News from Illinois CancerCare

What You Need to Know About Bladder Cancer

Bladder cancer is one of those diseases that is somewhat under the radar … until someone you love gets it. That’s why we’re highlighting it during Bladder Cancer Awareness Month, which is recognized every May.

Approximately 90% of all bladder cancers occur over the age of 55 and the average age at the time of diagnosis is 73. It is the fourth most common cancer among men, with 1 in 27 males contracting it; bladder cancer is less common among women, with just 1 in 89 women having the disease. The American Cancer Society recently shared the following projections for bladder cancer occurrences and deaths in the United States during 2020:

  • Approximately 81,400 new cases of bladder cancer (about 62,100 in men and 19,300 in women)
  • Approximately 17,980 deaths from bladder cancer (about 13,050 in men and 4,930 in women)

About half of all bladder cancers are discovered when they’re still located in the inner layer of the bladder wall. This is called a non-invasive or in situ cancer, and typically results in 5-year relative survival rates of 70 to 96%. Fortunately, distant spreading (metastasizing) to other parts of the body is less common, with only around 5% of bladder cancers becoming this invasive and troublesome.

Screening and Symptoms

Since early diagnosis is critical, you may be wondering how bladder cancer is detected. Unlike breast cancer and colon cancer, which are often found with routine screening (mammograms, colonoscopies, stool sample tests, etc.), there isn’t a screening test that has been proven to lower the death rate among people at average risk for bladder cancer.

However, if you’re at a significantly higher risk of getting bladder cancer, your healthcare provider might recommend tests to help you stay healthy. Things that put you in a higher risk category may include:

  • Previous bladder cancer
  • Certain birth defects of your bladder
  • Smoking (new studies suggest that vaping and e-cigarettes may pose a similar risk)
  • Radiation therapy in the pelvic area
  • Arsenic in drinking water
  • Chemicals in the workplace (salons, printers, dry cleaners as well as other similar businesses)

If you have symptoms or you fall into a high-risk category, your physician or nurse practitioner may recommend one of several different tests. Most tests use a urine specimen to detect blood, cancer cells or tumor markers (chromosome changes or substances like certain proteins or antigens).

Other tests may include imaging such as a CT (computerized tomography) scan to look at your kidneys, since they can be a source of blood in your urine or a cystoscopy. This exam uses a tiny camera attached to a long, thin tube that is inserted into your bladder through the urethra; this test provides a close look at your bladder lining to spot tumors.

Although these tests can find some bladder cancers early, they aren’t fool-proof. Most of the time, these tests are used to keep an eye out for a recurrence of previous bladder cancer. More research is needed to determine their effectiveness as routine screening tools.

Even though routine screening for bladder cancer isn’t currently recommended, there are some signs and symptoms you can look out for, including blood in your urine (without pain), frequent urination or painful urination. It’s always important to pay attention to your body and mention any changes to your physician or nurse practitioner, so they can determine if you need any of these tests described above.

It’s helpful to note that blood in your urine isn’t definitive proof of bladder cancer and could be the result of something less serious such as a urinary tract infection (UTI) or kidney stones. If you’re experiencing any of these symptoms, it’s important to reach out to your provider to see what tests and follow-up need to be done to protect your long-term health.

Treatment and Recovery

Depending on your overall health, the bladder cancer stage and other considerations, your Illinois CancerCare physician will recommend the best treatment approach for your individual needs. A brief description of the most common treatments is shown below. Most may be used either alone or in combination, as determined by your provider:

  • Surgery called transurethral resection of bladder tumor (TURBT), which uses a thin, rigid cystoscope inserted through your urethra to remove the tumor. Performed under general anesthesia, this eliminates the need for a surgical incision in your abdomen.
  • Partial cystectomy, which removes the malignancy in your bladder, along with a margin of healthy tissue surrounding the tumor. Also done under general anesthesia, the small hole created in your bladder during tissue removal is stitched up.
  • Radical cystectomy is an operation that removes the entire bladder and nearby lymph nodes. For female patients, surgeons typically also remove the ovaries, fallopian tubes, uterus, cervix and a small part of the vagina. Performed under general anesthesia, you will either have one main incision in your abdomen (called an open surgery) or multiple small incisions into which the physician inserts small instruments to remove the organs (also called laparoscopic or keyhole surgery). If you undergo a radical cystectomy, you will also need reconstructive surgery or other procedures to manage urine storage and output.
  • Intravesical therapy inserts chemotherapy or immunotherapy medication directly into the bladder through a catheter. This treatment is used with non-invasive bladder cancer or almost immediately after TURBT in order to kill any remaining cells. It may also be used after radiation or systemic chemotherapy.
  • Chemotherapy is a drug that can be delivered directly into the bladder through a catheter or into your entire system. Systemic chemotherapy is injected into a vein IV) or a muscle (IM). Although chemo is sometimes the only treatment prescribed, it is often used as an adjuvant therapy, which means that it’s used in conjunction with other options. Chemo can be administered before surgery to help reduce the size of your tumor, after surgery to kill any remaining malignant cells or after radiation get rid of any cells that remain.
  • Radiation therapy is similar to getting an x-ray, but contains stronger radiation focused on your tumor. It doesn’t hurt and each session typically only takes a few minutes. Usually, the longest part of your appointment is getting you situated into just the right position. Radiation may be used alone or with other therapies.
  • Immunotherapy uses medicines that help your own immune system recognize and destroy cancer cells. Depending on the type of cancer and medicine your physician recommends, you will either receive intravesical therapy which delivers a liquid directly into your bladder or an intravenous (IV) drug known as an immune checkpoint inhibitors. We recently provided an overview of immunotherapy on our website, so you can learn more here.
  • Targeted Therapy uses newer drugs that work differently from other types of treatment, like chemo. These medicines were developed as researchers have learned more about the genes and proteins inside cells that become cancerous.

As you finish treatment and transition into the recovery phase, you’ll be able to celebrate being among approximately 17 million survivors in the United States.