How Does Bladder Cancer Spread
Bladder cancer usually begins in the cells of the bladder lining. In some cases, it may spread into surrounding bladder muscle. If the cancer penetrates this muscle, it can spread to other parts of the body, usually through the lymphatic system.
If bladder cancer spreads to other parts of the body, such as other organs, it’s known as metastatic bladder cancer.
What Are The Signs Of These Types Of Tumors
The signs of urinary tract tumors depend on what area of the urinary system is affected. Tumors of the ureters, bladder, and urethra can cause hematuria , dysuria , difficulty urinating, and frequent urination. Recurrent and often unresolving secondary urinary tract infections are commonly associated with these types of tumors. If the tumor obstructs the ureter, preventing the flow of urine to the bladder, the kidney will swell with urine causing signs of abdominal pain. If the tumor obstructs the urethra, there may be lethargy, vomiting, diarrhea, straining or the inability to urinate.
“The signs of urinary tract tumors depend on what area of the urinary system is affected.”
Tumors of the kidneys can cause abdominal pain, blood in the urine, or non-specific signs such as lack of appetite, nausea or vomiting, weight loss, fever, lethargy, and swelling of the abdomen. Occasionally kidney tumors can cause increased urination and drinking.
Because many urinary tract tumors will spread to other areas in the body , there may be signs elsewhere . Kidney pain can sometimes be difficult to distinguish from back pain.
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:
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Cancerous Tumours Of The Bladder
A cancerous tumour of the bladder can grow into nearby tissue and destroy it. It can also spread to other parts of the body. Cancerous tumours are also called malignant tumours.
Bladder cancer is often divided into 3 groups based on how much it has grown into the bladder wall.
- Non-invasive bladder cancer is only in the inner lining of the bladder .
- Non–muscle-invasive bladder cancer has only grown into the connective tissue layer .
- Muscle-invasive bladder cancer has grown into the muscles deep within the bladder wall and sometimes into the fat that surrounds the bladder.
Radiotherapy With A Radiosensitiser
Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.
A radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This is a medicine which affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.
As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:
- erectile dysfunction
- difficulty passing urine
Most of these side effects should pass a few weeks after your treatment finishes, although there’s a chance they’ll be permanent.
Having radiation directed at your pelvis usually means you’ll be infertile for the rest of your life. However, most people treated for bladder cancer are too old to have children, so this isn’t usually a problem.
After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.
You may also be offered CT scans of your abdomen, pelvis and chest after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.
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Tests That May Be Done
Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.
Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .
Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.
Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.
Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.
What Questions Should I Ask My Doctor
Bladder cancer is relatively rare, so you may not know as much as youd like about the condition. Here are some questions that may be helpful:
- What stage of bladder cancer do I have?
- What are possible treatments?
- What are treatment side effects?
- Will I need surgery?
- How will surgery affect my daily life?
- How often does bladder cancer come back?
- How do you treat recurrent bladder cancer?
- Are there any cutting-edge clinical trials available?
A note from Cleveland Clinic
If you have bladder cancer, it may help to know about half of all people with the condition receive treatment when their tumors are limited to the inner layer of their bladder wall. For them, surgery to remove tumors means theyre cancer-free. But bladder cancer often comes back . If youre worried about recurring cancer, talk to your healthcare provider. Theyre your best resource for information on risk factors that increase the chance youll have another bout of bladder cancer. Theyll help you stay vigilant about symptoms that may be signs of recurring bladder cancer and be there for you if you need more bladder cancer treatment.
Last reviewed by a Cleveland Clinic medical professional on 08/26/2022.
References
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Looking For More Of An Introduction
If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net.
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ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to bladder cancer. This free fact sheet is available as a PDF, so it is easy to print.
New And Experimental Treatments
Several new treatments may prove useful in treating bladder cancer. Photodynamic therapy, used in early stage cancers, uses a laser light to activate a chemical that kills cancer cells. Some gene therapies use lab-created viruses to fight cancer. And targeted therapies aim to control the growth of cancer cells. You may be eligible to participate in a clinical trial of these or other cutting-edge treatments.
