What Is Metastatic Cancer
Metastatic cancer is a cancer that has spread from the part of the body where it started to other parts of the body. When cancer cells break away from a tumor, they can travel to other parts of the body through the bloodstream or the lymph system.
This image shows some parts of the lymph system, like lymph nodes and lymph vessels, as well as organs and tissues that contain many lymphocytes .
If the cells travel through the lymph system, they could end up in nearby lymph nodes or they could spread to other organs. More often, cancer cells that break off from the main tumor travel through the bloodstream. Once in the blood, they can go to any part of the body. Many of these cells die, but some may settle in a new area and start to grow.
Cancer cells must go through several steps to spread to new parts of the body:
- They must find ways to break away from the original tumor and enter the bloodstream or lymph system.
- They need to attach to the wall of a blood or lymph vessel and move into a new body part.
- They need to find ways to grow and thrive in their new location.
- They must be able to avoid attacks from the bodys immune system.
Sometimes the metastatic tumors have already begun to grow when the cancer is first found. And sometimes, a metastasis may be found before the original tumor is found. If a cancer has already spread to other parts of the body before its first diagnosed, it may be hard to figure out where it started.
Bladder Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Bladder
The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller to store urine made by the kidneys. There are two kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.
There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant :
- Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade:
- Low-grade transitional cell carcinoma often recurs after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body.
- High-grade transitional cell carcinoma often recurs after treatment and often spreads into the muscle layer of the bladder, to other parts of the body, and to lymph nodes. Almost all deaths from bladder cancer are due to high-grade disease.
See the following PDQ summaries for more information:
What To Expect At The Urologist’s Office
There are several ways doctors diagnose bladder cancer. First, the urologist will ask questions to find out if youve had chronic UTIs or blood in the urine before as well as do a physical exam to rule out an enlarged prostate, say, or even check for tumors. If necessary, the next steps will be a urine test, imaging, and a biopsy.
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Metastatic And Recurrent Cancers
Metastases require chemotherapy, generally cisplatin based, which is frequently effective but rarely curative unless metastases are confined to lymph nodes. This can be followed by maintenance immunotherapy with avelumab. Combination chemotherapy may prolong life in patients with metastatic disease. For patients who are cisplatin ineligible or have progressed after receiving cisplatin-based regimens, newer immunotherapies using PD-1 and PD-L1 inhibitors are available, such as pembrolizumab and atezolizumab. The first targeted therapy, erdafitinib, is now available for use in patients with FGFR3 and FGFR2 mutations who have failed treatment with chemotherapy.
Treatment of recurrent cancer depends on clinical stage and site of recurrence and previous treatment. Recurrence after transurethral resection of superficial tumors is usually treated with a 2nd resection or fulguration. Early cystectomy is recommended for recurrent high-grade superficial bladder cancers.
What Are The Layers Of The Bladder
The bladder consists of three layers of tissue. The innermost layer of the bladder, which comes in contact with the urine stored inside the bladder, is called the mucosa and consists of several layers of specialized cells called transitional cells, which are almost exclusively found in the urinary system of the body. These same cells also form the inner lining of the ureters, kidneys, and a part of the urethra. These cells form a waterproof lining within these organs to prevent the urine from going into the deeper tissue layers. These cells are also termed urothelial cells, and the mucosa is termed the urothelium.
The middle layer is a thin lining known as the lamina propria and forms the boundary between the inner mucosa and the outer muscular layer. This layer has a network of blood vessels and nerves and is an important landmark in terms of the staging of bladder cancer .
The outer layer of the bladder comprises of the detrusor muscle. This is the thickest layer of the bladder wall. Its main function is to relax slowly as the bladder fills up to provide low-pressure urine storage and then to contract to compress the bladder and expel the urine out during the act of passing urine. Outside these three layers is a variable amount of fat that lines and protects the bladder like a soft cushion and separates it from the surrounding organs such as the rectum and the muscles and bones of the pelvis.
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Occurrence In The United States
The American Cancer Society estimates that 81,180 new cases of bladder cancer will be diagnosed in the United States in 2022 and that 17,100 people will die of the disease. The incidence of bladder cancer increases with age, with the median age at diagnosis being 73 years bladder cancer is rarely diagnosed before age 40 years.
