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 (cancerous):
- 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.
- Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
- Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.
Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.
Diagnosis
Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.
The following tests and procedures may be used:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
- Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
- Urine cytology: Examination of urine under a microscope to check for abnormal cells.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
- The type of bladder cancer cells and how they look under a microscope.
- The patient’s age and general health.
Treatment options depend on the stage of bladder cancer.
Staging
The following stages are used for bladder cancer:
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:
- Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
- Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.
Stage I
In stage I, cancer has formed and spread to the layer of tissue under the inner lining of the bladder.
Stage II
In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.
Stage III
In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).
Stage IV
In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.
Treatment Options
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
Treatment of stage 0 may include the following:
- Transurethral resection with fulguration.
- Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
- Segmental cystectomy.
- Radical cystectomy.
- A clinical trial of photodynamic therapy.
- A clinical trial of biologic therapy.
- A clinical trial of chemoprevention therapy given after treatment so the condition will not recur (come back).
Stage I
Treatment of stage I bladder cancer may include the following:
- Transurethral resection with fulguration.
- Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
- Segmental or radical cystectomy.
- Radiation implants with or without external radiation therapy.
- A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).
Stage II
Treatment of stage II bladder cancer may include the following:
- Radical cystectomy with or without surgery to remove pelvic lymph nodes.
- Combination chemotherapy followed by radical cystectomy.
- External radiation therapy combined with chemotherapy.
- Radiation implants before or after external radiation therapy.
- Transurethral resection with fulguration.
- Segmental cystectomy.
Stage III
Treatment of stage III bladder cancer may include the following:
- Radical cystectomy with or without surgery to remove pelvic lymph nodes.
- Combination chemotherapy followed by radical cystectomy.
- External radiation therapy combined with chemotherapy.
- External radiation therapy with radiation implants.
- Segmental cystectomy.
Stage IV
Treatment of stage IV bladder cancer may include the following:
- Radical cystectomy with surgery to remove pelvic lymph nodes.
- External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
- Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.
- Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
- Chemotherapy alone or after local treatment (surgery or radiation therapy).
Visit the National Cancer Institute where this information and more can be found about Bladder Cancer or ask your cancer care team questions about your individual situation.