Bladder cancer ranks as the ninth most common cancer globally. In 2022, over 600,000 individuals were diagnosed with bladder cancer, and more than 220,000 succumbed to the disease. This type of cancer poses significant challenges in terms of both diagnosis and treatment costs. Diagnosis primarily relies on cystoscopy, a procedure that is both invasive and expensive.
Fortunately, the majority of bladder cancer cases are detected at an early stage, making them highly treatable. Despite this, approximately 25% of cases are identified at later stages, where treatment becomes more complex and outcomes are less favorable. The high cost and complexity of diagnosing and managing bladder cancer underscore the need for understanding the cancer better, improved diagnostic methods and treatments to better address this widespread health issue.
What is Bladder Cancer?
Bladder cancer occurs when cells in the bladder begin to grow uncontrollably. The bladder is a hollow, balloon-shaped organ located in the lower abdomen, responsible for storing urine. As these abnormal cells proliferate, they can form tumors and potentially spread to other parts of the body. Early detection and treatment are crucial for effective management of bladder cancer.
Also Read: Immunotherapy For Treating Stage 1 Bladder Cancer
Types of Bladder Cancer
Bladder cancer primarily begins in the urothelial cells, which line the bladder, urethra, ureters, and renal pelvis. Nearly all bladder cancers are urothelial carcinomas, also known as transitional cell carcinomas. Urothelial cells are capable of changing shape, stretching when the bladder is full and shrinking when it is empty.
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Common Types of Bladder Cancer
Urothelial Carcinoma (Transitional Cell Carcinoma)
This is the most common type of bladder cancer, originating in the urothelial cells that line the urinary tract.
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Rare Types of Bladder Cancer
Squamous Cell Carcinoma
This type starts in the thin, flat squamous cells lining the inside of the bladder. It often develops after long-term irritation or infection, such as from schistosomiasis, a tropical parasite more common in Africa and the Middle East but rare in the United States. Chronic irritation can cause transitional cells to transform into squamous cells.
Adenocarcinoma
This type begins in the glandular cells in the bladder lining, which produce mucus and other substances.
Small Cell Carcinoma
This rare type originates in neuroendocrine cells, which are nerve-like cells that release hormones into the blood in response to signals from the nervous system.
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Classification by Invasiveness
Non-Muscle-Invasive Bladder Cancer
This type has not penetrated the muscle wall of the bladder. The majority of bladder cancers fall into this category.
Muscle-Invasive Bladder Cancer
This type has spread through the bladder lining into the muscle wall or beyond, making it more challenging to treat.
Understanding these types and classifications helps in diagnosing and determining the appropriate treatment strategies for bladder cancer.
Stages of Bladder Cancer
Bladder cancer can be classified as either early stage or invasive. Early-stage cancer is confined to the lining of the bladder, while invasive cancer penetrates the bladder wall and may spread to nearby organs or lymph nodes. The stages of bladder cancer range from TA to IV, with increasing severity.
Early Stages (TA, T1, CIS)
- TA: Cancer is confined to the internal lining of the bladder.
- T1: Cancer has spread to the connective tissue just below the lining but not into the muscle wall.
- CIS (Carcinoma in situ): A flat, high-grade tumor confined to the bladder lining.
Invasive Stages (II to IV)
- Stage II: Cancer has spread to the muscle wall of the bladder.
- Stage III: Cancer has spread to the fatty tissue surrounding the bladder muscle.
- Stage IV: Cancer has metastasized to lymph nodes, nearby organs, or bones.
TNM Staging System
The TNM system provides a more detailed classification:
T (Tumor):
- T2: Tumor spreads to the muscle wall.
- T3: Tumor extends into the fatty tissue around the bladder.
- T4: Tumor spreads to nearby organs or the pelvic sidewall.
N (Node Involvement):
- N0: No cancer in lymph nodes.
- N1: Cancer in a single lymph node.
- N2: Cancer in multiple lymph nodes.
- N3: Cancer in one or more large lymph nodes (>5 cm).
M (Metastases):
- M0: No metastasis outside the pelvis.
- M1: Metastasis beyond the pelvis.
Understanding these stages helps in determining the extent of the disease and guiding appropriate treatment strategies.
Symptoms of Bladder Cancer
Bladder cancer often presents with various symptoms that can indicate the presence of the disease. The most common and usually the first noticeable symptom is blood in the urine, medically known as hematuria. However, other symptoms can also be indicative of bladder cancer. It’s important to understand these symptoms and seek medical advice if you experience any of them.
Blood in Your Urine (Hematuria)
The presence of blood in the urine is the most frequent symptom of bladder cancer. This can be visible to the naked eye, making the urine appear pink, red, or brownish. In some cases, the blood may not be visible and is only detected through a urinalysis performed by a healthcare provider.
While hematuria can be alarming, it is not exclusively indicative of bladder cancer as other conditions, such as infections or kidney stones, can also cause blood in the urine. Nonetheless, it is crucial to consult a healthcare provider if you notice this symptom.
Pain When You Urinate (Dysuria)
Dysuria refers to a burning or stinging sensation during urination. This discomfort can occur at the start of urination or persist after you have finished. In some cases, men and individuals assigned male at birth (DMAB) might experience pain in the penis before or after urinating. This symptom can also be associated with urinary tract infections, making it essential to seek medical evaluation to determine the underlying cause.
