How Is Bladder Cancer Diagnosed
Several different diagnostic tests and procedures may be used to detect bladder cancer, often in combination. They are selected based on a patients symptoms and risk factors and may include:
- Urinalysis: a quick test used to detect blood and other substances in urine.
- Urine cytology: urine is examined microscopically to see if cancer cells are present.
- Genomic urine tests: non-invasive molecular tests, such as Cxbladder, which measure gene expression to detect or rule out bladder cancer.
- Cystoscopy: a thin, flexible tube with a light and camera is inserted into the bladder through the urethra. If an abnormal area is seen, a small sample of tissue is usually collected for laboratory examination.
- Imaging: several types of imaging test can be used to visualize the inside of the body, such as ultrasound, CT scan, MRI scan, and x-ray.
Stage Iv Bladder Cancer Treatment
Only a small fraction of patients with stage IV bladder cancer can be cured, and for many patients, the emphasis is on palliation of symptoms. The potential for cure is restricted to patients with stage IV disease with involvement of pelvic organs by direct extension or metastases to regional lymph nodes.
What Tests Will The Urologist Make To Determine If It’s Cancer And The Stage It’s Reached
There will be a thorough examination, which includes checking your blood pressure, body mass index , full abdominal and pelvic examination.Investigations may involve MSU , urine for cytology, routine bloodwork, an ultrasound scan for assessment of upper tract and a flexible cystoscopy . Other investigations may require a CT urogram in highly suspicious cases and urinary markers.If a mass is found during flexible cystoscopy, then the patient should be counselled for transurethral resection of bladder tumour under general anaesthesia, which is the way to give a diagnosis and staging for cancer .
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How Do Bladder Cancer Survival Rates Differ By Disease Stage
Staging of bladder cancer provides information on the extent of cancer in the body and whether the cancer has spread beyond the bladder this information helps predict how likely the cancer will respond to treatment.
Approximately half of bladder cancers are found at an early stage, when the cancer is in the surface layer of the bladder only .12 About one third of bladder cancers have spread to the deeper layers of the bladder wall but are still only in the bladder the remainder of cancers have spread into nearby tissues or lymph nodes or, rarely, to distant parts of the body.
The 5-year survival rate for bladder cancer varies by stage of the disease at diagnosis, which emphasizes the importance of detecting bladder cancer at an early stage.13
Note: In situ = cancer is confined to the surface layer of the bladder Localized = cancer has not spread outside of the bladder Regional = cancer has spread to nearby structures or lymph nodes Distant = cancer has spread to distant parts of the body
Treatment Options Under Clinical Evaluation For Patients With Any T Any N M1 Disease
Prognosis is poor in patients with stage IV disease and consideration of entry into a clinical trial is appropriate.
Other chemotherapy regimens appear to be active in the treatment of metastatic disease. Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed.
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Turbt Radiation And Chemotherapy
Other patients may have another type of procedure called a transurethral resection of bladder tumor , in which the bladder tumor are removed from the bladder lining. The surgeon may use a procedure called fulguration to try to eliminate cancer cells that remain after the tumor is removed. Another treatment option for some patients is external radiation therapy with or without chemotherapy treatment. Some patients may choose to take part in a clinical trial to investigate a new type of treatment for bladder cancer.
What Is The First Sign Of Bladder Cancer
Blood in the urine, referred to as hematuria, is usually the first sign of bladder cancer. This is because early bladder cancer commonly causes bleeding without associated pain or other symptoms.
- Depending on the amount of blood present, urine may appear pink, red, or brownish in color.
- Blood may not be present all the time – there may be relatively long periods of clear urine .
If you have noticed blood in your urine it is important to speak to your doctor as soon as possible.
Other early symptoms of bladder cancer that may be experienced are urinary irritation or changes in bladder habits, such as increased urination frequency and/or urgency, pain or a burning sensation during urination, or difficulty passing urine.
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Ubc Occurrence Is About Threefold Higher In Europe And North America
Although usually not perceived as such by the general population, UBC is among the more commonly occurring cancers. It ranks tenth in worldwide absolute incidence: sixth in men and seventeenth in women . Approximately 550,000 new UBCs were diagnosed worldwide in 2018 . The worldwide Age Standardized Incidence Rate per year is 9.6 per 100,000 for males and 2.4 per 100,000 for females. Figure 1 shows the worldwide ASRs for UBC in both sexes.
Fig. 1
The incidence varies significantly between geographical regions, with the highest rates observed in Europe and North America, but also in Syrian, Israeli, Egyptian and Turkish males. About threefold lower rates are seen in South-East Asia, except for Japan, and in Latin America and Northern Africa in both sexes . The lowest rates are observed in Sub-Saharan Africa, Mexico and some Middle Eastern and Central Asian countries.
