Bladder Cancer

Bladder cancer is a condition that begins in the bladder tissue.

The bladder is the hollow muscular organ that stores urine.

Bladder cancer happens when the cells in the lining of your bladder multiply rapidly, forming a tumor that can destroy normal tissue. The abnormal cells can spread through the body, causing metastatic cancer, if they continue to grow.

Symptoms of bladder cancer include issues with urination, such as frequent or urgent urinating, blood in the urine and pain when urinating.

There are many options for diagnosing and treating bladder cancer. Many cases of bladder cancer are caught in the early stages, when it is most treatable. However, early-stage bladder cancer has a high risk of coming back after treatment. This means it is important to monitor health after bladder cancer treatment to notice signs of recurrence.

Bladder cancer definition, symptoms and complications

What is bladder cancer?

The bladder is an organ in the abdomen that is capable of shrinking and expanding to accommodate the urine collected within the body. This organ is an essential part of the body system that collects waste to be removed from the body.

Cancer beginning in the bladder occurs when abnormal cells begin to grow out of control in the bladder, often first detected after issues with urination have occurred. The tumors beginning in these organs can spread to nearby tissues, such as lymph nodes and other organs as it progresses.

Are there different types of bladder cancer?

There are three types of bladder cancer that begin in the lining cells of the bladder, including:

• Urothelial carcinoma: Most bladder cancers begin in the cells that line the inside of the bladder. These are cells in the innermost layer of the bladder are able to stretch when the bladder is full and shrink when it is empty. Urothelial carcinoma can be low-grade or high-grade, and these are treated differently. This type of bladder cancer was previously called transitional cell carcinoma.
• Squamous cell carcinoma: This cancer begins in the thin, flat squamous cells, usually after long-term infection or irritation.
• Adenocarcinoma: This rare type of cancer begins in glandular (secretory) cells found in the lining of the bladder.

There are also different names for bladder cancer based on its location.

• Cancer limited to the lining of the bladder is called superficial bladder cancer.
• Cancer that has spread through the lining of the bladder and invades the muscle wall is invasive.
• If it is invasive or has spread to nearby organs and lymph nodes it is metastatic bladder cancer.

What are the symptoms of bladder cancer?

Symptoms differ between patients, but those experiencing early stages of bladder cancer may experience the following:

• Urgency and frequency of urination
• Blood in the urine (slightly rusty to bright red in color)
• Frequent urination
• Pain during urination
• Lower back pain

Like other cancers, bladder cancer progresses in stages, during which symptoms may change or become more severe. The following stages are used to track the progress of bladder cancer:

• Stage I: The cancer goes through the bladder lining but does not reach the bladder muscle.
• Stage II: The cancer has spread from the bladder lining to the bladder muscles.
• Stage III: The cancer has spread beyond the bladder into the fatty tissue and lymph nodes surrounding it.
• Stage IV: The cancer has spread to nearby structures such as the prostate gland, uterus, vagina, rectum, abdominal wall, or pelvic wall. Metastasis may occur, leading to cancerous cells traveling to other regions or organs in the body.

Are there complications to bladder cancer?

Common complications resulting from bladder cancer include issues related to the function of the bladder and structures around the bladder. Anemia, swelling of the ureters (hydronephrosis), urethral stricture or urinary incontinence can all occur. Further, erectile dysfunction for people with penises or sexual dysfunction for those with vaginas may also happen in later stages of bladder cancer.

Bladder cancer causes, risk factors and prevention

What causes or contributes to the development of bladder cancer?

While there are no singular causes for any type of cancer, there are some factors that may trigger its onset. For bladder cancer, older age, previous cancer treatment, genetic disease, exposure to certain chemicals, or smoking may be causes.

Read: Benefits of quitting smoking at any age>>

Are there risk factors for developing bladder cancer?

