG) vaccine, developed in 1921 to fight tuberculosis, has proven effective in preventing cancer recurrence when injected directly into the bladder.
T2 and T3 tumors
More aggressive T2 and T3 tumors may require more than just the removal of visible tumors. By this stage of the disease, many urologists will recommend aradical cystectomy, in which the entire bladder is removed along with the adjacent lymph nodes, the prostate gland, and the seminal vesicles.Supplemental chemotherapy is often recommended.
While a radical cystectomy is undoubtedly life-altering, newer reconstructive techniques have lessened the functional impact of the procedure. Today, a skilled urologist can create a substitute bladder using part of the intestinal tract and redirect the urine flow so that you can urinate as before. On the downside, erectile dysfunction is more the rule than the exception.
Less aggressive T2 tumors may sometimes be treated with a partial cystectomy. This involves the removal of the affected area of the bladder and does not require reconstructive surgery. Partial cystectomy is rarely used in people with stage T3 cancer.
T4 tumors
If cancer has yet to affect distant organs, chemotherapy (with or without radiation) will usually be the first-line option.If chemo is able to shrink the tumor, cystectomy may be considered. If the chemotherapy is intolerable, radiation may be used in combination with immunotherapeutic drugs, such as atezolizumab or pembrolizumab.
Because treatment is unlikely to cure a T4 tumor, much of the focus is placed on slowing the progression of the disease and maintaining the best quality of life possible.
Statistically speaking, the five-year survival rate is as follows:
Note, though, that this does not mean that you are only expected to live for five years. The figures are simply meant to gauge the effectiveness of treatment. Many people treated for bladder cancer will go on to live long, healthy lives well in excess of 15 years.
Even if you have been successfully treated for bladder cancer, it often takes time to readjust to what lies ahead. Recurrence of the disease is common, and you will likely need to change your lifestyle to stay one step ahead of the disease.
According to research from the David Geffen School of Medicine in Los Angeles, 39.1% of people treated for bladder cancer will have a recurrence without disease progression, while 33% will experience a recurrence with disease progression.To this end, a routine evaluation may be needed every three to six months depending on the nature and severity of your disease. This may involve routine cystoscopy, urinary cytology, and other blood, urine, or imaging tests.
You also need to take the extra steps to decrease your personal risk of relapse. Among the considerations:
A Word From Verywell
While highly treatable, bladder cancer remains a scary prospect for men given the high rate of recurrence and the need for surgical intervention.
With that being said, early diagnosis is associated with less invasive interventions. Most TURBT surgeries, in fact, require no more than a couple of days in the hospital and a couple of weeks of recovery time. By contrast, delayed diagnoses places you at increased risk of more invasive—and potentially life-changing—medical procedures.
It is important, therefore, to pay attention to your genitourinary health and to not ignore symptoms that either persist or recur. In the end, there is no such thing as a “less worrisome” amount of blood in urine. Even milder signs such as urinary frequency should be considered a red flag if they persist for more than a few days.
If your healthcare provider is unable to find the source of your urinary symptoms, ask for a referral to aboard-certified urologistwho can run a more extensive battery of tests. Whatever you do, don’t let embarrassment or discomfort stand in your way of getting the diagnosis you need.
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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