What is Bladder Cancer?
Your bladder is a hollow muscle that stores urine until it is passed through the urethra, when you urinate.The bladder has 4 layers of tissue:
- The inside layer is the bladder lining.
- Next to that is connective tissue (that also has nerves and blood vessels).
- The third layer is the thick bladder muscle, which squeezes when you urinate, and
- The outside layer is made up of fatty tissue.
Bladder cancer occurs when the cells in the bladder—like the cells in other parts of your body—grow and divide. If a normal cell collects too many genetic errors, it can turn into a cancer cell. As the cancer cell grows and divides, it will begin to form a tumor. This can cause bleeding or affect how your bladder functions.
There are some risk factors for bladder cancer that you cannot control. These include:
- Being male
- Getting older
- Family history of bladder cancer
- Birth defects in the bladder or urinary tract
Other risk factors include:
- Exposure to chemicals at work or in the environment
- Bladder irritation caused by:
- Kidney and bladder stones
- Inflammation and infections
- Long-term catheter use
- Having had radiation to treat another type of cancer
Some common symptoms of bladder cancer include:
- Blood in your urine
- Pain when you urinate
- Having to urinate more often than usual
However, these symptoms can also be signs of bladder problems that aren’t cancerous. If you have these symptoms, make sure to see your doctor.
Diagnosis and Staging
If you have symptoms of bladder cancer, your doctor may suggest a blood test or an imaging test, such as a CT scan or an ultrasound. Your doctor may also send you to a urologist to look in your bladder in a procedure called a cystoscopy (sis-TOS-kuh-pee). If you have bladder cancer, your urologist will perform a surgical procedure called a TURBT (pronounced turb-tee). This is short for TransUrethral Resection of Bladder Tumor. Your doctor will decide what treatments to offer based on three main factors: the type, grade, and stage of the bladder cancer.
A cystoscopy (sis-TOS-kuh-pee) is a procedure that allows your doctor to see and examine the inside of your bladder. For the procedure:
- Your doctor will insert a scope into your urethra, the tube that carries urine out of your body. The scope has a special lens that allows your doctor to get a close look at the lining of your bladder.
- Your doctor will fill your bladder with a sterile solution.
- Your doctor will remove a small piece of bladder tissue. This is called a biopsy.
- The tissue is sent to a pathologist, who will examine it under a microscope to see if there are any cancer cells.
For more details, watch this Getting a Cystoscopy video from our friends at Cancer Research UK.
If you have bladder cancer, your urologist will perform a surgical procedure called a TURBT. This is the most common way to remove early-stage tumors. For the procedure:
- You will be given anesthesia.
- Your urologist will insert a scope through the urethra into the bladder. This part is very similar to a cystoscopy.
- Your urologist will remove any abnormal looking tissue using the scope’s wire loop.
- A pathologist will look at this tissue under a microscope to learn more about the cancer.
This tells you and your health care team where the cancer started:
- Urothelial (transitional cell) – most common bladder cancer that starts in the cells that line the bladder and urethra
- Squamous cell carcinoma
The grade describes what the cancer cells look like when viewed by a pathologist.
Low grade: less likely to come back
High grade: more likely to come back
Stage (Non-Muscle Invasive or Muscle-Invasive)
The stage of the bladder cancer tells you and your health care team how far the cancer has spread. Bladder cancer can be non muscle invasive (Stages 0-1) or muscle invasive (Stages 2-4).
Non-muscle invasive bladder cancer is when the tumor(s) have not spread into the bladder muscle. It is the most common form of bladder cancer. Three out of 4 patients diagnosed with bladder cancer have non-muscle invasive cancer. These tumors are Stage 0 (which can be further divided into stage 0a and stage 0is/Tis) or Stage 1 bladder cancer.
Also called Stage Ta or papillary tumors, these tumors are commonly found on a small area of tissue. Like other bladder cancers, it often returns, but it has a lower risk of spreading to the muscle after treatment.
Also called carcinoma in situ or CIS, is found on or near the surface of the bladder. It has a higher risk of of coming back after treatment.
Also called a T1 tumor, has spread into the bladder’s connective tissue, but not into the muscle. These tumors have a high risk of coming back and spreading into the muscle.
Muscle-invasive bladder cancer means the tumor(s) have grown into the muscle of the bladder and may have spread outside the bladder. About 1 out of every 4 bladder cancers are muscle invasive. These tumors are stage II (2), stage III (3) or stage IV (4).
The cancer has spread into the bladder muscle.
The cancer has spread through the muscle of the bladder to the fatty layer and/or has spread outside the bladder to nearby lymph nodes or tissue.
Also known as metastatic bladder cancer, has spread to the lining of the walls of the abdomen or pelvis. It may also have spread to other parts of the body.
