WHAT IS BLADDER CANCER?

The exact cause of bladder cancer can be challenging to identify, though several risk factors can increase the chances of developing it. Genetics, chemical exposure, and other lifestyle factors can all contribute to a higher risk.

Several things can increase your risk, including:

• Smoking
• Age, especially those over 55
• Exposure to certain industrial chemicals
• Previous cancer treatments
• A family history
• Arsenic in drinking water
• Certain medications

One of the most common symptoms is blood in the urine or hematuria. Hematuria might be found during a routine urine test. Other symptoms include:

• Frequent urination
• Painful urination
• A burning sensation when urinating
• Urgent need to urinate, even if your bladder isn’t full

Since these symptoms can be similar to those of other conditions, like a urinary tract infection, it’s essential to see your doctor for an evaluation to rule out any serious issues.

Several tests may be performed when diagnosing NMIBC

• Urinalysis. A sample of your urine is tested for blood, abnormal cells, and signs of infection.
• Urine cytology. This test analyzes a urine sample under a microscope to look for cancerous cells.
• Cystoscopy. A doctor inserts a thin, flexible tube with a camera, called a cystoscope, into your bladder through the urethra to visually inspect the bladder lining for any tumors or abnormalities.
• Imaging tests. Tests like a CT urogram or MRI may be used to provide detailed images of the urinary tract and assess for the spread of cancer.

If any suspicious areas are found, a biopsy might be performed to confirm whether you have bladder cancer. A biopsy is the only way to diagnose bladder cancer definitively.

Staging refers to how far the cancer has spread within the body. In the case of bladder cancer, staging is determined by how deeply the tumor has invaded the bladder wall and whether it has spread to nearby tissues or other parts of the body.

Staging helps your doctor understand the cancer’s extent, impacting your treatment options and prognosis.

For non-muscle-invasive bladder cancer, the tumor is usually confined to the bladder’s inner lining and has not spread to muscle or beyond. An earlier-stage cancer tends to have better outcomes and a wider range of less invasive treatment options. NIMBC stages are:

• Stage 0: Cancer cells are only in the bladder’s inner lining and haven’t spread.
• Stage 1: Cancer has invaded the connective tissue under the bladder lining but hasn’t reached the muscle layer.

In general, cancers found at earlier stages have a more favorable prognosis. Since the tumor is still localized and hasn’t invaded deeper tissues, there’s a higher chance of successful treatment. However, even with NMIBC, there’s a risk of recurrence, so regular follow-ups are needed.

In advanced stages, known as muscle-invasive bladder cancer (MIBC) or metastatic bladder cancer, the cancer has spread into the muscle layer of the bladder or beyond. At this stage, more aggressive treatments are required, which may include surgery to remove the bladder, chemotherapy, radiation therapy, or immunotherapy.

Transurethral Resection of Bladder Tumor

Transurethral resection of bladder tumor (TURBT) is the first treatment for NMIBC. In this procedure, a doctor uses a cystoscope, a thin tube with a camera, to remove any tumors or abnormal tissue in the bladder. It’s done under anesthesia; most people can go home the same day. A catheter may be used for a few days afterward to help with healing. Sometimes, a second TURBT is needed if the tumor is aggressive.

Blue Light Cystoscopy

Your doctor may use blue light cystoscopy to improve tumor visibility. A dye is injected into the bladder, making tumors glow under blue light, which helps ensure no small tumors are missed.

After TURBT, additional treatment may be recommended to prevent cancer from coming back:

• Intravesical chemotherapy. Medicine is placed directly into the bladder to target cancer cells without affecting the rest of the body.
• Intravesical BCG. This immunotherapy uses weakened bacteria to stimulate the immune system to attack any remaining cancer cells. It is typically given weekly for six weeks.

Regular follow-up cystoscopies every 3 to 6 months are necessary to monitor for cancer recurrence, as NMIBC has a higher risk of coming back.

1. Can NMIBC be prevented?

While you can’t always prevent bladder cancer, there are steps you can take to reduce your risk, like quitting smoking, drinking plenty of water, and avoiding exposure to harmful chemicals.

2. How often do I need to follow up after treatment for NMIBC?

Because it can recur, regular follow-ups are necessary. Your doctor will likely recommend a cystoscopy every 3 to 6 months for the first few years after treatment to check for any signs of cancer returning.