Bladder Cancer

What is bladder cancer?

Bladder cancer, which usually begins in the lining of the bladder, is a relatively uncommon type of cancer. The bladder is defined as a tiny hollow organ responsible for holding urine (pee).

There are different treatment methods available for bladder cancer; one of them is surgery to take out the cancer. After treatment, there are possibilities of bladder cancer recurring. As such, those with the condition should be more vigilant and consider routine follow-ups.

Medical practitioners can effectively treat early-stage bladder cancer, which is detected and addressed before spreading further. However, nearly 75% of all these cases usually recur.

How does bladder cancer affect the body?

The bladder is a triangular-shaped organ positioned between the hipbone, over the urethra, and beneath the kidneys. Urine from kidneys is drained into the bladder lined with urothelium tissue. The urothelium is composed of cells that expand whenever the bladder is full of pee and constrict when empty. Typically, a human bladder is capable of holding about two cups of urine.

Bladder cancer occur when particular cells in the bladder lining undergo mutation or changes, turning into abnormal cells that proliferate and form tumors in the bladder. If not treated, this condition can spread to the surrounding lymph nodes through the bladder walls. Eventually, it could invade other parts of the body, including the lungs, liver, and bones.

Types of bladder cancer

Bladder cancer is categorized into three types based on the cells lining the bladder wall where the cancer originated. They are:

• Transitional cell carcinoma: Also referred to as urothelial bladder cancer, this cancer begins in the transitional cells within the bladder wall inner lining. Its one of the most common types of bladder cancer, accounting for nearly 90% of all cases. This condition develops when abnormal cells metastasize from the inner lining to deeper layers of the bladder or through bladder walls to the fatty tissues surrounding the bladder.
• Squamous cell carcinoma: This type starts in the thin, flat squamous cells lining the inside of the bladder. About five percent of all bladder cancers are squamous and usually occur in individuals who have had prolonged episodes of bladder irritation or inflammation.
• Adenocarcinoma: These kinds of cancers affect the glands lining the organs, such as the bladder. Adenocarcinoma is a very uncommon type, making up nearly 1% to 2% of bladder cancer cases.
• Small cell carcinoma of the bladder: This is another rare bladder cancer type thataffects around 1,000 individuals in the United States.
• Sarcoma: In rare cases, bladder cancer can begin in the bladder muscle cells, forming soft tissue sarcomas.

Medical providers can as well classify bladder cancers into the following categories:

• Non-invasive: This type of bladder cancer is confined to a small part of the tissue or can only develop on or near the bladder surface.
• Non-muscle-invasive: This is the bladder cancer that has grown deep into the bladder but has not reached the muscle.
• Muscle-invasive: This is a bladder cancer type that has invaded the bladder wall muscle and might have extended into the fatty layers or tissues of organs beyond the bladder.

How common is bladder cancer?

In general, bladder cancer is the 4th most prevalent cancer, which affects men and individuals designated male at birth (DMAB). The probability of bladder cancer occurring in men and those DMAB is four times higher compared to women and persons designated female at birth (DFAB). Nonetheless, women and those DFAB with bladder cancer often have more advanced types since they are unaware of the symptoms.

As per the Bladder Cancer Advocacy Network, females tend to overlook the hematuria (blood in the pee), the primary bladder cancer symptom. This is because they often associate bloody urine with typical gynecological problems.

Mostly, bladder cancer affects individuals aged 55 and above, while the average age of diagnosis is 73 years. Furthermore, white men and those DMAB are twice as likely to get bladder cancer compared to blacks.

Symptoms

What are the first symptoms of bladder cancer?

The most common symptom of bladder cancer is usually blood in the urine. However, having blood in the pee is not a conclusive sign of the cancer, as other health conditions can also cause the problem. Even so, it’s important to visit a doctor if you notice any blood stains when peeing.

Additional bladder cancer symptoms are:

• Haematuria (visible blood in the urine): During urinalysis, the practitioner can notice microscopic traces of blood in the urine.
• Dysuria (pain when urinating): This is characterized by a stinging or burning sensation that men and those DMAB feel when starting to pee or afterwards.
• Frequent urination: The need to pee often implies urinating multiple times within 24 hours.
• Difficulty urinating: This involve having a weaker urine flow than normal or an irregular flow (starts and stops).
• Persistent bladder infections: The symptoms of bladder infections and those of bladder cancer share similarities. See your doctor if the infection doesn't resolve after antibiotics treatment.

