Bladder Cancer

The bladder is part of your urinary tract. The urinary tract rids your body of liquid waste. Bladder cancer means that certain cells in the urinary tract have changed in ways that aren’t normal.

When Bladder Cancer Forms

Cancer is a disease in which cells in an area of the body begin changing and multiplying out of control. The multiplying cells may form a lump of tissue (tumor). With time, the cancer cells destroy healthy tissue. They may spread to other parts of the body. Why cells become cancerous is not clear. But bladder cancer is strongly linked to cigarette smoking. The longer a person smokes and the more a person smokes, the greater that person’s chances of developing bladder cancer.

Types of Cancer That May Form

Three types of bladder cancer may form:

• Papillary tumors stick out from the bladder lining on a stalk. They tend to grow into the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall.
• Sessile tumors lie flat against the bladder lining. Sessile tumors are much more likely than papillary tumors to grow deeper into the layers of the bladder wall.
• Carcinoma in situ (CIS) is a cancerous patch of bladder lining. The patch may look almost normal or may look inflamed.

Each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time.

During your evaluation, your doctor uses cystoscopy to look inside your bladder. If the cancer is in an early stage (superficial) and growing slowly (low grade), it may be removed using cystoscopy. Removal of a tumor during cystoscopy is known as transurethral resection (TUR). Most of the time, tissue removed during TUR can be studied to see if more treatment is needed.

Removing a Tumor

TUR is usually done in a hospital as an outpatient procedure. If the tumor is large, you may be kept in the hospital overnight. You will be given anesthesia so you don’t feel pain during the procedure. Regional anesthesia numbs just the lower part of your body. If you have general anesthesia, you will be completely asleep.

During the Procedure

A cystoscope containing a cutting tool is inserted into your bladder through your urethra. The bladder is then examined. If tumors are found, they are removed, if possible. A biopsy (sample) of both tumor and normal-looking tissue may be taken. These samples are looked at under a microscope for cancer cells. In some cases, a laser is used to burn a tumor away. The laser destroys tissue, so none is left for biopsy.

After the Procedure

After the procedure, a catheter (flexible tube) may help drain your bladder for a few days. Bladder tumors can come back (recur) after treatment. To be sure that all cancer cells are destroyed, TUR may be followed by other types of treatment, such as intravesical therapy. This uses special medications that are placed in the bladder to destroy cancer cells.

Risks and Possible Complications

• Bleeding.
• Infection.
• Perforation of the bladder.

Certain types of bladder tumors are hard to remove using surgical procedures like transurethral resection (TUR). These include tumors that are high grade, occur in more than one area, are flat against the bladder wall, or come back after treatment. In these cases, special medications that destroy cancer cells may be placed into the bladder. This treatment is called intravesical therapy. Intravesical therapy may be an option if you have a hard-to-remove tumor. It may also be done after TUR to help keep the cancer from coming back.

Medication Inside Your Bladder

Intravesical therapy is usually done in the doctor’s office. A catheter (flexible tube) is used to fill the bladder with liquid medication. This medication may be a liquid chemotherapy drug, which kills cancer cells, or BCG (a type of bacterium), which helps boost your body’s immune system.

During Treatment

You’re asked to hold the medication in your bladder for up to 2 hours, then urinate. If BCG is used, your doctor may advise you to pour bleach into your toilet after you urinate. This kills any leftover bacteria. Intravesical therapy is usually given weekly for 6-8 weeks. Depending on the medication used, you may be prescribed antibiotics to help prevent infection. If you have a fever at any time during treatment with BCG, call your doctor right away.

After Treatment

After your weekly treatments, you may be given regular follow-up treatments for up to a year or more. These follow-up treatments help keep the cancer from coming back. After the treatments are over, cystoscopy and urine cytology may be done every 3 months or so to help check for cancer cells.

Risks and Possible Complications

• Bladder infection.
• Bladder irritation (burning, need to urinate frequently, pain on urination).
• Changes in your blood cell counts (with certain chemotherapy drugs).
• Scarring of the bladder (rare).
• General infection (with BCG) (very rare).

Intravesical Therapy Video

Radiation is a way of treating cancer. Radiation uses beams of energy to destroy cancer cells. With each dose, the tumor gets smaller. The cancer cells die and healthy cells take their place. Radiation may be used alone or with chemotherapy, and may be done before or after surgery.

Destroying Cancer Cells with Radiation

Your radiation oncologist designs a treatment plan for you. This plan is based on an evaluation of your disease and overall health. Radiation may be directed at the bladder itself and other areas to which the cancer may have spread.

During Treatment

You’re asked to change into a gown. A technician positions you on the table. Short doses of radiation are aimed at the target areas. Each treatment lasts a few minutes and is given once a day, 5 days a week, for 5-7 weeks. Because some nearby tissue is affected, you may have side effects.

After Treatment

You can return to your normal activities soon after each visit. You may still notice some side effects after your full course of treatment has ended. These usually clear up within a few weeks.

Short-Term Side Effects

• Mild to moderate diarrhea.
• Bladder irritation (burning, frequent urination).
• Mild fatigue (low energy).
• Some loss of pubic hair.
• Rectal irritation or bleeding (rare).

Risks and Possible Complications

• Continued bladder irritation.
• Loss of bladder function.
• Impotence (problems with erections).
• Bleeding from bladder (rare).
• Permanent damage to intestine or rectum (rare).