About Bladder Cancer & Why Getting a Second Opinion Could Be Beneficial

Bladder cancer begins when bladder cells begin to multiply at a rapid rate. There are different types of bladder cancer; one which is non-invasive and slow growing, and others which are invasive and grow more quickly. The treatment you are offered will depend on a number of factors including which type of bladder cancer you have however getting a second opinion can help you consider all your treatment options.

The Benefits of Getting a Second Opinion for Bladder Cancer 

It’s widely encouraged for patients to get a second opinion about their diagnosis and/or treatment options for any form of cancer.  In some cases, the symptoms of bladder cancer can be confused with other conditions such as UTI's and kidney stones so a second view can help confirm your diagnosis and provide you with additional information. A deeper understanding can provide you with more information that can be useful in planning those important next steps.

Whatever the reason, Oncolomed can help facilitate second opinions with bladder cancer specialists from leading hospitals globally. Learn more about the benefits and how you can obtain a second opinion online through OncoloMed.

What is Bladder Cancer

Bladder cancer is a cancer which begins in the lining of the bladder. Bladder cancer may spread into the surrounding muscle, and into organs near the bladder.

It is usually slow growing and therefore occurs more often in people over the age of 75. It is more common in men than women, but the prognosis is often less positive for female sufferers.

Bladder cancer is categorized as either:

NMIBC – Slow growing, non-invasive type of bladder cancer also known as grade 1 or grade 2. This is the most common type and usually remain contained within the bladder. Grade T1 bladder cancer is unusual in that it is an early stage cancer but may grow quickly.

MIBC – A faster growing, invasive type of bladder cancer also known as high grade or grade 3. High grade bladder cancer is more aggressive, and more likely to return.

Causes of Bladder Cancer

The exact cause of bladder cancer is unknown, however exposure to harmful substances is thought to account for around 50% of bladder cancers. Long term smokers are more likely to suffer from bladder cancer as the harmful substances contained in tobacco are filtered by the renal system and the bladder is frequently in contact with these toxic elements.

Exposure to specific industrial chemicals is also thought to increase the likelihood of bladder cancer. These include benzidine, arsenic, and chemicals used in the manufacture of textiles, paint, and rubber. A number of chemicals which may be linked to bladder cancer have since been banned. Other factors which may contribute to an increased likelihood of developing bladder cancer include:

• Frequent urinary infections
• Type 2 diabetes
• Early menopause
• Crohn’s disease
• Family history – If a member of your immediate family has had bladder cancer, your risk may be increased
• Age – Bladder cancer is most often seen on people over the age of 55
• Gender – Bladder cancer is around three times more common in men than in women

The Main Symptoms of Bladder Cancer

The most common indicator of the presence of bladder cancer is blood in your urine. While this symptom may also indicate a range of other conditions such as bladder infection or kidney stones, it is important to arrange to see your doctor if this symptom appears. The earlier you see a doctor can lead to a higher chance of successful treatment. The presence of blood in urine is not always obvious, and may appear as a brown discoloration, or in streaks. It may always be present, or it may come and go, sometimes with months in between.

Other symptoms may include:

• Need to urinate more often
• Burning sensation when urinating
• Difficulty urinating
• Swollen legs
• Weight loss
• Lumps in the neck or abdomen
• Jaundice

While a number of these symptoms may lead to other diagnoses, it is important to seek medical advice early on to ensure a correct diagnosis can be made and it can be treated at an early stage.

Types of Bladder Cancer

Non-muscle invasive bladder cancer

Also known as urothelial cell bladder cancer, this particular type of bladder cancer has spread into the muscle layer of the bladder and is more likely to spread. This type requires more intensive treatment than non-muscle invasive bladder cancer in order to prevent or limit the possibility of it spreading to other areas of the body.

Muscle invasive bladder cancer

Also known as urothelial cell bladder cancer, this particular type of bladder cancer has spread into the muscle layer of the bladder and is more likely to spread. This type requires more intensive treatment than non-muscle invasive bladder cancer in order to prevent or limit the possibility of it spreading to other areas of the body.

Metastatic bladder cancer

Metastatic bladder cancer is cancer which has spread from the bladder to other parts of the body. The prognosis for this type of cancer is less positive, but there are a range of treatments available to maintain and extend quality of life for bladder cancer sufferers.

How is Bladder Cancer Diagnosed?  

The first step in a bladder cancer diagnosis is making an appointment to see your doctor. They will go through your symptoms with you and ask questions about your lifestyle and family history. They may take a urine sample to be tested for blood or signs of bladder infection. They may also carry out a physical examination.

Should bladder cancer still be a possibility they may refer you for imaging tests such as an ultrasound, CT scan or x-rays to get more information about your condition. They may also recommend a cystoscopy, where the lining of the bladder is examined for inflammation and a tissue sample may be taken to be examined for signs of bladder cancer.

Bladder Cancer Staging and Grading

The stages of bladder cancer are indicative of the size of the cancer and if, or how much it has spread. The stage the cancer is at helps to determine the best treatment plan for that person.

Doctors use a system called TNM to stage bladder cancer. This stands for Tumour, Node, and Metastasis.

Tumour or T, describes the size of the tumour. There are four stages within the T stage:

CIS or TIS – Very early, high grade cancerous cells are apparent in the innermost layer of the lining of the bladder.

