The lower urinary tract is made up of the bladder, urethra, and in males, the prostate. The bladder collects and stores urine, which has passed from the kidneys through the ureter. Once the bladder has reached its capacity of stored urine, the urine then exits the body through the urethra.
Bladder cancer occurs when the cells lining the inner wall of the bladder grow and multiply out of control until they become a mass of cancerous cells – a malignant tumor. In aggressive cases, cancer cells can spread to the deeper layers of the bladder wall, and even to other tissues and organs in the body such as the lymph nodes, bones, lungs, and liver.
There are many different types of bladder cancer, which are classified according to the type of cell in which the cancer originated. The most common type, accounting for over 90 percent of bladder cancer cases, is known as transitional cell carcinoma or urothelial carcinoma, which is a cancer that develops from the cells of the bladder lining. Another type of bladder cancer, squamous cell carcinoma, is caused by an infection or chronic inflammation in the bladder. It is found in only 4-5 percent of cases. There are also rarer types of bladder cancer as well.
Risk Factors for Bladder Cancer
Generally speaking, bladder cancer is more commonly found in people 40 years and older, although it is becoming more common in people younger than 40 as well. It is also more commonly found in men than in women. At present, major factors that may increase the risk of bladder cancer include:
- Smoking, including secondhand smoke, and those who have a history of smoking.
- Regular exposure to certain chemicals over a long period of time, especially those working in the printing industry; or textile, paint, rubber, or leather processing industries.
- Chronic bladder inflammation and irritation, such as urinary tract infections and bladder stones, or long-term use of a urinary catheter, etc.
- Genetics (certain genetic syndromes or disorders) or a family history of bladder cancer.
- Certain medications used in chemotherapy.
Symptoms of Bladder Cancer
Common symptoms include:
- Hematuria (blood in the urine) is the most common symptom of bladder cancer; usually painless.
- Abnormal bladder habits such as pain during urination, frequent urination, burning, irritation, or urinary incontinence.
- Symptoms caused by cancer cells spreading to other organs such as, lower back pain (on either side of the body), bone pain, enlarged lymph nodes, swollen feet, fatigue, lack of appetite, and weight loss.
Detection and Diagnosis of Bladder Cancer
Bladder cancer can usually be detected in its early stages, due to the fact that many patients will see the doctor as they notice blood in their urine.
Preliminary screening includes:
- Urinalysis – This is performed in order to detect whether or not there are abnormal red blood cells in the urine, as well as to test for cancer cells that may be suspended in the urine and excreted from the body during urination (urine cytology).
- Bladder Endoscopy (Cystoscopy) – This involves the doctor inserting a cystoscope (narrow tube) through the urethra into the bladder in order to examine the location, size, and shape of the tumor(s), as well as to collect a tissue sample (biopsy) for testing to determine whether or not the cells are cancerous – as well as what kind of cancer it may be and how aggressive it is. This particular method of screening is a very accurate in diagnostic testing for bladder cancer.
- Diagnostic Radiology – This includes an ultrasound of the kidneys, ureter, and urinary bladder (Ultrasound KUB); x-ray examination of the kidneys and urinary tract; and CT scan of the entire abdominal area. Additional testing may also include bone and lung x-rays if the cancer is suspected to have spread to these areas.
Stages of Bladder Cancer
Stages of the cancer are determined according to the depth of invasion of cancer cells, the extent to which it has spread, as well as any abnormal functioning of the organs within the body. Knowing the stage of the cancer is extremely important, as it helps the doctor determine the most appropriate treatment route.
Bladder cancer is divided into 4 stages:
- Stage 1 - This is the beginning stage. Cancer at this stage occurs in the bladder's inner lining, but has not yet invaded the bladder wall.
- Stage 2 - Cancer cells have invaded the bladder wall, but the cancer is still confined to the bladder.
- Stage 3 - The cancer cells have spread through the bladder wall to surrounding tissue.
- Stage 4 - Cancer cells have spread to the lymph nodes and other organs such as bones, liver, or lungs.
Treatment Options for Bladder Cancer
Treatment options for bladder cancer depend on a number of factors, including the type, stage, and aggressiveness of the cancer, as well as the overall health of the patient.
For early stage bladder cancer, treatment options include:
- A transurethral resection of bladder tumor (TURBT), which is a standard surgical procedure for non-muscle invasive bladder cancer, both to diagnose and remove cancerous tissue. During surgery, a cystoscope (endoscope) is directed into the bladder through the urethra. A resectoscope is then used to remove the tumor, as well as burn away any remaining cancer cells.
- For some patients, the doctor may also recommend the use of cancer-killing drugs to reduce the chances of recurrence. The procedure involves the anti-cancer drug solution being administered through a catheter, which is inserted through the urethra into the bladder. The catheter is then removed and the patient is required to hold the fluid in the bladder for about 2 hours before releasing it through urination. This treatment is carried out on a weekly basis for at least 6 consecutive weeks.
In cases where the cancer has invaded the layers of the bladder wall, or has reached stage 2 or higher, the doctor may consider surgery to remove the entire bladder (combined with chemotherapy and/or radiation therapy) to reduce the chances of spread and recurrence of the cancer.
In a radical cystectomy, the entire bladder is removed, as well as its surrounding lymph nodes and other structures adjacent to the bladder that may contain cancer. In men, a radical cystectomy typically includes removal of the prostate and seminal vesicles which are behind the bladder and adjacent to the prostate. In women, it involves removal of the uterus, fallopian tube, ovaries, and part of the vagina.
If the entire bladder is completely removed, a new urinary tract must be constructed for urine to exit the body. Options include:
- Ileal Conduit Urinary Diversion – A segment of the distal small intestine, the ileal, is used for the diversion of urine, which drains freely from the ureters. The proximal end of the segment is closed, and urine drains through the stoma (the distal end of the segment with an opening in the abdominal wall) to a bag that collects urine that is worn on the outside of the body.
- Continent Urinary Diversion (Indiana Pouch) – A part of the patient’s intestine is used to create a reservoir inside the body to collect urine. A catheter is used to empty urine through the stoma throughout the day.
- Orthotopic Continent Urinary Diversion (Neobladder) – A part of the patient’s intestine is used to create a reservoir inside the body to collect urine, which is then connected to the urethra, allowing for normal urination.
Many people with stage 1 bladder cancer are generally able to detect it and are quick to seek medical attention. And as a result, causes the number of severe cases to remain low. However, although people are quick to seek treatment, it is still a highly recurrent form of cancer. People diagnosed with stage 1 bladder cancer must maintain good care of their physical health and avoid any risk factors that may further the progression, as well as undergo follow-up cystoscopy exams every 3 months or according to their doctor’s orders.
Although bladder cancer is generally able to be detected and treated early, it is still a highly recurrent form of cancer. It’s vital that patients maintain good care of their physical health and avoid any risk factors that may further its progression.