How Can Bladder Cancer Be Detected Early
You will require a two-week-wait haematuria clinic referral if you are aged 45 or above and have unexplained visible blood in the urine in the absence of a urinary tract infection or visible haematuria that persists or recurs after successful treatment of a UTI.In addition, all patients aged 60 or above with unexplained symptomatic non-visible haematuria or have recurrent UTI should also be considered for a two-week-wait haematuria clinic.The doctor will take a comprehensive history, which includes smoking or exposure to tobacco smoke. It is important to also take your occupational history, such as exposure to aromatic amines or polycyclic aromatic hydrocarbons and chlorinated hydrocarbons, which occur in paint, dye, metal and petroleum industries, and additionally if there has been exposure to hair dye or ionizing radiation.Other risk factors include previous schistosomiasis infection or a family history of bladder cancer.
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Intermediate Risk Early Bladder Cancer
People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy. The liquid is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away.
You should be offered follow-up appointments at 3, 9 and 18 months, then once every year. At these appointments, your bladder will be checked using a cystoscopy. If your cancer returns within 5 years, you’ll be referred back to a specialist urology team.
Some of the chemotherapy medicine may be left in your urine after treatment, which could severely irritate your skin.
It helps if you sit down to urinate and that you’re careful not to splash yourself or the toilet seat. Always wash the skin around your genitals with soap and water afterwards.
If you’re sexually active, it’s important to use a barrier method of contraception, such as a condom. This is because the medicines may be present in your semen or vaginal fluids, which can cause irritation.
You also shouldn’t try to get pregnant or father a child while having chemotherapy for bladder cancer, as the medicines can increase the risk of having a child with birth defects.
What Is Muscle Invasive Bladder Cancer
Muscle invasive bladder cancer is a cancer that spreads into the detrusor muscle of the bladder. The detrusor muscle is the thick muscle deep in the bladder wall. This cancer is more likely to spread to other parts of the body.
In the U.S., bladder cancer is the third most common cancer in men. Each year, there are more than 83,000 new cases diagnosed in men and women. About 25% of bladder cancers are MIBC. Bladder cancer is more common as a person grows older. It is found most often in the age group of 75-84. Caucasians are more likely to get bladder cancer than any other ethnicity. But there are more African-Americans who do not survive the disease.
What is Cancer?
Cancer is when your body cells grow out of control. When this happens, the body cannot work the way it should. Most cancers form a lump called a tumor or a growth. Some cancers grow and spread fast. Others grow more slowly. Not all lumps are cancers. Cancerous lumps are sometimes called malignant tumors.
What is Bladder Cancer?
When cells of the bladder grow abnormally, they can become bladder cancer. A person with bladder cancer will have one or more tumors in his/her bladder.
How Does Bladder Cancer Develop and Spread?
The bladder wall has many layers, made up of different types of cells. Most bladder cancers start in the urothelium or transitional epithelium. This is the inside lining of the bladder. Transitional cell carcinoma is cancer that forms in the cells of the urothelium.
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Standard Treatment Options For Stages Ii And Iii Bladder Cancer
The most common treatments for muscle-invasive bladder cancer are radical cystectomy and radiation therapy. There is no strong evidence from randomized controlled trials to determine whether surgery or radiation therapy is more effective. There is strong evidence that both therapies become more effective when combined with chemotherapy. The treatments with the highest level of evidence supporting their effectiveness are radical cystectomy preceded by multiagent cisplatin-based chemotherapy and radiation therapy with concomitant chemotherapy.
Radical cystectomy
Radical cystectomy is a standard treatment option for stage II and stage III bladder cancer, and its effectiveness at prolonging survival increases if it is preceded by cisplatin-based multiagent chemotherapy. Radical cystectomy is accompanied by pelvic lymph node dissection and includes removal of the bladder, perivesical tissues, prostate, and seminal vesicles in men and removal of the uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra in women. Studies of outcomes after radical cystectomy report increased survival in patients who had more, rather than fewer, lymph nodes resected whether this represents a therapeutic benefit of resecting additional nodes or stage migration is unknown. There are no randomized controlled trials evaluating the therapeutic benefit of lymph node dissection in this setting.
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Segmental cystectomy
Carcinogenesis And Risk Factors
Increasing age is the most important risk factor for most cancers. Other risk factors for bladder cancer include the following:
- Use of tobacco, especially cigarettes.
- Family history of bladder cancer.
- HRAS mutation .
- Rb1 mutation.
There is strong evidence linking exposure to carcinogens to bladder cancer. The most common risk factor for bladder cancer in the United States is cigarette smoking. It is estimated that up to half of all bladder cancers are caused by cigarette smoking and that smoking increases a persons risk of bladder cancer two to four times above baseline risk. Smokers with less functional polymorphisms of N-acetyltransferase-2 have a higher risk of bladder cancer than other smokers, presumably because of their reduced ability to detoxify carcinogens.
