Bladder cancer is the sixth most common cancer in the United States. Over 81,000 people will be diagnosed with bladder cancer in 2019 and nearly 18,000 people will die of the disease. Most bladder cancers are urothelial carcinomas, though less common tumors, such as, adenocarcinoma, small cell carcinoma, and squamous cell carcinoma, can occur.
Signs/Symptoms of Bladder Cancer
The most common indication of bladder cancer is blood in the urine (hematuria). This bleeding can range from being visible to the naked eye to only being detectable on a chemical test and through microscopic analysis. Hematuria can be continually present or intermittent, and in most cases there is no pain; however, in rare cases, bladder cancer can cause lower back pain or difficulty voiding. There are many causes for blood in the urine other than bladder cancer, so it is important that one sees his or her urologist for a complete evaluation.
Other symptoms of bladder cancer may include changes in urinary frequency, increased urgency with urination, and burning with urination.
Cigarette smoke is considered to be the leading cause of Bladder Cancer. Smokers have a three times greater incidence of bladder cancer than non-smokers, and up to half of all bladder cancer is a result of cigarette smoking. Other causes of bladder cancer can include certain industrial chemicals found in paints, solvents, tars, rubbers, and dyes.
Diagnosing Bladder Cancer
Blood in the urine requires several tests that often begin with some form of imaging of the kidneys, such as a CT scan or Renal Ultrasound. A complete evaluation also requires a cystoscopy performed by a urologist. If an abnormal area or growth is seen during the cystoscopy, a biopsy will be performed in which a small instrument is placed through the cystoscope to remove a piece of tissue for diagnosis. Complete tumor removal (transurethral resection of bladder tumor or TURBT) typically requires anesthesia. During the TURBT, the urologist passes a resectoscope into the bladder to remove tumors. Once the tumor has been removed, a pathologist examines the tumor to give a diagnosis.
Bladder Cancer Stages and Grading
Bladder tumor grade and stage are important for determining appropriate treatment. A grade (low or high) is given based on how abnormal the cells appear to the pathologist. High-grade tumors are more aggressive and can progress more quickly.
Staging is based on how deeply the bladder cancer is growing into the bladder wall tissues. The deeper a cancer, the more difficult and involved the treatments can be. Staging of the primary tumor (T stage) is as follows:
- Tis-carcinoma in situ (high-grade flat tumor confined to urothelium)
- Ta-noninvasive papillary tumor confined to urothelium
- T1-tumor invades lamina propria
- T2a-tumor invades superficial muscle
- T2b-tumor invades deep muscle
- T3a-microscopic perivesical fat invasion
- T3b-macroscopic perivesical fat invasion
- T4a-tumor invades adjacent organs (uterus, ovaries, prostate)
- T4b-tumor invades pelvic sidewall or abdominal wall
The N and M stages are also used to describe the status of the regional lymph nodes and other distant organs.