Bladder Cancer

Condition Basics

What is bladder cancer?

Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumours. In bladder cancer, these growths happen in the bladder.

The bladder is the part of your urinary tract that stores your urine until you are ready to let it out.

The most common type of bladder cancer starts in the inner layer of the bladder. It is called transitional cell carcinoma. It happens most often in people who are in their 60s or older.

What causes it?

Experts don't know exactly what causes bladder cancer. But they have found that genetic changes play a role. Also, cigarette smoking and chemicals from your environment can cause cell changes in your bladder, where urine is stored. These cell changes can lead to cancer.

What are the symptoms?

Blood in the urine is the main symptom. Other symptoms include having to urinate often or feeling pain when you urinate. Bladder cancer can also cause pain in the lower back and pelvis.

How is it diagnosed?

Your doctor will ask about your medical history and do a physical exam. You may get a urine test. A cystoscopy may be done to see inside your bladder. If abnormal tissue is found, another procedure, a transurethral resection of the bladder tumour (TURBT), will be done to take a biopsy or remove the tissue.

How is bladder cancer treated?

Treatment for bladder cancer is based on the stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the cancer. Other treatment options may include chemotherapy, immunotherapy, radiation therapy, and targeted therapy.

Cause

The exact cause of bladder cancer isn't known. But experts have found that genetic changes are involved. Also, cigarette smoking and chemicals from your environment can cause cell changes in the lining of your bladder, where urine is stored. These cell changes can lead to cancer.

Other things that can cause cell changes in your bladder include having bladder stones or having the schistosomiasis parasite.

What Increases Your Risk

Anything that increases your chances of getting a disease is called a risk factor. The main risk factors for bladder cancer include:

• Smoking. Cigarette smokers are much more likely than other people to get bladder cancer.
• Being older than 40, being male, or being white.
• Personal or family history of bladder cancer.
• Past radiation treatment to the pelvis.
• Being exposed to cancer-causing chemicals. These chemicals are found in many products, including dyes, paints, solvents, inks, and the dust from leather.
• Repeated infections in the bladder or irritation of the lining of the bladder.
• Having Lynch syndrome.

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What Happens

Bladder cancer often begins in the lining of the bladder. It may spread into the bladder wall and out to the lymph nodes or other organs. Most bladder cancer can be successfully treated. But bladder cancer often comes back, so you may get other treatments to lower the chances of that happening.

When to Call a Doctor

Call your doctor if you:

• Have blood in your urine.
• Feel pain when you urinate.
• Are urinating small amounts frequently.
• Have back or flank pain.

If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Examinations and Tests

To diagnose bladder cancer, your doctor will:

• Ask about your medical history. You may be asked about smoking, any contact with chemicals that cause cancer, and any history of cancer in your family.
• Do a physical exam. This may include a rectal or pelvic exam.
• Test your urine to look for blood or abnormal cells.
• Do a cystoscopy. This is a test that lets your doctor look into your bladder with a thin, lighted viewing tool.
• If an area of abnormal tissue or a tumour is found during your cystoscopy, you may have a CT scan or MRI. You will also likely have a transurethral resection of the bladder tumour (TURBT). During a TURBT, your doctor will take a sample of tissue (biopsy) or remove the tissue (tumour).

If your doctor finds cancer, there may be other tests to see how much the cancer has grown and if it has spread.

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Treatment Overview

Treatment for bladder cancer is based on the stage of the cancer and other things, such as your overall health. Most people have:

Surgery.

The doctor may be able to remove the tumour. Sometimes part or all of the bladder has to be removed.

Other treatments include:

Chemotherapy.

These medicines kill fast-growing cells. These include cancer cells and some normal cells. Chemotherapy may be given before or after surgery. Or it may be put into the bladder.

Radiation therapy.

This uses high-dose X-rays to destroy cancer cells and shrink tumours. Radiation may be used before or after surgery.

Other treatments include immunotherapy, which can be put into the bladder or given by I.V., and targeted therapy.

If bladder cancer comes back inside the bladder, it can be removed. If it comes back outside of the bladder, it can be treated to slow the growth of the cancer and relieve symptoms.

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Supportive Care

Hospice palliative care is a type of care for people who have a serious illness. It's different from care to cure your illness, called curative treatment. Hospice palliative care provides an extra layer of support that can improve your quality of life—not just in your body, but also in your mind and spirit. Sometimes hospice palliative care is combined with curative treatment.

The kind of care you get depends on what you need. Your goals guide your care. You can get both hospice palliative care and care to treat your illness. You don't have to choose one or the other.

Hospice palliative care can help you manage symptoms, pain, or side effects from treatment. It may help you and those close to you better understand your illness, talk more openly about your feelings, or decide what treatment you want or don't want. It can also help you communicate better with your doctors, nurses, family, and friends.

End-of-life care

It can be hard to live with an illness that cannot be cured. But if your health is getting worse, you may want to make decisions about end-of-life care. Planning for the end of your life does not mean that you are giving up. It is a way to make sure that your wishes are met. Clearly stating your wishes can make it easier for your loved ones. Making plans while you are still able may also ease your mind and make your final days less stressful and more meaningful.

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Self-Care

• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Eat healthy food. If you are not hungry, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss.
• Get some physical activity every day, but do not get too tired.
• Get enough sleep and take time to do things you enjoy. This can help reduce stress.
• Think about joining a support group. Or discuss your concerns with your doctor, counsellor, or other health professional.
• If you smoke, ask your doctor about aids to stop smoking.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Take care of your urinary tract to prevent problems such as infection, which can be caused by bladder cancer and its treatment. Limit drinks with caffeine, drink plenty of fluids, and urinate every 3 to 4 hours.
• If you have not already done so, prepare an advance care plan. An advance care plan provides instructions to your doctor and family members about what kind of care you want if you become unable to speak for yourself.

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Complementary Treatments

Some people use complementary therapies along with medical treatment. They may help relieve the symptoms and stress of cancer or the side effects of cancer treatment. Therapies that may be helpful include:

• Acupuncture to relieve pain and other symptoms.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and tension.
• Breathing exercises to help you relax.

Talk with your doctor about any of these options you would like to try. And let your doctor know if you are already using any complementary therapies. They are not meant to take the place of standard medical treatment. But they may help you feel better and cope better with treatment.

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Getting Support

Relationships take on new importance when you're faced with cancer. Your family and friends can help support you. You may also want to look beyond those who are close to you.

• Reach out to your family and friends.

  Remember that the people around you want to support you, and asking for help isn't a sign of weakness.

• Tell them how they can help.

  Your friends and family want to help, but some of them may not know what to do. It may help to make a list. For example, you might ask them to:

  • Run errands or pick up kids.
  • Deliver meals or groceries to your home.
  • Drive you to appointments.
  • Go to doctor visits with you and take notes.
• Look for help from other sources.

  Places to turn for support include:

  Counselling.

  Counselling can help you cope with cancer and the effect cancer is having on your life. Different types of counselling include family therapy, couples therapy, group counselling, and individual counselling.

  Your health care team.

  Your team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counselling.

  Spiritual or religious groups.

  These groups can provide comfort and may be able to help you find counselling or other social support services.

  Social groups.

  Social groups can help you meet new people and get involved in activities you enjoy. Focus on activities that bring you comfort, such as spending time outdoors or being with children.

  A cancer support group.

  Cancer support groups offer support and practical advice. You can hear others talk about:

  • What it's like to live with cancer.
  • Practical ways to manage your cancer treatment and its side effects.
  • Ways to cope with your illness.

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