Causes of Bladder Cancer

Researchers and practitioners do not fully understand why particular bladder cells mutate and turn into cancerous cells. However, they have identified several risk factors associated with increased chances of bladder cancer. They include:

• Smoking: The risk of bladder cancer doubles in people who smoke cigarettes. Smoking pipes and cigars and exposure to second-hand smoke can also increase the probability.
• Radiation exposure: Undergoing radiation therapy for cancer treatment can increase the likelihood of bladder cancer.
• Chemotherapy: Some chemotherapy medications can increase the risk of developing bladder cancer.
• Exposure to certain chemicals: According to studies, individuals working with particular chemicals used in rubber, dyes, paint, leather, hairdressing products and some textiles are at a higher risk of bladder cancer.
• Chronic catheter use: Individuals who require a catheter in the bladder regularly may be more susceptible to squamous cell carcinoma.

Diagnosis and Tests

How do healthcare providers diagnose bladder cancer?

These tests can help detect bladder cancer:

• Urinalysis: This test is used to analyse urine and rule out infections.
• Cytology: Involves microscopic examination of cells to look for bladder cancer signs.
• Cystoscopy: Medical providers recommend this primary test for the identification and diagnosis of bladder cancer. It involves using a cystoscope, a pencil-sized lighted tube to see the inside of the bladder and urethra. A fluorescent dye and exclusive blue lighting may be used to make cancer in the bladder more visible. Tissue samples may also be taken during cystoscopy.

If the results of these tests indicate bladder cancer, the practitioners will conduct additional exams to find out more about the condition:

• Transurethral resection of bladder tumor (TURBT): This procedure is done to remove tumors for more tests. It may also be used as a treatment option to take out tumors and prevent them from invading the muscle wall of the bladder. TURBT is an outpatient test performed under general or spinal anaesthesia.
• Magnetic resonance imaging (MRI): This utilizes magnetic fields and computer-generated radio waves to capture detailed pictures of the bladder.
• Computed tomography (CT) scan: This test can be conducted to check if the cancer has grown beyond the bladder.
• Chest X-ray: This procedure enables the doctors to check if bladder cancer has invaded the lungs.
• Bone scan: This test, similar to a chest X-ray, checks if the bladder cancer has invaded the bones.

Doctors can use the information they obtain from these procedures to stage bladder cancer. Typically, cancer staging makes it easy to plan the treatment and create a possible outlook or projected result.

Bladder cancer can be categorized as early stage, which is confined to the bladder lining, or invasive, which penetrates the bladder wall and likely spreads to the surrounding lymph nodes or organs.

The cancer stages usually range from TA (constricted to the inner bladder lining) to IV (most invasive). TA, TI, and CISare the earliest stages where cancer is still confined to the bladder lining or within the connective tissue under the lining. However, the condition has not spread to the main muscle of the bladder.

Stages II to IV represent invasive cancer. During stage II, cancer has moved to the muscle wall of the bladder, while in stage III, it has extended to the fatty tissue beyond the bladder muscle. For stage IV, the cancer has grown past the bladder to the lymph nodes or other organs and bones.

TNM, which denotes tumor, node involvement, and metastases, is a much more sophisticated and ideal system for staging cancer:

• Tumor (T): Invasive bladder tumors may range from T2 (spreading to the main muscle wall) to T4 (extending outside of the bladder to the surrounding organs or pelvic side wall).
• Node involvement (N): Lymph node involvement ranges from N0 (absence of cancer in the lymph nodes) to N3 (presence of cancer in multiple nodes or a single or more massive lymph nodes bigger than 5 centimetres).
• Metastases (M): M0 indicates no metastasis or spread beyond the pelvis, while M1 implies metastasis past the pelvis.

Treatment

Four primary bladder cancer treatments are available, and doctors can use one or a combination of these options. They include:

Surgery

The most common treatment for bladder cancer is surgery, with a choice of surgical options depending on the cancer stage. In many cases, TURBT, the diagnostic procedure, may be used to address bladder cancer that has not spread further. Practitioners can either take out the tumor or burn it away using high-energy electricity (fulguration).

Another treatment method is radical cystectomy, which is a surgery to remove the bladder and the nearby organs. The procedure is usually considered when cancer has spread beyond the bladder, or numerous early-stage tumors are present. For men and those DMAB, the surgery is done to remove the prostate and seminal vesicles, while in women and persons DFAB, the uterus, ovaries, and a section of the vagina may be removed. Practitioners also perform urinary diversion surgery to enable the passage of urine.

In addition, chemotherapy or radiation therapy may be recommended after surgery to help kill any remaining cancerous cells. This treatment is known as adjuvant therapy.

