Bladder Cancer

The bladder is a hollow organ composed of layers including an inner lining and muscular outer layers. Bladder cancer typically begins in the inner layer of the bladder and grows into the bladder wall. In order to determine the best treatment for bladder cancer patients, doctors must determine how deeply the cancer has spread into these layers.

Bladder Cancer Risk Factors

Bladder cancer risk factors include:

  • Smoking
  • Age (most prevalent in people over 60)
  • Race (occurs in Caucasians twice as often as blacks)
  • Gender (occurs in men four times as often as women)
  • Chronic bladder infections
  • Exposure to chemical dyes or industrial chemicals
Bladder Cancer Symptoms

Symptoms of bladder cancer include painless blood in the urine, frequent urination or feeling the need to urinate without being able to do so, pain during urination, and, rarely, lower back pain.

Unless you have strong risk factors that would justify special screening tests, or a urinanalysis showing blood in your urine, the best advice is to see your doctor right away if you have any of the symptoms listed above.

Diagnosing Bladder Cancer

In order to diagnose and/or evaluate bladder cancer, your urologist will order many of the tests listed below.  The tests ordered will depend on the type of bladder cancer you have, since not all bladder cancers are the same in every person.

  • Imaging tests: A variety of tests such as IVP (intravenous pyelogram), a CT scan, MRI, or ultrasound may be done to give the doctor more information about the cancer and whether it has spread (metastasized) beyond the bladder.
  • Urine cytology: In this test, urine from the bladder is sent to the lab to microscopically see if cancer cells (or pre-cancer cells) are present.
  • Urine culture: A sample of your urine is sent to the lab to see if you might have an infection. Infections can sometimes cause symptoms like those of bladder cancer and can occur in the face of cancer.
  • Cystoscopy: If bladder cancer is suspected, a urologist may perform a cystoscopy, in which a tiny lighted fiberoptic scope called a cystoscope is inserted into the urethra in order to examine the bladder. This procedure is very similar to a colonoscopy to assess for colon cancer. If necessary, a biopsy may be performed at the same time (under anesthesia).
  • Flow cytometry or image cytometry: These tests, done on a urine sample, bladder washings, or on a tissue sample, measure the amount of DNA in bladder cells. This information can be useful in finding bladder cancer that has come back (recurred) after treatment.
  • Bladder tumor marker studies: These tests look for certain substances released by cancer cells into the urine. More research is needed before these tests are used routinely. These are best used for patients with a known bladder cancer.
After Bladder Cancer Diagnosis

If bladder cancer has been diagnosed in your initial tests, more tests may be conducted to find out if cancer cells have spread within the bladder or to other parts of the body.

The process used to find out if cancer has spread within the bladder lining and/or muscle of the bladder wall or to other parts of the body is called cancer staging. It is important to know the stage in order to plan the best bladder cancer treatment. The following tests and procedures may be used in the staging process:

  • Physical examination: A check of general signs of health, including looking for anything unusual, such as swollen or tender lymph nodes.
  • Cystoscopy: An examination of the bladder and urethra using a cystoscope (a thin, lighted instrument) inserted into the urethra. Tissue samples may be removed and examined under a microscope to check for cancer cells.
  • CT scan (or CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. A computer linked to an x-ray machine creates the pictures. This test is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).
  • Chest x-ray or CT scan of the chest: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.
  • Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
Bladder Cancer Grading and Staging

Grading of tumors by the pathologist, after the tumor has undergone biopsy and resection, provides information about the potential behavior of the bladder tumor. Low grade (Grade 1) tumors look more like normal bladder cells, and tend to remain on the surface of the bladder lining, while the high grade (Grade 3) tumors have much angrier looking cells and tend to shed cells into the urine, and are more likely to invade into the bladder surface.

Staging is the process of finding out how extensive or widespread the bladder cancer is. The treatment and the outlook for your recovery depend on the stage of the bladder cancer. The microscopic examination of the tumor biopsies shows the depth of invasion into the bladder wall, which determines the clinical stage of the tumor.

The most superficial disease, confined to the mucosal surface, is called Ta, when there is a visible tumor polyp, or Tis(in-situ), when the tumor is flat. Tumor invading into the next layer of the bladder (lamina propria) is called T1. The tumors that invade into bladder muscle are termed T2, through bladder wall into surrounding fat is T3, and invading neighboring structures is called T4.

To further assess the extent of the bladder cancer, an intravenous pyelogram (IVP) is used to evaluate the kidneys and ureters, as about 8 percent of patients with bladder tumors will also have tumors in the upper urinary tract. CT Scan of the abdomen and pelvis may demonstrate enlarged lymph nodes, which drain the bladder, blockage of the kidneys, as well as possible spread to other organs.

Bladder Cancer Survival Rates

The five-year bladder cancer survival rate refers to the percentage of patients who live at least five years after their cancer is found. Of course, many people live much longer than five years. Five-year relative bladder cancer survival rates don't factor in patients dying of other diseases. These numbers provide an overall picture, but keep in mind that every person's situation is unique and the statistics can't predict exactly what will happen in your case.

Learn more about cancer treatment options.

The Emory Department of Urology is affiliated with The Winship Cancer Institute of Emory University, Georgia's only National Cancer Institute-Designated Cancer Center and serves as the coordinating center for cancer research and care throughout the Emory University system. With NCI Designation Winship joins an elite group of 65 cancer centers in the United States to have earned this coveted status.

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