Bladder cancer develops when healthy cells in the bladder grow out of control and form a tumor. Most often, the bladder cancer cells remain in the organ’s interior lining, and if diagnosed early, the condition is highly treatable. However, the malignant cells can invade the bladder wall.
Tumors of the bladder are categorized by type, stage and grade — characteristics essential to determining the most successful therapeutic option and prognosis.
The most common type is Transitional Cell Carcinoma, which is found in the bladder lining and accounts for roughly 90% of cases in the United States. Other — rarer, but more invasive — types include Squamous Cell Carcinoma, Adenocarcinoma and Small Cell Bladder Cancer.
The tumor’s stage indicates how far the cancer has spread. In Stage I, the cancer is limited to the bladder’s inner lining. Stage II indicates invasion of the cancer into the bladder wall. In Stage III, the cells have spread through the bladder wall to surrounding tissue, and in Stage IV they have spread to other organs.
The tumor’s grade (high or low) reflects how aggressive the cancer cells are, e.g., the risk of invasion of the bladder wall is greater when the cancer cells are high grade.
The causes of bladder cancer are not always clear. However, several risk factors have been identified:
- Smoking is the h4est risk factor, responsible for nearly 50% of bladder cancer deaths among men (roughly 40% among women), according to the American Cancer Society. The harmful chemicals found in smoke and excreted via urine can damage the bladder lining.
- Exposure to chemicals commonly used in the manufacture of dyes, rubber, leather, textiles and paint products, may increase bladder cancer risk.
- Chronic bladder inflammation
- Age, race and gender are risk factors: Caucasian men over age 55 are at greater risk than people of other races, women and younger people.
- Family history of cancer
- Previous cancer treatment
In its early stage, bladder cancer can be asymptomatic or mimic symptoms of benign conditions, such as bladder stones, enlarged prostate or urinary tract infection. If symptoms do appear they should be evaluated as soon as possible. Warning signs include:
- Blood in urine, which may, or may not be visible
- Frequent urination
- Painful urination
- Difficulty urinating
- Urinary tract infection
- Abdominal pain
- Persistent lower back, upper thigh or pelvic pain
Tests and procedures utilized to diagnose bladder cancer include:
- Urine cytology – This microscopic examination of a urine sample checks for abnormal cells.
- Cystoscopy – With the patient under local anesthesia, a urologist inserts a cystoscope — a slender, flexible tube with a miniature lens and lighting system — through the urethra into the bladder to check for signs of cancer.
- Biopsy – The urologist removes suspicious tissue for microscopic analysis.
- Intravenous urography – A dye is injected into the bloodstream, traveling to the kidneys, ureters and bladder to determine the origin of blood in the urine.
- Imaging studies – The urinary tract and surrounding tissue can be imaged by a variety of minimally, or noninvasive, procedures, including: pyelograms, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasound.
The treatment of bladder cancer treatment depends on many factors, including the type, stage and grade of the tumor, as well as the patient’s age, treatment preferences and general health.
- For Early-Stage Bladder Cancer
Transuethral resection of bladder tumor (TURBT) - Often used to remove Stage I cancers limited to the bladder’s inner lining, TURBT involves employing a resecting cystoscope to remove tumors or suspicious tissue with a small wire loop passed through the urethra and into the bladder. Lasers and other devices may also be used to destroy the tumor base.
TURBT is often followed with intravesical therapy, whereby medication is placed directly into the bladder. Bacillus Calmette-Guerin (BCG), an immunotherapeutic drug, used in this manner is through to cause an immune reaction that works to reduce the risk of recurrence.
- For More Invasive Bladder Cancer
Cystectomy – When the cancer has invaded the bladder wall, a cystectomy may be performed to remove part or all of the bladder. possible, a cystectomy is performed using minimally invasive laparoscopic surgery through a few, small incisions in the abdomen.
A partial cystectomy removes only a portion of the bladder and is used when a solitary tumor located in the bladder wall is confined to a specific area, and its removal will not harm bladder function. When the cancer has spread beyond the bladder wall, a radical cystectomy removes the entire bladder, as well as nearby lymph nodes and organs that may be affected.
Reconstructive Surgery – For radical cystectomy patients reconstructive surgery can be performed to creat a new way to store and excrete urine. There are several options, including the creation of:
Urostomy – A urinary conduit (tube), created from a segment of the intestine, is attached to the ureters leading urine from the kidneys through a stoma to the outside of the body into a pouch.
Neobladder – In select cases, a new bladder-like reservoir is created out of a segment of the intestine. It sits in the cavity once occupied by the bladder and is attached to the urethra, allowing for more normal urination after bladder removal. In some cases a catheter is necessary to drain the urine from the new bladder.
Chemotherapy – The use of drugs to destroy cancer cells is fundamental to the treatment of invasive bladder cancer. Provided intravenously or intravesically, several powerful agents are available for bladder cancer patients, each with benefits and potential side effects.
Radiation therapy – Radiation therapy, which uses high-energy beams to kill cancer cells, may be provided by technology located outside the body or from radioactive material placed directly into the bladder near the tumor. Bladder cancer patients may receive radiation therapy before surgery to reduce the size of the lesion and make it easier to excise the lesion, and/or postoperatively to destroy any remaining cancer cells. Some patients receive only radiation therapy, for others it is given in combination with chemotherapy.
While there is no known way to prevent bladder cancer, there are ways to reduce risk, including:
- Do not smoke
- Follow safety instructions when working with chemicals
- Drink water throughout the day to flush out toxic substances
- Eat a variety of fruits and vegetables rich in antioxidants