Understanding Bladder Cancer: From Diagnosis to Treatment

Bladder cancer originates in the cells lining the bladder and it typically starts as small growths or tumors on the inner surface of the bladder. These growths are initially not cancerous, but they can potentially spread to other parts of the body if not treated on time.  

In the United States, bladder cancer is one of the most commonly diagnosed cancers. According to the American Cancer Society*, approximately 82,290 new cases of bladder cancer will be diagnosed by the end of 2023. 

In this blog post, we will share detailed insights into bladder cancer symptoms, diagnosis as well as bladder cancer stages and treatment options. Read on for more. 

Bladder Cancer Symptoms  

Bladder cancer can manifest in various ways, often indicating potential issues within the urinary system. Recognizing these signs is crucial for early detection and timely medical intervention. Common symptoms of bladder cancer include:  

• Blood in the urine or hematuria 

• Increased frequency of urination  

• Discomfort or pain while urinating, also known as dysuria 

• Urinary urgency  

• Pelvic pain or discomfort  

• Back or abdominal pain 

• Unexplained weight loss  

• Fatigue  

• Swelling in the lower extremities 

While these symptoms can be indicative of bladder cancer, they can also indicate other medical conditions. Individuals experiencing any persistent or unusual urinary symptoms should seek immediate medical attention for accurate diagnosis and timely intervention.   

Bladder Cancer Diagnosis

1. Cystoscopy 

This procedure involves the insertion of a cystoscope, a slender tube equipped with a light and lens, through the urethra into the bladder. It allows a healthcare provider to visually inspect the bladder and urethra for any abnormalities.  

Providers may also use the cystoscope to remove small tumors or collect tissue samples for biopsy.  

2. Biopsy

Often performed during cystoscopy, a biopsy involves the removal of a sample of cells or tissue from the bladder. A pathologist then examines this sample under a microscope to detect signs of cancer.  

3. Computed Tomography (CT) Urogram or Intravenous Pyelogram (IVP)

A CT Urogram captures detailed images of the urinary tract by using contrast dye and CT scans. This process involves a series of images of the kidneys, bladder, and ureters, both before and after contrast dye is injected. Additionally, it also provides insights into nearby structures, such as bones and blood vessels, to assess urinary tract functionality and identify potential signs of disease.  

Similarly, an IVP employs X-rays to visualize the urinary tract following the injection of contrast dye.  

4. Urine tumor marker test

This test examines the urine for substances produced either by bladder cancer cells or as a response to bladder cancer. Detecting these markers aids in diagnosing specific types of bladder cancer.  

Staging Tests 

Once diagnosed, healthcare providers determine the stage of bladder cancer to finalize treatment options. A urologic oncologist, specializing in urinary and reproductive organ cancers usually recommends the following tests to assess the extent of cancer spread.   

• Computed Tomography (CT) Scan  

• Magnetic Resonance Imaging (MRI)  

• Chest X-ray  

• Bone Scan  

Bladder Cancer Stages

The cancer stage denotes the extent of cancer within the body, considering factors like tumor size, spread, etc. Understanding the stage of bladder cancer is crucial for determining an effective treatment strategy.  

Various staging systems exist for cancer diagnosis, with bladder cancer often being staged through the TNM system. Based on TNM results, healthcare providers categorize stage I, stage II, stage III, or stage IV.  

Stage 0 (noninvasive papillary carcinoma and carcinoma in situ)

It refers to noninvasive bladder cancer, indicating that cancer cells are present in the bladder's inner lining but haven't penetrated the bladder wall.  

Stage 0 is further divided into 0a and 0is stages. Stage 0a is known as noninvasive papillary carcinoma, resembling elongated growths extending into the bladder lumen.  

Stage I

It involves non-muscle-invasive bladder cancer that has extended into the connective tissue but hasn't reached the bladder's muscle layers.  

Stage II

Also termed muscle-invasive bladder cancer, stage II signifies cancer's spread through connective tissue into the bladder's muscle layers.  

Stage III

Known as locally advanced bladder cancer, stage II bladder cancer is divided into IIIA and IIIB stages.  

• In stage IIIA, cancer grows through the bladder muscles and wall into the surrounding fat layer. It may have also extended to reproductive organs without affecting lymph nodes or might have spread to a single lymph node in the pelvis, not near major arteries.  

• In stage IIIB, cancer has spread to more than one lymph node in the pelvis that isn't near common iliac arteries or to a lymph node near these arteries.  

Stage IV

This stage is further categorized into two substages: IVA and IVB.  

• In stage IVA, cancer may have spread to the abdominal or pelvic wall, or lymph nodes above the common iliac arteries.  

• In Stage IVB, cancer has metastasized and spread to other body parts like the lungs, bones, or liver.    

Bladder Cancer Treatment

1. Surgery

It is the primary approach for addressing bladder cancer, and the specific surgical technique depends on the cancer's location.   

Types of bladder cancer surgery:  

• Transurethral Resection (TUR) with Fulguration: This procedure involves a cystoscope insertion through the urethra, equipped with a wire loop for tumor removal or burning via high-energy electricity (fulguration).  

• Partial cystectomy: This procedure is suitable for low-grade tumors within the bladder wall. During this procedure, surgeons remove part of the bladder, allowing normal urination post-recovery.  

• Radical cystectomy with urinary diversion: For more extensive cases, healthcare providers remove the entire bladder, nearby organs, and lymph nodes. Urinary diversion procedures create alternative urine pathways.  

2. Radiation therapy

By utilizing high-energy X-rays, radiation therapy eradicates or restricts the growth of bladder cancer cells. Oncologists often suggest external beam radiation therapy for bladder cancer to target the affected area from outside the body.  

3. Chemotherapy

This procedure involves use of drugs to prevent further growth of cancer cells, either by killing or inhibiting cell division. For bladder cancer, systemic chemotherapy delivers drugs intravenously, while intravesical chemotherapy flushes the bladder with cancer-killing drugs.  

4. Immunotherapy

It has become a pivotal treatment for bladder cancer, particularly in cases of advanced or metastatic disease. Immunotherapy blocks immune checkpoints, enabling an individual's immune system to target and attack cancer cells. Additionally, some immunotherapy drugs can stimulate an immune response within the bladder to combat cancer cells.  

5. Targeted therapy

It involves the use of drugs to specifically target certain molecules or pathways involved in the growth and spread of cancer cells. Targeted therapies offer a more precise and less toxic alternative to traditional chemotherapy by disrupting specific cancer-promoting mechanisms. However, their effectiveness depends on the molecular characteristics of the tumor.  

6. Clinical trials 

These trials typically involve the testing of novel therapies for cancer treatment. They aim to evaluate the safety and efficacy of these interventions, often in comparison to standard treatments or in combination with existing therapies. Individuals should discuss the pros and cons of any clinical trial with healthcare providers to take an informed decision. 

The Bottom Line

Advancements in medical science and ongoing research are continuously enhancing the available treatment options for bladder cancer and improving prognosis. With the guidance of skilled medical professionals and a supportive network, individuals diagnosed with bladder cancer can fight against this cancer effectively.  

For any queries or concerns about bladder cancer stages, diagnosis, or treatment options, contact Advanced Cancer Treatment Centers, one of the top cancer treatment centers in Florida. ACTC Brooksville is a leading cancer center in America that offers personalized cancer treatment plans under the guidance of a multidisciplinary team of healthcare professionals and state-of-the-art facilities. Schedule an appointment now! 

* Key statistics for bladder Cancer. (n.d.). American Cancer Society.