Partnering with your doctor and using trusted resources will be important to learning as much as you can about the type of bladder cancer you have so you can make informed treatment decisions. Seek out a doctor or cancer center that uses a multi-disciplinary team to assist you along the way. In addition, it can be helpful to learn from other bladder cancer survivors who may share valuable advice and information.
About the Bladder
As part of the urinary tract, the bladder helps eliminate waste from the body. The urinary tract, which includes the renal pelvis, ureters, bladder and urethra, is lined with urothelial cells that can change shape and stretch without breaking apart. This is particularly important for the functioning of the bladder, which expands and contracts as urine collects in or is expelled from the bladder.
The bladder is a hollow expandable muscular organ that collects and stores urine produced in the kidneys (see The Urinary Tract). Urine flows from the kidneys to the bladder through two thin tubes called ureters. The bladder wall is flexible, and the bladder can hold approximately two cups of urine. When it is full and you are ready to urinate, the muscles in the bladder wall contract and force the urine out of the body through a tube called the urethra.
The bladder wall is composed of four layers:
- Urothelium: Also called the transitional epithelium or mucosa, this innermost layer is composed of cells called urothelial or transitional cells.
- Lamina propria: The next layer is composed of thin connective tissue, blood vessels and nerves.
- Muscularis propria: The third layer is made up of thick muscle. Together with the lamina propria, it is also called the submucosa.
- Perivesical fat: The outermost layer, also called the serosa, is made up of fatty connective tissue to help separate the bladder from nearby organs and protect it.
How Bladder Cancer Begins
Bladder cancer develops when gene(s) in normal cells mutate and multiply uncontrollably. They form a disorganized mass of billions of abnormal cells called a tumor.
The most common type of bladder cancer is urothelial carcinoma, also called transitional cell carcinoma. Other forms (called histologic subtypes) of bladder cancer include squamous cell carcinoma, adenocarcinoma and small cell carcinoma, all of which are almost always invasive. Distinguishing one histologic type of cancer from another is based on the appearance of the cells under a microscope.
Also important in describing bladder cancer is its form, or morphology. There are two subtypes: papillary and flat. Papillary tumors grow from the bladder’s inner lining and project toward the center of the bladder while flat tumors grow along the surface of the lining.
- Noninvasive tumors have not penetrated any other layers of the bladder.
- Non-muscle invasive tumors have grown into the lamina propria but not into the muscle.
- Muscle-invasive tumors have grown into the bladder wall’s muscle and sometimes into surrounding tissues or organs outside the bladder, such as the liver, lung or bone.
Getting a Second Opinion
Getting a second opinion can ensure your diagnosis is accurate and can make you aware of clinical trials to consider. Doctors bring different training and experience to treatment planning. Some doctors may favor one treatment approach, such as a trial, while others might suggest a different combination of treatments.
Other specialists can confirm your pathology report and stage of cancer. They can also answer any additional questions you may have. Most doctors welcome a second opinion and will recommend another physician or hospital. Above all, the goal is for you to have the best care available.