Bladder cancer is about 4 times more common in men than in women. The male predominance in bladder cancer in the United States reflects the prevalence of transitional cell carcinoma . With small cell carcinomain contrast to TCCthe male-to-female incidence ratio is 1:2.
Bladder cancer is the fourth most common cancer in men in the United States, after prostate, lung, and colorectal cancer, but it is not among the top 10 cancers in women. Accordingly, more men than women are expected to die of bladder cancer in 2022, with 12,120 deaths in men versus 4980 in women. Nevertheless, women generally have a worse prognosis than men.
The incidence of bladder cancer is twice as high in White men as in Black men in the United States. However, Blacks have a worse prognosis than Whites.
Limited data indicate that small cell carcinoma of the urinary bladder probably has the same epidemiologic characteristics as urothelial carcinoma. Patients are more likely to be male and older than 50 years.
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After Bladder Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Bladder Or To Other Parts Of The Body
The process used to find out if cancer has spread within thebladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
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What Are The Stages Of Bladder Cancer
Bladder cancer can be either early stage or invasive .
The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.
Stages II to IV denote invasive cancer:
- In Stage II, cancer has spread to the muscle wall of the bladder.
- In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
- In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.
A more sophisticated and preferred staging system is known as TNM, which stands for tumor, node involvement and metastases. In this system:
- Invasive bladder tumors can range from T2 all the way to T4 .
- Lymph node involvement ranges from N0 to N3 .
- M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.
S Of Benign Bladder Tumors
What about Clinical Trials?
You may hear about clinical trials for your bladder cancer. Clinical trials are research studies that test if a new treatment or procedure is safe and effective.
Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. Trials are available for all stages of cancer. The results of a clinical trial can make a major difference to patients and their families. Please visit our clinical trials research webpage to learn more.
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Women And Bladder Cancer: Sharing Stories To Advance Research
BCAN was invited to share the experiences of women diagnosed with bladder cancer at the Bladder Cancer in Women: Identifying Research Needs to Improve Diagnosis and Treatment program sponsored by Johns Hopkins Greenberg Bladder Cancer Institute and the American Urological Association Translational Research Collaboration. Each of these womens stories are memorable and unique. Sadly, their stories are repeated around the country because women are not the typical bladder cancer patient. Read the the transcript of their presentation.
Ask Your Doctor For A Referral To A Urologist
For women diagnosed with a UTI, Dr. Donat has this advice: Make sure your doctor sends a urine culture for testing, she says. If you did have a culture, make sure it came back positive to confirm that you actually have an infection. If the culture was negative or your bladder symptoms continue despite treatment, dont be afraid to ask your doctor for a referral to a urologist to get a formal evaluation.
Tests can sometimes distinguish the bleeding associated with bladder cancer from postmenopausal uterine bleeding, but the results are not always clear-cut. Your gynecologist can send a catheterized urine sample for testing to determine the source of the blood and to evaluate for gynecologic causes of the bleeding, Dr. Donat explains. If your gynecologic exam fails to identify the source of the bleeding or is inconclusive, or if your irritative bladder symptoms persist, you should also seek out the expertise of a urologist.
Hematuria may originate in the bladder or the kidneys, says Dr. Donat, so a urologist needs to check both. This is best done with a special CT scan of the urinary tract called a CT urogram and by looking in the bladder with a lighted telescope called a cystoscope. This procedure, called a cystoscopy, is usually done in an office in just a few minutes and does not require anesthesia, says Dr. Donat. A urine test called a cytology may also be sent to check for cancer cells in the urine.
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Why Cancer Cells Tend To Spread To The Parts Of The Body They Do
Where a cancer starts is linked to where it will spread. Most cancer cells that break free from the primary tumor are carried in the blood or lymph system until they get trapped in the next downstream organ or set of lymph nodes. This explains why breast cancer often spreads to underarm lymph nodes, but rarely to lymph nodes in the belly. Likewise, there are many cancers that commonly spread to the lungs. This is because the heart pumps blood from the rest of the body through the lungs blood vessels before sending it elsewhere.
Determining The Stage And Extent Of Your Cancer
Once your physician confirms you have cancer of the bladder, they might recommend additional testing to determine if the cancer has spread to other areas of your body, like your lymph nodes.