Key members of a treatment team can include:
- urology nurses
- wound/ostomy nurse
- medical oncologist
- oncology nurse
- palliative care specialist
- social worker
- financial counselor
Talk to your doctor about the risks and benefits of each type of therapy to determine which is best for you.
Your treatment will be based whether you have non-muscle invasive or muscle-invasive bladder cancer.
Survivorship and Coping
Cancer survivorship doesn’t begin when treatment ends. It starts at the time of your diagnosis. You can think of survivorship as having two parts:
From diagnosis through the end of treatment
During this time, your focus will be on learning more about the type of bladder cancer you have, you treatment options, and making treatment decisions that are right for you. Survivorship will also be about learning the best way to manage and cope with short-term symptoms or side effects that you have from your cancer or its treatments.
After treatment ends
During this time, your focus will be on adjusting to life after your initial treatment is over. At this time, your focus will be on understanding when you need to see your doctor for follow-up, managing any long-term side effects of your cancer and its treatments and, for many patients, learning how your new bladder works.
The Bladder Cancer Advocacy Network (BCAN) also provides support through their Survivor to Survivor program which provides support and information on coping with side effects to women and men at all stages of survivorship. To contact their free hotline, 888-901-2226.
Whether you are someone with cancer or someone close to you has cancer, it can be very helpful to talk with others in a similar situation who will understand what you are going through. Support from others who understand can help to improve your ability to cope, your ability to feel more into control over your situation and give you a sense of hope.
Bladder cancer affects not only those with the disease, but also the people who care for them. Caregiving for a person with bladder cancer can be stressful and frustrating. You may feel angry, guilty, alone, afraid, or sad. If you are caring for a person with bladder cancer:
- Find support. Share your feelings with others. Look for caregiver support groups, either in person or online. Ask the patient’s cancer center if they have a support program for caregivers.
- Look for extra help. Ask family, friends and members of your community if they can help. If they offer, give them specific tasks. If you can afford it, consider hiring people to help care for the person with bladder cancer. Or have them help with chores, childcare or errands.
- Take breaks. Carve out time for yourself. Spend time with people important to you, and take time for activities you enjoy. Don’t feel guilty about making time for yourself—it is important for your own health.
- Take care of yourself. Just as the person with bladder cancer needs to pay attention to their diet, exercise and sleep, so do you. If you smoke, find a smoking cessation program. Limit alcohol.
- Learn about the Family and Medical Leave Act (FMLA). You may qualify to take up to 12 weeks of unpaid, job-protected leave to care for a seriously ill family member.
- Learn about financial assistance. You may have high out-of-pocket costs from parking, transportation and food as part of your caregiving duties. Ask the hospital where the person with cancer is receiving treatment if they can provide help with financial counseling for caregivers. You can also visit our Managing the Costs of Cancer Treatment page for resources that can help.
For more tips and information about caregiving and support, see our caregiver page.
A Healthy Lifestyle
Be sure to talk to your health care team about exercise, diet, and nutritional supplements. It is not yet known if these can help reduce the risk of your cancer returning or spreading. But eating a good diet, not smoking, being active, and staying at a healthy weight are good for your heart and overall health.
Having to go for repeat testing or needing repeat surgeries can also cause anxiety, sadness, depression or frustration.
These follow-up tests can also cause a great deal of stress. Follow up cystoscopies may cause pain and discomfort, which can cause even more anxiety. Patients have nicknamed these feelings scanxiety.
Many people find individual counseling and support groups help them manage these feelings. Exercise, meditation and joining a support group can also help.
Survivorship Care Planning (After Treatment Ends)
A survivorship care plan is a document that includes information about the treatments you have received and the follow-up care you need. Having a survivorship care plan can help you keep track of all the treatments you’ve had, your test results, and when to follow-up with your cancer care team. It can also help you keep copies of all medical records and insurance payments in one place.
A survivorship care plan is a document that includes information about the treatments you have received and the follow-up tests and scans you will need in the future. Because bladder cancer has a high risk of coming back, these follow-up tests are very important.
You will also want to:
- Know when you should follow up with your health care team and how (what exams, tests, or scans you will need).
- Know what symptoms might suggest your bladder cancer has returned or spread so you can tell your health care team about them as soon as possible.
- Know what short- and long-term side effects that you may experience and how to manage them.
- Talk to your urologist about your risk for other types of cancers.
- Talk to your health care team about exercise, diet, and nutritional supplements. It is not known if they can reduce the risk of a recurrence. But we do know that eating a good diet, not smoking, being active, and staying at a healthy weight are good for your heart and overall health.
- Have access to resources for emotional support. You can learn more about finding support in this section of our website.
- Keep copies of all of your medical records and insurance payments.