Definition
Non-muscle invasive bladder cancer (NMIBC) is cancer found in the tissue that lines the inner surface of the bladder. However, the bladder muscle is not involved.
Bladder cancer is the 6th most common cancer in the United States. Nearly 84,000 people will be diagnosed in the United States with bladder cancer in 2021, according to Urology Care Foundation. Bladder cancer is more common in males than females. Three times more men than women tend to get this disease.
Bladder cancer is also more common as a person grows older. It is found most often in the age group of 75-84. More Caucasians than any other ethnicities seem to develop bladder cancer. However, there are more Blacks who do not survive the disease.
Symptoms
Some people may have symptoms that suggest they have bladder cancer. While others may feel nothing at all. If you are experiencing symptoms, you should speak to a urologist (a doctor who focuses on problems of the urinary system and male reproductive system).
Talk to your doctor if you have the following symptoms:
- Hematuria (blood in the urine) – the most common symptom, often without pain
- Frequent and urgent urination
- Pain when you pass urine
- Pain in your lower abdomen
- Back pain
Blood in the urine is the most common symptom of bladder cancer. It is generally painless. Often, you cannot see blood in your urine without a microscope. If you can see blood with your naked eye, you should tell your healthcare provider immediately (even if the blood goes away).,
Blood in the urine does not always mean that you have bladder cancer. There are a number of reasons why you may have blood in your urine. You may have an infection or kidney stones. However, a small amount of blood might be normal in some people.
Frequent urination and pain when you pass urine (dysuria) are less common symptoms of bladder cancer. If you have these symptoms, it’s important to see your healthcare provider. He/she will find out if you have a urinary tract infection or something more serious, like bladder cancer.
Causes
People can get bladder cancer when they come into contact with tobacco or other cancer-causing agents. Smoking tobacco causes about half of all bladder tumors. If you smoke, you are more likely to get bladder cancer than those who have stopped smoking. There also are some risks related to genes and certain types of infections. Another known risk factor is a type of radiation beam aimed at the pelvis. Patients with other cancers, such as lymphomas and leukemia, who receive treatment with the drug cyclophosphamide, may also have a higher risk for bladder cancer. Additionally, if you come in contact with chemicals used to make plastics, paints, textiles, leather at work; you may also be at a higher risk of developing bladder cancer.
Diagnosis
Your healthcare provider will first perform a full medical history and physical exam. He/she may refer you to a urologist for more tests and to form a diagnosis. If your diagnosis is bladder cancer, additional tests will find out the stage of your disease. It will also give your doctor an idea of what treatment is best for you.
Grading is one of the ways to know if the disease will come back. It also tells doctors how quickly the cancer may grow and/or spread.
Tumors can be low or high grade. High-grade tumor cells are very abnormal, poorly organized and tend to be more serious and aggressive.
The tumor stage tells how much of the tissue has cancer. Doctors can tell the grade and stage of bladder cancer by taking a small sample of the tumor. This is called a biopsy. A pathologist in a lab examines the sample under a microscope and determines the grade and stage of the cancer.
Once diagnosed, the rates of survival are quite favorable for patients with NMIBC. Survival in high-grade disease ranges from about 70-85% at 10 years and a much higher rate for low-grade disease. However, it is important that the disease is diagnosed early so that doctors can predict the course of the disease and choose the best treatment to stop it from growing.
The stages of bladder cancer are:
- Ta: Tumor on the bladder lining that does not enter any layers of the bladder
- Tis: Carcinoma in situ (CIS)- A high-grade cancer but “flat” cancer. It looks like a reddish, velvety patch on the bladder lining
- T1: Tumor goes through the bladder lining, into the second layer, but does not reach the muscle layer
- T2 : Tumor grows into the muscle layer of the bladder
- T3: Tumor goes past the muscle layer into tissue surrounding the bladder, usually fat surrounding the bladder
- T4: Tumor has spread to nearby structures of the bladder such as the prostate in men or the vagina in females
Treatment
A cancer diagnosis can be very frightening. However, your doctor and medical team are here to guide you through the process.
Your healthcare team should tell you about every treatment option available as well as the possible risks and the side effects of treatment on your quality of life.
Your options for treatment will depend on how much your cancer has grown. After staging and grading your cancer, your urologist assess the best way to manage your care considering your risk. Risks are classified as low, intermediate or high and suggest the likelihood of tumor recurrence and/or progression. Treatment also depends on your general health and age.
Treatments for non-muscle invasive bladder cancer include:
- Cystoscopic transurethral resection of the bladder tumor (TURBT)
- Intravesical Therapy
- Surgery
If these options fail to treat your cancer, your doctor may recommend removing the complete bladder.
You should expect to return to your doctor for re-evaluation and further tests for some time after treatment and surgery. After you complete your initial evaluation and treatment for NMIBC, your healthcare provider may bring you back in, within three to four months, for a cystoscopy to see how you are doing. This helps him/her evaluate if the entire tumor was removed and assess the risk of the tumor recurring.
You may also be given imaging tests as your healthcare provider sees fit. These imaging tests look for cancer in your kidneys and ureters.
If you had bladder removal surgery, it takes time to heal. The time needed to recover is different for each person. It is common to feel weak or tired for a while. However, like any other major surgery, bladder surgery may have complications such as gastrointestinal (GI) problems, urinary diversion, hormonal changes, reproductive health, sexual dysfunction and pain or discomfort. Older patients and women are more likely to get complications after cystectomy.
There are some things you can do before surgery to help your recovery. If you smoke, try to get quit. You also need to make sure you eat right so that your body can heal and can cope with the changes.
Remember that each person is different and each body may respond differently to therapy. It is important that you take care of yourself and remain in contact with your healthcare provider. Try to adopt healthy lifestyle habits including exercise, a well-balanced diet and no smoking. Your healthcare provider also may recommend a cancer support group or individual counseling