Testing might include:
The doctor will use the information from this testing to determine the stage of your cancer. The bladder cancer stages are indicated by a 0 to IV range of Roman numerals. The lowest cancer stages indicate it’s confined to your bladder’s inner layers and hasn’t begun affecting your muscular bladder wall. Stage IV, the highest stage, indicates the cancer has begun spreading to distant organs and lymph nodes of your body.
The cancer stages system is continually evolving and becoming more complex with the improvement of cancer diagnosis and treatment. The stage of cancer you have will also determine which treatment will serve you best.
For more information on bladder cancer stages, please refer to the American Cancer Society website.
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What Is Bladder Cancer Again
Its the sixth most common type of cancer in the U.S. and , the hollow organ that stores urine. Most cases of bladder cancer are caught when the tumors are still in the first, or inner, lining of the bladder. But if theyre not removed or they return after treatment, they can spread into the other three layers, including the muscle and fatty tissues. Thats when you might need a major operation to remove your bladder and give you a fighting chance for recovery. And by the way, that chance for recovery is good. The average five-year survival rate is 77% when its caught at its earliest stage, the number jumps to 96%.
Who Has An Increased Risk Of Having Kidney Cancer
The causes of kidney cancer are not certain, but there are some reasons why the risk of development can increase. High blood pressure and obesity are two reasons for increased risk. This is because the kidneys deal with the number of red blood cells in the body and if you have high blood pressure it can be difficult for the body to moderate it.
Obesity is also a risk factor because the amount of insulin in the body is too high causing the kidneys to not process the fat and other growth factors in the blood. Other factors that play into the increased risk for kidney cancer include smoking and treatment for prior kidney failure, as these weaken the kidneys ability to process the blood.
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What About Other Treatments That I Hear About
When you have cancer you might hear about other ways to treat cancer or treat your symptoms. These may not always be standard medical treatments. These treatments can be vitamins, herbs, special diets, and other things. You may be curious about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to be helpful. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
What Do Women Need To Know About Bladder Cancer
Bladder cancer can affect women at any age. Smoking is the greatest controllable risk factor. Smokers get bladder cancer twice as often as non-smokers. However, up to 50% of bladder cancer patients may have no history of smoking. Learn more about the risks associated with bladder cancer.
Bladder cancer symptoms may be identical to those of a bladder infection and the two problems may occur together. If symptoms do not disappear after treatment with antibiotics, insist upon further evaluation to determine whether bladder cancer is present. Bladder cancer has the highest recurrence rate of any form of cancerbetween 50-80 percent.
Watch our informative webinar, Women and Bladder Cancer the Unspoken Demographic.
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Why Is There A Disparity Between Men And Women With Bladder Cancer
In many cases, there are significant delays in diagnosing bladder cancer in women. Many women ignore the most basic symptomblood in the urine. They may associate it with menstruation or menopause and delay reporting this symptom to their doctors. Even after reporting the problem to their doctors, blood in the urine may be initially misdiagnosed. It may be seen as a symptom of post-menopausal bleeding, simple cystitis or a urinary tract infection. As a result, a bladder cancer diagnosis can be overlooked for a year or more.
How Do I Know If I Have Bladder Cancer
Many people with bladder cancer do not exhibit symptoms. A bladder cancer diagnosis is often made when red blood cells are detected in a urine test . Urologists are generally the doctors who diagnose and treat bladder cancer. Their specialty is the urinary tract, which includes the bladder, kidneys, ureters, and urethra.
Common Symptoms of Bladder Cancer
Blood in the urine
In many cases, blood in the urine is an early sign of bladder cancer. The blood may change the color of the urine to pink, orange, or dark red. The color of the urine could even be normal, and small amounts of blood may be discovered during the urine test . Blood may be there one day and gone the next. The urine could remain clear for months. However, if the patient has bladder cancer, the blood will eventually reappear.
The early stages of bladder cancer often cause bleeding but with very little pain or discomfort. Its important to note that blood in the urine does not always indicate that you have bladder cancer. More often than not, its caused by benign tumors, an infection, bladder stones, or another non-cancerous ailment. Its still critical to be seen by a doctor if you have blood in the urine.
Bladder habit changes
While bladder symptoms are more often the result of conditions unrelated to cancer, bladder cancer may cause changes to bladder habits, including:
Needing to urinate with little or no results Having to urinate more than usual Painful urination
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