Ta – Cancer only present in the innermost lining of the bladder.

T1 – Cancer is growing in the connective tissue below the bladder lining.

T2 – The cancer has grown through the connective tissue and into the muscle. The T2 stage is split into two sub-stages.

T2a – Cancer has grown into superficial muscle.

T2b – Cancer has grown into deeper muscle layers.

T3 – The cancer has grown through the layers of muscle and into the fat underneath. The T3 stage is split into two sub-stages.

T3a – Cancerous cells in the fat layer can only be seen under a microscope.

T3b – Cancer in the layer of fat can be seen in screening tests of felt during physical examination.

T4 – The cancer is metastatic and has grown into other areas of the body outside of the bladder. The T4 stage is split into two sub-stages.

T4a – The cancer has spread to the prostate, uterus, or vagina.

T4b – The cancer has spread to the wall of the pelvis or abdomen.

Node or N, describes whether the cancer has spread into lymph nodes. There are four N stages of bladder cancer:

N0 – No cancer present in lymph nodes.

N1 – Cancer cells found in one lymph node in the pelvic region.

N2 - Cancer cells found in more than one lymph node in the pelvic region.

N3 - Cancer cells found in more than one lymph node outside of the pelvic region.

M, or Metastases, describes whether the cancer has spread to other parts of the body.

M0 – Cancer has not spread to other parts of the body.

M1 – Cancer has spread to other parts of the body.

Doctors will occasionally use stages to describe bladder cancer btu this is less common than the TNM system. There are five bladder cancer stages:

Stage 0 – Is split into two sub-stages.

Stage 0a – The cancer is in the inner layer of the bladder lining only.

Stage 0is – High grade cancer cells or very early-stage cancer cells are only in the inner layer of the bladder lining.

Stage 1 – Cancer has grown into the connective tissue underneath the bladder lining.

Stage 2 – The cancer has grown through the connective tissue into the bladder muscle wall.

Stage 3 – The cancer has grown through the muscle wall into the fat layer beyond and may have spread to other nearby areas of the body such as lymph nodes, uterus or prostate.

Stage 4 – The cancer has spread to more localised regions such as the abdomen or pelvis, or further afield such as the lungs or liver.

Treatment for Bladder Cancer

There are a number of treatment options for bladder cancer which can be decided by yourself and your medical team, depending on the type of cancer, stage of development, and a number of other factors such as your general health. Treatment is also different for non-muscle-invasive and muscle-invasive types of bladder cancer. It is important that you should be in control of your treatment and have access to all available options.

A team of doctors and specialists will discuss the best treatment for you, but the most common options are:

Treatment for non-muscle-invasive bladder cancer

Common treatments for this type of bladder cancer include:

TURBT – transurethral resection of the bladder tumour. This procedure, carried out under general anaesthetic, requires a surgeon to remove visible tumours from the lining of the bladder, and is often carried out at the same time a cystoscopy. Following this procedure, you may undergo a single dose of chemotherapy. People who have this kind of treatment most often leave hospital after two nights and are fully recovered within two weeks. This procedure is followed by regular check-ups for signs of the cancer returning, which, if located, may be treated with an electric current to destroy the new cancerous cells. This is called fulguration.

Chemotherapy – People with a slightly higher risk bladder cancer may be treated with a short course of chemotherapy, followed by regular check-ups for signs of return.

People at high risk with this type of cancer may require a second TURBT surgery and further scans. Following this it is likely that you will be offered one of the following two options:

Course of BCG Vaccine – The BCG vaccine used to prevent TB is also used to encourage the immune system rid the body of the cancerous cells. It can help prevent bladder cancer form returning and reduces the risk of non-muscle-invasive bladder cancer turning into a muscle-invasive cancer.

Cystectomy – Surgery to remove the bladder. When the bladder is removed a new way for the body to rid itself of urine must be created. There are different ways of doing this which will be discussed with you by your medical team.

Treatment for muscle-invasive bladder cancer

Common treatments for this type of bladder cancer include:

Radiotherapy – People with muscle-invasive bladder cancer are often given a course of radiotherapy lasting four to seven weeks. With this, a radiosensitiser medicine is usually given at the same time, which amps up the effect of the radiotherapy, but has less effect on normal tissue. Following radiotherapy, you will need regular check-ups to ensure the bladder cancer does not return.

The options for you will be discussed and agreed between you and your medical team.

Treatment for metastatic bladder cancer

The treatment available to a person with metastatic bladder cancer will depend on how far and where the cancer has spread. Treatment may include chemotherapy or radiotherapy, or in very advanced cases palliative care and treatment will be offered to maintain and prolong quality of life.

Living with Bladder Cancer

Receiving a bladder cancer diagnosis can be a shock and may trigger stress, anxiety and distress. Getting the right information to help you make the best decisions for your condition is key to dealing with the process ahead. A wide range of information, support and treatment is available to you and your loved ones for dealing with bladder cancer and getting the best treatment for you.

How OncoloMed Can Support Your Cancer Treatment Journey

Oncolomed can guide and support you through your cancer treatment journey. Through our network of global specialists, we can help you get a second opinion and access innovative cancer treatments that you may not have considered previously. We will facilitate everything every step of the way you need so you can focus on your health.

We have helped and empowered over 500+ patients globally. Take a look at our cancer patient stories to learn how we have helped or get in touch with us to start a conversation with our caring team.