21) Carol & Mike Werner / Visuals Unlimited / Corbis
American Urological Association: “Bladder Cancer.”
American Urological Association Foundation: “Hematuria.”
Journal of the American Medical Association: Association Between Smoking and Risk of Bladder Cancer Among Men and Women.
Occupational & Environmental Medicine: Bladder cancer among hairdressers: a meta-analysis.
British Journal of Cancer: Occupation and bladder cancer: a cohort study in Sweden.
National Cancer Institute: “Staging,” “Bladder Cancer Treatment,” “Drugs Approved for Bladder Cancer,” “SEER Stat Fact Sheets: Bladder.”
NIH Research Matters: “Smoking and Bladder Cancer.”
ScienceDaily: “Cigarette Smoking Implicated in Half of Bladder Cancers in Women Bladder Cancer Risk from Smoking Is Higher Than Previously Estimated, Study Confirms.”
Stanford Cancer Institute: “Information About Bladder Cancer.”
World Health Organization: “Tobacco Free Initiative — Cancer.”
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How To Treat A Benign Bladder Tumor
Treatment for your tumor will depend on what type of tumor you have. First, your doctor may diagnose the tumor via biopsy or endoscopy. An endoscopy will provide a visual look, while a biopsy will provide a tissue sample of the tumor. After diagnosing the tumor, your doctor will develop a treatment plan
What Makes A Tumor Benign
It is caused by cells dividing more than normal or not dying when they should. Tumors can be classified as benign or malignant. Benign tumors are those that stay in their primary location without invading other sites of the body. They do not spread to local structures or to distant parts of the body.
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How To Assess Bladder Mass
To assess a bladder mass, urologists perform a physical examination, and blood and urine tests to evaluate for the presence of blood in the urine. You may also have a bladder wash to obtain cells from your bladder for a pathologist to analyze. But ultimately, the urologist needs to look inside your bladder via a procedure called cystoscopy.
Bladder Cancer In Men Vs Women
Bladder cancer is 3 to 4 times more common in people assigned male at birth than in people assigned female at birth.
Researchers believe the increased prevalence of bladder cancer in those assigned male at birth may be due to differences in how carcinogens are metabolized before they pass through the bladder . Or it may be that male sex hormones promote tumor formation in the bladder, whereas female sex hormones inhibit this progression.
In contrast, people assigned female at birth tend to be diagnosed at later stages of the disease, do not respond as well to treatment, and have a higher cancer-specific mortality rate, so its especially important for those assigned female at birth to be aware of early symptoms and seek prompt evaluation.
One study looked at the prevalence of the early cancer symptoms in both sexes, concluding that:
- Visible hematuria was present in 65% of men and 68% of women.
- Dysuria was present in 32% of men and 44% of women.
- Urgency was present in 61% of men and 47% of women.
- Nocturia was present in 57% of men and 66% of women.
Painful urination is often dismissed as due to a bladder infection or friction and may be less likely to be investigated, particularly in women. One study found that 47% of female bladder cancer patients were treated for symptoms up to a year before a diagnosis was made, without receiving any further evaluation. A lower percentage of females than males saw a urologist as well.
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How Is This Type Of Tumor Diagnosed
Your veterinarian may suspect a urinary tract tumor if your pet experiences recurrent urinary tract infections or the infections do not resolve with treatment. In this case, abdominal radiographs or ultrasound are usually recommended to determine the cause, such as an abnormal mass in the kidneys, bladder, or elsewhere along the urinary tract. With suspicion of any form of urinary tract tumor, your veterinarian will recommend bloodwork to assess kidney function and perform a urinalysis. Sometimes cancerous cells can be found in the urine.
“With suspicion of any form of urinary tract tumor, your veterinarian will recommend bloodwork to assess kidney function and perform a urinalysis.”
