Your bladder is the hollow, muscular organ in your lower belly where urine is stored. When you urinate, the muscles of your bladder contract and push urine out through a tube called the urethra. Bladder cancer starts when cells in the bladder start to grow out of control. These cells can form into a bladder tumor. They can also spread outside your bladder to lymph nodes and to structures far from the bladder, like your bones, lungs or liver. This is known as metastasis.
Almost all bladder cancers start on the surface of the inner lining of the bladder. This cancer is called transitional cell carcinoma (TCC). When TCC grows into the muscle layers beneath the surface lining, it's harder to treat and more likely to spread. TCC can be described as:
- Non-invasive. It has not grown into muscle layers.
- Invasive. It has grown into bladder muscle.
- Flat, or papillary. Papillary cancers grow outwards and away from the muscles. These cancers are less likely to be invasive.
- Low-grade. The cancer cells look more like normal cells.
- High-grade. The cancer cells look less normal. These cancers are more likely to be invasive.
Other types of cancer can also start in the bladder. These cancers are rare, making up less than five percent of all bladder cancers. They include squamous cell cancer, adenocarcinoma, small cell carcinoma and sarcoma. Treatment for these cancers is similar to treatment for TCC.
Nearly 80,000 new cases of bladder cancer are diagnosed each year in the United States, accounting for about five percent of all cancers in the country. Men are three to four times more likely to have bladder cancer than are women, and most people diagnosed with bladder cancer are older than 55. The biggest risk factor for developing bladder cancer is smoking. Smokers are three times more likely than nonsmokers to get this cancer.
The first sign of bladder cancer is usually blood in your urine. You might notice this blood yourself, or your doctor might find traces of blood during a routine urine check. Blood in the urine is an early sign of bladder cancer, which helps doctors diagnose this cancer at an early stage. Other signs and symptoms may include:
- More frequent urination
- Pain or burning when passing urine
- Having a strong urge to pass urine
- Having trouble passing urine
Late signs and symptoms of bladder cancer can include being unable to pass urine, back or bone pain, nausea, weight loss and weakness.
Diagnosis of bladder cancer starts with a complete history and physical exam. Your doctor may test your urine for blood and bladder cancer cells. If your doctor suspects bladder cancer, you will need a procedure called cystoscopy. A thin, flexible scope is inserted through your urethra and up into your bladder. Your doctor will look for areas in your bladder that could be cancers. Samples of tissue (biopsies) may be taken and checked under a microscope. A biopsy is the only way to diagnose bladder cancer. You also may have imaging studies to see if the cancer has spread beyond the bladder.
Then, your doctor will determine the stage of your cancer. To do this, your doctor will need to know if your cancer is invasive or noninvasive and whether it's high- or low-grade as well as its size and location. Bladder cancer stages range from 1 to 4, with stage 4 being the most advanced.
Your treatment will depend on the stage of your cancer, your age, your general health and your feelings about the risks and benefits of different treatment options. Most people with bladder cancer will need some type of surgery. Many people will also need another type of treatment, such as chemotherapy, radiation therapy or immunotherapy.
No matter what treatment is best for you, it's important to have close follow-up with your doctors and specialists. You may need repeat cystoscopy examinations. This is important because bladder cancer can return or start up in new areas of your bladder or urinary tract.