Chemotherapy

This involves using drugs to kill cancer cells. Doctors can recommend intravesical therapy to administer chemotherapy medication directly to the bladder through a tube implanted in the urethra. The treatment targets cancer while sparing the healthy tissues.

Immunotherapy

This treatment uses the body's immune system to attack the cancerous cells. The different methods of immunotherapy include:

• Bacillus Calmette-Guérin (BCG): A vaccination that helps stimulate the immune system.
• PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the T-cell surface that assists in regulating the immune response in the body. On the other hand, PD-L1 is a protein present on the surface of certain cancer cells. When the two proteins join, it prevents the T-cells from destroying the cancer cells. Therefore, inhibitor therapy stops the connection and clears the way to allow T-cells to kill the cancer cells.

Radiation therapy

This can serve as an alternative to bladder removal surgery and may be combined with chemotherapy and TURBT. Doctors can recommend this treatment option based on factors including tumor growth and its characteristics.

Targeted therapy

This treatment focuses on gene alterations that transform healthy cells into cancerous cells. FGFR gene inhibitors are an example of a drug that targets cells with specific genetic changes stimulating the growth of cancer cells.

Prevention

What are the warning signs of bladder cancer?

One of the most prevalent warning signs of bladder cancer is blood in the pee. It is, therefore, important to see a doctor whenever you notice blood in your urine.

How can you prevent bladder cancer?

Preventing bladder cancer might not be entirely possible. However, understanding the risk factors that can increase the likelihood of developing the condition may be beneficial. These risk factors may include:

• Smoking cigarettes: The risk of bladder cancer is more than doubled by cigarette smoking. In addition, pipes and cigar smoking or second-hand smoke exposure increases the risks
• Cancer therapies: Radiation therapy is known to be the second most prevalent risk factor of bladder cancer. Certain chemotherapy medications can also increase the possibility of developing the disorder.
• Chemical exposure: Working chemicals like aromatic amines (those found in dyes) increase the risks of bladder cancer. Also, extensive occupational exposure to leather, rubber, paint, hairdressing products, and some textiles can contribute to the condition.
• Infections: Individuals with recurrent bladder infections, bladder stones, or urinary tract infections are at a higher risk of bladder cancer.
• Previous bladder cancer: People who have previously been diagnosed with the bladder are at risk of developing new or recurring tumors.

Is bladder cancer a fatal condition?

Bladder cancer can spread or metastasize to different parts of the body if not treated, and this can affect life expectancy. As with other cancers, early diagnosis and treatment are essential to increase the possibility of living longer with the condition.

According to the National Cancer Institute, up to 96% of individuals treated for early-stage cancer survived five years following diagnosis. The overall 5-year survival rate of bladder cancer is 77%.

How do I take care of myself?

Almost 50% of all bladder cancer cases are early-stage and somewhat easy to manage. However, bladder cancer usually recurs, and routine check-ups following treatment are important for those who have had the disease.

One way you can care for yourself is to stay cautious when it comes to follow-up care. You should also consider these tips from the Bladder Cancer Advocacy Network:

• Following a heart-healthy diet: Go for menus with low-fat dairy products, skinless poultry and fish, nuts and legumes, and a range of fruits and vegetables.
• Eating high-fibre foods: Since the treatment of bladder cancer may lead to digestive problems, consuming a fibre-rich diet could be helpful.
• Exercising: Gentle activities and exercises can aid in stress management.
• Connecting with others: Being around individuals who understand your situation may be helpful, especially with conditions like bladder cancers that often recur.

Urinary Diversion

In some cases, bladder cancer may require surgery to remove the bladder and the body's natural urine reservoir. This will necessitate a urinary diversion procedure. Urinary diversion surgeries comprise three different types, all involving surgical conversion of a section of the intestine into a passage tube for urine or storage reservoir.

Urinary diversion might be a tough lifestyle change for many people. So, in case you require a surgical procedure, you should first consult with your practitioner to know the advantages and disadvantages of each type. This will help you understand what to expect and how to care for yourself.

When should I contact my healthcare provider?

After bladder cancer treatment, it's essential to contact your practitioner any time you experience symptoms that might indicate cancer recurrence.

What questions should I ask my provider?

Given the rarity of bladder cancer, many people may not understand as much as they would like about this condition. Therefore, asking your doctor these questions will help you:

• What is my current stage of bladder cancer?
• What are the possible treatment options for my condition?
• Are there side effects of the treatment?
• Will I require surgery?
• How will the surgery affect my everyday life?
• How frequently does bladder cancer recur?
• What is the treatment for recurring bladder cancer?
• Are there any cutting-edge clinical trials available?