Your veterinarian may find larger and/or firmer kidney during a physical examination. In this case, usually abdominal radiographs or ultrasound are recommended, possibly with a tissue biopsy of the enlarged kidney. A biopsy is a surgical excision of one or more pieces of the abnormal tissue or tumor. This biopsy is then examined by a veterinary pathologist under the microscope. This is called histopathology. Histopathology is not only helpful to make a diagnosis but can indicate how the tumor is likely to behave. There are several kinds of biopsy techniques and your veterinarian or veterinary oncologist will recommend the best one for your pet.
What Is The Most Common Type Of Bladder Cancer
Urothelial carcinoma is the most common type of bladder cancer in the United States. Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder for instance, from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the United States.
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How Is This Diagnosed
If you notice symptoms of bladder wall thickening or any symptoms related to your urinary tract system, see your doctor.
Theyll likely have you undergo several tests, such as a urinalysis. For this test, a sample of your urine is checked for signs of infection, blood cells, or abnormal protein levels. If your doctor suspects bladder cancer, theyll check for cancer cells, too.
If cancer is a possibility, a cystoscopy may also be performed. During this procedure, a thin, flexible scope is guided up the urethra to check the lining of your urethra and bladder. A cystoscopy can also evaluate recurrent infections in the urinary tract.
In addition, a woman may undergo a pelvic exam to help diagnose an infection or other disorder.
Causes Of Bladder Cancer
Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years.
Tobacco smoke is a common cause and it’s estimated that more than 1 in 3 cases of bladder cancer are caused by smoking.
Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned.
Read more about the causes of bladder cancer.
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What Does Your Bladder Do
Your bladder is part of your urinary system. The job of the urinary system is to filter waste products from your blood and transport the waste products or urine, out of your body. The diagram below shows the organs of the urinary system.
Most of the urinary tract is lined with a special layer of cells called transitional cells. The primary machines in the human filtering system are the two kidneys located close to the backbone and protected by the ribs. The kidneys work independently. They have the significant task of filtering approximately 20% of total blood volume each minute and removing the by-products of digestion and of other body functions.
Once produced, the urine is stored in the central part of the kidney called the renal pelvis. At regular intervals, the renal pelvis contracts and propels the urine through the ureters. These narrow, thin-walled tubes extend from inside the renal pelvis to the bladder. The bladder is a thick-walled structure, consisting of a relatively thin inner layer with a thick muscle covering.
What Are Bladder Tumors
Bladder tumors are abnormal growths that occur in the bladder. If the tumor is benign, its noncancerous and wont spread to other parts of your body. This is in contrast to a tumor thats malignant, which means its cancerous.
There are several types of benign tumors that can develop within the bladder.
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Five Types Of Standard Treatment Are Used:
Surgery
One of the following types of surgery may be done:
- Transurethral resection with fulguration: Surgery in which a cystoscope is inserted into the bladder through the urethra.A tool with a small wire loop on the end is then used to remove thecancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
- Radical cystectomy: Surgery to remove the bladder and anylymph nodes and nearby organs that contain cancer. This surgery may bedone when the bladder cancer invades the muscle wall, or when superficialcancer involves a large part of the bladder. In men, the nearby organs that areremoved are the prostate and the seminal vesicles. In women, the uterus, theovaries, and part of the are removed. Sometimes, when the cancer hasspread outside the bladder and cannot be completely removed, surgery to removeonly the bladder may be done to reduce urinarysymptoms caused by the cancer.When the bladder must be removed, the surgeon creates another way for urine toleave the body.
- Partial cystectomy: Surgery to remove part of thebladder. This surgery may be done for patients who have a low-grade tumor thathas invaded the wall of the bladder but is limited to one area of the bladder.Because only a part of the bladder is removed, patients are able to urinate normally afterrecovering from this surgery. This is also called segmental cystectomy.
- Urinary diversion: Surgery to make a new way forthe body to store and pass urine.
Radiation therapy
Chemotherapy