Bladder Cancer

The bladder is a vital human organ that has the role of storing urine until it leaves the body. Situated in the lower part of the abdomen, the bladder is connected to the kidneys (where urine is formed) through ureters. When we urinate, liquid is squeezed through a tube called urethra. Bladder cancer is a form of cancer that starts in the bladder, usually in the bladder wall, and, as it grows, affects the other layers of the bladder and may spread to the surrounding organs.


Bladder Cancer Overview & Facts

Bladder cancer is one of the most common types of cancer. Globally, it affects 3.5 million people and it accounts for nearly 200,000 deaths every year. In the United States, 80,000 patients are diagnosed with bladder cancer every year and, according to the American Cancer Society, about 17,000 of these cases result in death.

Bladder cancer is more common in men than it is in women and usually develops between the ages 65 and 85, although earlier diagnosis is also possible. Compared to other types of cancer, bladder cancer is relatively rare and onset usually happens in the early stages, when it is highly treatable and with a high survival rate.

Depending on the location where the cancerous cell first appears, there are three types of bladder cancer, and each of these three types requires a different treatment approach:

  1. Urothelial carcinoma. This is the most common type of bladder cancer and it occurs when cancerous cells appear in the lining of the bladder.
  2. Adenocarcinoma is the rarest type of bladder cancer and occurs when cancerous cells appear in the bladder glands that secrete mucus.
  3. Squamous cell carcinoma is linked to the chronical irritation of the bladder and can appear when a catheter used for a long time triggered an infection. In the United States, squamous cell carcinoma isn’t very common, but its prevalence is higher in countries that have a high rate of schistosomiasis (parasitic infection).

If the tumor was found inside the bladder wall, then the patient is dealing with non-invasive bladder cancer, whereas invasive bladder cancer occurs when the tumor has spread outside the bladder walls.

At present, bladder cancer affects men more than women, but in the past years studies have shown a considerable rise of bladder cancer in women, while the figures for men have remained constant.


Bladder cancer


Signs and Symptoms of Bladder Cancer

Although there are several bladder cancer symptoms, the main sign of bladder cancer is hematuria (blood or redness in urine). This is the most obvious sign, the one that prompts patients to see a specialist for further investigation. Up to 90% of people who suffer from bladder cancer also experience hematuria, but this symptom on its own can also indicate many other conditions apart from cancer. Hematuria can be visible with the naked eye or it can be visible only under the microscope. Apart from blood in urine, other symptoms of bladder cancer include:

  • Back pain, especially the lower back
  • Discomfort while urinating
  • The feeling of having to urinate but not being able to

In the late stages of the disease, the patient may also experience pelvic pain and a solid mass can be felt during physical examination.


Bladder Cancer Diagnosis

Because many of the signs and symptoms of bladder cancer can also correspond to other conditions, professional diagnosis is required. The bladder cancer diagnosis is given by an oncologist only after ruling out the following conditions, which manifest in similar ways:

  • Prostate infections
  • Overactive bladder syndrome
  • Kidney stones
  • Cystitis
  • Kidney cancer
  • Kidney infections

To discover the cause of the symptoms, doctors employ a series of bladder cancer tests and investigations that start with a thorough analysis of the patient’s medical history, because genetics play an import role in the prevalence of this type of cancer. Blood tests will also be required to rule out other conditions and the patient will often undergo the following procedures as part of the investigation:

  • Urine tests, which look for tumor markers in urine
  • Cystoscopy is a medical procedure where the doctor uses a thin tube and a miniscule video camera to look inside the patient’s bladder and look for anomalies. A more accurate version of this procedure is blue light cystoscopy, where the specialist also uses a blue light to analyze areas that could go unnoticed during the regular procedure.
  • A biopsy involves taking one or more small samples from the bladder, which will then be inspected under the microscope to look for signs of cancer.
  • X-rays, which can detect tumors and other abnormal growths on the bladder walls
  • MRI scans, useful when the doctor suspects that the cancer may have spread outside the bladder and affected other organs
  • CT scans, like MRI scans, indicate whether or not the tumor has spread to other organs
  • Ultrasound shows the mass of the tumor and where it has spread
  • Bone scan – this is only done when the patient also experiences bone pain in addition to bladder cancer symptoms and the specialist suspects that the cancer has spread to the bones.

Although the symptoms of bladder cancer can be very uncomfortable and make patients feel embarrassed, doctors recommend an appointment as soon as the first signs of hematuria set in to find out if it is caused by a tumor or by something else. If caught early, bladder cancer is highly treatable and has a high survival rate – up to 98% five year outlook for patients diagnosed with stage 0 bladder cancer, 88% for stage I and 63% for stage III.