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What Are The Survival Rates For Bladder Cancer
If the cancer is just on the inner lining of the bladder , the 5-year survival rate is about 98%.
If the cancer is growing just beyond the inner lining into the bladder wall, but is still just in the bladder , the 5-year survival rate is about 88%.
Those with bladder cancer that’s spread into the muscular wall of the bladder, but not outside the bladder, or to nearby lymph nodes or organs have a 5-year survival rate of about 63%.
If the cancer has spread through the bladder muscle into the layer of tissue around the bladder and maybe to nearby organs , but has not spread to lymph nodes or other organs , the 5-year survival rate is about 46%.
When bladder cancer has moved beyond the bladder to the pelvic or abdominal wall, to lymph nodes, or to distant parts of the body , the 5-year survival rate is about 15%.
Treatment Options For Recurrent Bladder Cancer
Treatment options for patients with recurrent bladder cancer include the following:
Palliative radiation therapy should be considered for patients with symptomatic tumors.
Clinical trials
Recurrent or progressive disease in distant sites or after definitive local therapy has an extremely poor prognosis, and clinical trials should be considered whenever possible.
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Monitoring For Bladder Cancer Recurrence
Those who have already been treated for bladder cancer have unique monitoring needs to protect against the threat of recurrence. Generally doctors recommend a cystoscopy to examine the inside of the bladder and urethra every 3 to 12 months, depending on your risk of recurrence, for several years after bladder cancer treatment. If several years of surveillance have gone by and no cancer recurrence has been detected, a cystoscopy once a year may be enough, though the final decision rests with the doctor and additional testing may be required depending on the nature and severity of the original cancer.
If you’re recovering from treatment, ask your doctor about Cxbladder. Cxbladder is an accurate and non-invasive surveillance alternative designed to detect or rule out the return of bladder cancer. The test provides reliable results with a single urine sample, reducing the need for frequent cystoscopies in some patients, which can be both uncomfortable and inconvenient.Learn more about Cxbladder
Stage Information For Bladder Cancer
The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall by the tumor. This determination requires a cystoscopic examination that includes a biopsy and examination under anesthesia to assess the following:
- Size and mobility of palpable masses.
- Degree of induration of the bladder wall.
- Presence of extravesical extension or invasion of adjacent organs.
Clinical staging, even when computed tomographic and/or magnetic resonance imaging scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive. CT imaging is the standard staging modality. A clinical benefit from obtaining MRI or positron emission tomography scans instead of CT imaging has not been demonstrated.
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What Affects Survival
Your outlook depends on the stage of the cancer when it is diagnosed. This means whether the cancer is just in the bladder lining or whether it has spread into the muscle wall of the bladder or beyond.
The type of bladder cancer can affect your likely survival. And the grade of the cancer may also be important. Grade means how abnormal the cells look under the microscope.
Most bladder cancers are diagnosed when they are still only in the bladder lining. These are called early bladder cancers. The outlook for early bladder cancers depend on several factors, including:
- exactly how far the cancer cells have gone into the bladder lining
- the number of tumours
- how wide the tumours are
- how abnormal the cancer cells look under the microscope
- whether CIS is present
- whether this a recurrence and how often a tumour has recurred
Your doctor looks at all these factors. They use them to decide whether there is a low, medium or high risk of the cancer coming back or spreading into the muscle of the bladder. Your doctor will be able to tell you about your risk group and how this affects your outcome.
What Are The 5
In 2020, approximately 17,980 deaths in the United States are predicted to be attributed to bladder cancer1. This represents the eighth most common cause of cancer deaths in men.
The general 5-year survival rate for people with bladder cancer is 77%, while the 10-year survival rate is 70% and the 15-year survival rate is 65%1. Notably, as each patient and cancer are different, it is not possible to definitely know the disease course for an individual patient.
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Strategies To Improve Treatment
Most new treatments are developed in clinical trials. The development of more effective cancer treatment for bladder cancer requires that new and innovative therapies be evaluated in patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of bladder cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits with their physician.
What Causes Bladder Cancer
Bladder cancer occurs when cells within the lining of the bladder wall begin to grow in a disordered, uncontrolled way.
Exactly what prompts this disordered growth is not fully known. However, several factors associated with a higher risk of bladder cancer have been identified, including:
- Age – most people diagnosed with bladder cancer are older than 55 years.
- Sex – compared to women, men are 4 times more likely to develop bladder cancer.
- Smoking – smoking is associated with around half of all bladder cancers in men and women.
- Race – in the United States, White Americans have the highest rate of bladder cancer.
- Previous bladder cancer – people who have had bladder cancer may have a recurrence.
- Workplace exposures – certain chemicals in some workplaces may contribute to higher rates of bladder cancer in workers. For example, painters, hairdressers, and truck drivers are at increased risk.
- Arsenic in drinking water.
- Certain types of medication.
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