Frequent Urination
Needing to urinate frequently, or more often than usual, is another symptom of bladder cancer. This frequent urination can occur during the day and night, disrupting normal routines and sleep patterns. It is often accompanied by a persistent feeling of needing to empty the bladder, even if little urine is passed each time.
Difficulty Urinating
Bladder cancer can also cause problems with the flow of urine. This may include a weak urine stream, a stream that starts and stops, or trouble beginning urination. These symptoms can be due to the tumor causing obstruction or irritation within the bladder or urethra.
Persistent Bladder Infections
Recurring bladder infections that do not resolve with standard antibiotic treatment can also be a sign of bladder cancer. Both bladder infections and bladder cancer share similar symptoms, such as pain during urination and frequent urination. If you experience persistent bladder infections, it is important to consult with a healthcare provider to rule out the possibility of bladder cancer.
When to See a Healthcare Provider
Any of the symptoms mentioned above warrant medical attention, particularly if they persist or worsen over time. Early detection of bladder cancer can significantly improve treatment outcomes. Therefore, if you notice blood in your urine, experience pain when urinating, have frequent or difficult urination, or suffer from persistent bladder infections, it is essential to contact a healthcare provider for a thorough evaluation and appropriate diagnostic tests.
Causes of Bladder Cancer
The exact cause of bladder cancer remains unknown, but healthcare providers and researchers have identified several risk factors that may increase the likelihood of developing this disease. Understanding these risk factors can help in recognizing potential risks and taking preventive measures.
Smoking Cigarette
Smoking is one of the most significant risk factors for bladder cancer. Smokers are more than twice as likely to develop bladder cancer compared to non-smokers.
Radiation Exposure
Exposure to radiation, particularly radiation therapy used to treat previous cancers, can increase the risk of developing bladder cancer. This is due to the potential for radiation to cause mutations in bladder cells.
Chemotherapy
Certain chemotherapy drugs are known to raise the risk of bladder cancer. These drugs can have carcinogenic effects, particularly when used to treat other cancers.
Chemical Exposure
People who work with specific chemicals used in industries such as dye production, rubber manufacturing, leather processing, painting, textile production, and hairdressing are at higher risk.
Frequent Bladder Infections
Chronic bladder infections, bladder stones, and other urinary tract infections can elevate the risk of squamous cell carcinoma of the bladder. The persistent irritation and inflammation associated with these conditions can lead to cellular changes in the bladder lining.
Chronic Catheter Use
Individuals who require long-term catheterization are at an increased risk of squamous cell carcinoma of the bladder. The constant presence of a catheter can cause chronic irritation and inflammation, contributing to the development of cancerous changes in the bladder lining.
Line of Treatment for Bladder Cancer
Healthcare providers employ various treatments for bladder cancer, often using a combination of approaches tailored to the cancer’s stage and characteristics. Here are the primary treatment methods:
Surgery
Surgery is a common treatment for bladder cancer, with options depending on the cancer’s stage:
- Transurethral Resection of Bladder Tumor (TURBT): Used to diagnose and treat early-stage bladder cancer, TURBT involves removing the tumor or using high-energy electricity to burn it away (fulguration).
- Radical Cystectomy: This surgery removes the bladder and surrounding organs for advanced cancer or multiple early-stage tumors. In men and people assigned male at birth (DMAB), it includes removing the prostate and seminal vesicles. In women and people assigned female at birth (DFAB), it includes removing the ovaries, uterus, and part of the vagina. Urinary diversion surgery is performed to allow urine passage post-cystectomy.
- Adjuvant Therapy: Post-surgery, chemotherapy or radiation therapy is often used to eliminate any remaining cancer cells.
Chemotherapy
Chemotherapy involves cancer-killing drugs and can be administered in different ways:
- Intravesical Therapy: Chemotherapy drugs are delivered directly to the bladder through a tube inserted into the urethra, targeting cancer cells while sparing healthy tissue.
Immunotherapy
Immunotherapy leverages the body’s immune system to combat cancer:
- Bacillus Calmette-Guérin (BCG): A vaccine that boosts the immune system to fight bladder cancer.
- PD-1 and PD-L1 Inhibitor Therapy: PD-1 on T-cells and PD-L1 on cancer cells normally connect, preventing T-cells from attacking cancer cells. Inhibitor therapy blocks this connection, enabling T-cells to kill cancer cells.
Radiation Therapy
Radiation therapy uses high-energy radiation to destroy cancer cells and can be an alternative to surgery:
- Combination Therapy: Radiation therapy is often combined with TURBT and chemotherapy, providing an alternative to bladder removal surgery. Treatment recommendations depend on tumor growth and characteristics.
Targeted Therapy
Targeted therapy focuses on the genetic changes that cause healthy cells to become cancerous:
- FGFR Gene Inhibitors: These drugs target genetic mutations in the FGFR gene that promote cancer cell growth.
Each of these treatments can be used alone or in combination, depending on the specific needs of the patient and the characteristics of their bladder cancer. Healthcare providers assess various factors to determine the most effective treatment plan.
Conclusion
Bladder cancer is a complex and challenging disease, but early detection and a comprehensive understanding of its causes, types, symptoms, and treatment options can significantly improve outcomes. By recognizing risk factors and seeking timely medical advice, individuals can better navigate their diagnosis and treatment, leading to more effective management of the condition.