Bladder cancer diagnosis


Treatment and Care of Bladder Cancer

Bladder cancer treatment depends on the type of cancer that was diagnosed, its degree of invasiveness and, of course, stage. Stage I and II cancers are easier to treat, while Stage III and IV require more aggressive treatment and have lower survival rates. When providing care for bladder cancer, the doctor will also keep in mind the patient’s general health state and other conditions he may have. Treatment for bladder cancer includes:

  • Surgery to remove the cancerous tumor.
  • Intravesical chemotherapy is used to treat tumors located in the bladder lining, while at the same time reducing the risk of recurrence or progression.
  • Systemic chemotherapy is used for the whole body is recommended as a follow-up treatment for patients who gave already undergone surgery or who cannot have surgery.
  • Radiation therapy can kill cancer cells where surgery is not possible or the patient does not want it.
  • Immunotherapy can be used in addition to other bladder cancer treatments to increase the body’s resistance against cancerous cells.
  • Reconstruction surgery. If the bladder had to be removed completely to get rid of the cancerous growth, then the patient can opt for reconstructive surgery. This creates a new tube through which urine can exit the body.

In some cases, only one of these treatments will suffice to remove the cancerous cells, but, depending on the severity of the patient’s condition, his team of healthcare providers may suggest a complex approach consisting of two or more of these treatments.

Because bladder cancer may reappear in a few years, doctors typically discuss this option with their patients and develop a long-term treatment that focuses on follow-up visits and frequent tests. If the cancerous mass was successfully removed the first time, patients typically have to come back for a cystoscopy every six months or even more often if the cancer was very aggressive. If the cancer does not come back after a few years, then the frequency of these cystoscopies can be reduced to once a year.

Follow-up care often includes a series of dietary of lifestyle changes, depending on the patient. Meanwhile, joining a group of cancer survivors has shown excellent results in coping with the mental challenges of bladder cancer treatment.


Causes & Risk Factors of Bladder Cancer

Compared to other types of cancers, the causes of bladder cancer are generally understood and scientists have also created a list of bladder cancer risk factors take make patients susceptible to developing this condition.


Bladder cancer and tobacco smoking

At present, tobacco smoking remains the main cause of bladder cancer all over the world, accounting for more than half of bladder cancer cases. Studies show a clear connection between the incidence of bladder cancer and the number of daily cigarettes. Smoking more than 15 cigarettes every day increases risk considerably, but people who smoke more than that do not necessarily have a higher risk. Although quitting smoking somewhat reduces the risk of bladder cancer, the condition can still occur in an ex-smoker. Current research shows that passive smoking does not cause bladder cancer.


Other causes

After tobacco, exposure to certain toxic chemicals also increase the risk of bladder cancer and accounts for 30% of global bladder cancer cases. These toxic chemicals include carcinogens benzidine and 2-Naphthylamine. They can be found in tobacco smoke, but also in exhaust fumes. Jobs such as bus drivers, mechanics, factory workers and shoemakers put people at risk of developing bladder cancer because they are exposed to these carcinogens every day and don’t always use protective gear. Hairdressers can also develop the disease because they are exposed to hair dyes on a daily basis.

Apart from these two major bladder cancer risk factors, this type of cancer is more likely to appear in patients who have cases of bladder cancer in their family history or have certain genetic mutations.

Previous cancer treatments with the chemotherapy drug Cytoxan and radiation therapy in the pelvic area have also been shown to increase bladder cancer risk.

Statistically, bladder cancer affects males more than females, and being white and over the age of 55 increases risk.

Lastly, obesity and chronic bladder inflammation have also been linked to a higher risk of bladder cancer.


Bladder Cancer Prevention

Bladder cancer prevention is possible when individuals try to control risk factors, reduce exposure to the carcinogens that cause bladder cancer and in general try to lead a healthy lifestyle with proper nutrition and physical exercise.

  • Giving up smoking or avoiding tobacco smoking altogether
  • Wearing protective gear at work to reduce exposure to toxic substances
  • Adding more carrots, citrus and selenium-rich fruits and vegetables into the diet
  • Drinking at least 1.5 liters of water every day
  • Avoiding a high intake of fat
  • Engage in sports and physical activities for at least 30 minutes every day
  • Maintaining normal weight

Because certain rare types of bladder cancer do give hematuria and because hematuria is not always visible with the naked eye, doctors recommend people over the age of 65 and people with a family history of bladder cancer to see their healthcare providers for preventive screening.

Last updated on March 2nd, 2018

Chris Riley

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