Anything that increases the risk of getting a disease is called a risk factor. Having a risk factor does not mean that someone will get a particular type of cancer; not having risk factors doesn’t mean that someone will not get a particular type of cancer. Some risk factors of bladder cancer include:

• Using tobacco, especially smoking cigarettes
• Having a history of bladder infections
• Having a family history of bladder cancer
• Being exposed to certain chemicals in the workplace
• Drinking well water that has high levels of arsenic
• Drinking water that has been treated with chlorine
• Using urinary catheters for a long time
• Past treatment with certain anticancer drugs or radiation therapy to the pelvis

Can bladder cancer be prevented? How?

When the cause of bladder cancer is not genetic or inherited, there are ways to decrease the risk of developing this condition. Examples may be to decrease or quit smoking, avoid exposure to or ingestion of certain chemicals and monitoring the effects of other medical treatments, such as catheters.

Bladder cancer diagnosis and treatment

How is bladder cancer diagnosed?

The following screenings, tests and procedures may be used to detect or diagnose bladder cancer and determine the stage of its progress:

• Physical exam and history: The physician carefully examines the patient’s health history, past treatments, symptoms and/or abnormalities.
• Digital rectal or vaginal exam: The doctor or nurse inserts a gloved finger into the rectum or vagina to check for lumps or abnormal areas in this area.
• Urinalysis: A physician examines a urine sample for contents, such as sugar, protein, red and white blood cell levels.
• Urine cytology: A urine sample is examined under a microscope for abnormal cells.
• Cystoscopy: A small scope is inserted through the urethra into the bladder to check for abnormal tissue areas. The thin, tube-like instrument may also have a tool to remove suspicious tissue samples, which are later checked under a microscope for cancerous cells.
• Intravenous pyelogram (IVP): A contrast dye is injected into a vein, and a series of x-rays are taken of the kidneys, ureters and bladder to see if cancer is present in these organs. As the contrast dye moves through the organs, x-rays can also visualize any blockages possibly caused by cancerous tumors.

What options are available for bladder cancer treatment? Are any more common or successful?

There are multiple factors of bladder cancer that require medical attention, and several methods of treatment may be necessary to address all patient symptoms. Treatment also depends on cancer stage. Treatment methods include:

• Transurethral resection (TUR): In this surgery, a cystoscope is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity.
• Radical cystectomy: This is a surgery that removes the affected bladder and nearby lymph nodes. A hysterectomy (removal of the uterus) will usually be performed at the same time, because the uterus would lose its supporting tissue system. For invasive bladder cancer, chemotherapy is often given before surgeries like cystectomy.
• Creation of a neobladder: A replacement bladder can be made out of intestinal tissue after the original bladder is removed, placed in the same spot and connected to the urethra. Neobladders are only appropriate for certain patients when the chances of recurrence are low and in the absence of certain other chronic conditions. They preserve the ability to control urination, achieve erections and have comfortable intercourse.
• Radiation and chemotherapies: In many circumstances, a combination of radiation therapy and chemotherapy can allow bladder preservation with the same rates of cure as surgery. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. Chemotherapy involves the administration of drugs, either orally or intravenously, to kill cancer cells. After surgery, some patients are given chemotherapy to lessen the chances the cancer will come back. Recently, several new drugs have increased the options for physicians treating patients with bladder cancer.
• Chemoradiation: This treatment combines chemotherapy and radiation to increase the effects of both. Different combinations of these therapies may be used depending on cancer stage and patient health.
• Biologic or immunotherapy: This treatment uses the patient’s own immune system to fight the cancer. After removing the cancer, the patient is treated with a biologic therapy, which is given in a solution that is placed directly into the bladder using a catheter. This can be administered for a brief period and repeated in a series of treatments. In non-invasive bladder cancer, the biologic approach is usually a single remedy.

What is the prognosis for bladder cancer? Is there a cure?

The prognosis and treatment options depend on the following:

• The stage of the cancer (whether it affects part of the bladder, involves the whole bladder, or has spread to other places in the body).
• Whether the tumor can be completely removed by surgery.
• The patient’s general health.

If the cancer is superficial, prognosis also depends on how many tumors there are, the size of the tumors and whether the tumor has come back after treatment. Bladder cancer in the early stages can often be cured.