Bladder cancer usually starts in the cells lining the inside of the bladder. It usually announces itself with blood in the urine: sometimes obvious, sometimes spotted by a lab before you see anything. Visible or not, it deserves a urology workup.
Symptoms
- Visible blood, or blood a lab finds in a sample
- Stinging as urine passes
- Frequent or sudden trips to the bathroom
- Trouble urinating
- An ache low in the back or pelvis
- Fatigue or weight loss
Infections and stones cause many of the same symptoms. Testing sorts out which is which. Advanced Urology's page on hematuria (blood in urine) explains the wider list of causes.
How it is diagnosed
A urinalysis looks for blood and abnormal cells. A cystoscopy lets the urologist see the bladder lining directly. CT or ultrasound looks at the kidneys and the rest of the urinary tract, and a biopsy confirms the diagnosis. PET/CT is available to stage muscle-invasive or advanced bladder cancer.
Types of bladder cancer
Most bladder cancers are urothelial carcinoma, also called transitional cell carcinoma. It can stay in the lining (non-muscle invasive) or grow into the bladder wall (muscle invasive), and that difference shapes treatment. Squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma are less common.
Treatment options
- Removing the tumor
- Tumors in the lining are usually removed through the urethra during a short procedure, which also gives tissue for staging.
- Medicine placed in the bladder
- BCG, mitomycin or valrubicin can be instilled through a catheter in the office to lower the chance of recurrence or progression. Because the medicine stays in the bladder, the usual side effects are burning and frequent urination, not the nausea or hair loss of IV chemotherapy.
- IV immunotherapy
- Pembrolizumab (Keytruda) is an option for some high-risk non-muscle-invasive cancers that have not responded to BCG, when bladder removal is not chosen.
- Radical cystectomy
- Removal of the bladder for aggressive cancer, sometimes done robotically, with a plan for how urine will leave the body afterward.
After treatment
Recurrence is common with bladder cancer, so the plan includes scheduled cystoscopy and urine tests for years afterward. Stopping smoking is one of the most useful things a patient can do.
Your team
Bladder cancer is part of the practice of Vahan Kassabian, MD, Herman Bagga, MD, FACS and Marc Greenstein, DO. More from Advanced Urology on bladder cancer.