When you first hear you have bladder cancer, you may feel overwhelmed. Everything may seem unfamiliar and confusing, making you feel disconnected. Know that you will be surrounded by a multidisciplinary team of skilled health care professionals who are prepared to support and guide you. They will help you see that you are more than your cancer diagnosis.
One of the first things you can do is to learn as much as possible about the type of bladder cancer you have and its treatments. This content will provide you with information about the types of bladder cancer, staging, treatments, support services and more. Becoming an informed patient will help empower you to make the decisions ahead. If there is something you do not understand, ask your doctor to explain.
Bladder Cancer Basics
The bladder is a hollow, expandable muscular organ that collects and stores urine produced in the kidneys (see Figure 1). Urine flows from the kidneys to the bladder through two thin tubes called ureters. 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.
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: Thick muscle makes up the third layer. Together with the lamina propria, it is also called the submucosa.
- Serosa: The outermost layer is made up of fatty connective tissue (known as perivesical fat) to help separate the bladder from nearby organs and protect it.
Bladder cancer develops when genes in normal cells mutate and cause the cells to 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. Also important in describing a bladder cancer is its form or morphology. There are two subtypes: papillary and flat. Papillary tumors grow from the bladder’s inner lining toward the center of the bladder, while flat tumors grow along the surface of the lining.
Bladder tumors are also described by their invasiveness:
- 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’s wall muscle and sometimes into surrounding tissues or organs outside the bladder.
Getting a Second Opinion
Seeking a second opinion is recommended for multiple reasons. Some doctors may favor one treatment approach, while others might suggest a different combination of treatments. Another doctor’s opinion may change the diagnosis or reveal a treatment your first doctor was not aware of. You need to hear reasons and recommendations for all of your treatment options. A second opinion is also a way to make sure your pathology diagnosis and staging are accurate.
Other specialists can confirm your pathology report and stage of cancer and might suggest changes or alternatives to the proposed treatment plan. They can also answer any additional questions you may have.