CONDITIONS
Bladder Cancer
Bladder Cancer
A type of cancer beginning in the cells of urinary bladder is known as bladder cancer. A growth of abnormal tissue (tumour) develops in the bladder lining and may spread into the bladder muscles in some cases. If diagnosed at an early stage, most bladder cancers are highly treatable. Sometimes, however, it is possible that even early-stage bladder cancers can come back even after successful treatment.
Bladder cancer accounts for 3% of global cancer diagnoses, with 90% diagnosed in people 55 years of age and older. Bladder cancer is four times more common in men than in women. In India, approximately 18,000 new cases of bladder cancer are diagnosed in a year.
The most common symptom of bladder cancer is usually painless – it is the presence of blood in urine (hematuria). This is the most important cue to consult the doctor and take his advice for a proper diagnosis.
What are the types of bladder cancer?
Bladder cancer may be classified on how far it has spread as follows:
Non-muscle-invasive bladder cancer (early bladder cancer): Cancerous cells are contained inside the lining of the bladder.
Muscle-invasive bladder cancer (or invasive bladder cancer): Cancerous cells spread beyond the lining, into the surrounding bladder muscle.
Advanced or metastatic bladder cancer: Bladder cancer spreading to other parts of the body.
What are the symptoms of bladder cancer?
- Blood in urine (hematuria) – this causes the urine to appear bright red or cola colored. In some cases, the urine may appear normal, and blood is detected in the lab test
- Frequent urination
- Painful urination
- Back pain
What are the causes and risk factors of bladder cancer?
An exact cause of bladder cancer remains to be found but there are certain risk factors (parameters that increase the chances) for bladder cancer –
Smoking – Tobacco smoking one of the most common causes and it is estimated that more than 1 in 3 cases of bladder cancer are caused by it.
Increasing age – Increased risk as age progresses
Males are more prone to bladder cancer than females.
Exposure to harmful chemicals – Long term exposure to chemicals such as arsenic and others that are used in the manufacturing of dyes, rubber, leather, textiles and paint products may increase the risk.
Personal or family history of cancer – The chances of a person getting bladder cancer again are high. The risk of disease also increases with a presence of a history of bladder cancer.
Previous cancer treatment – Some anti-cancer drugs may increase the risk of bladder cancer.
Chronic bladder inflammation – Repeated bladder infections or any other infections that causes the bladder to be irritated for long periods of time.
Can cancer of the bladder be prevented and how?
There is no guaranteed way like a vaccine to prevent bladder cancer. However, few precautions may help in decreasing the risk –
Giving up smoking: Tobacco products are known to cause cancers. Quit smoking and if a person is a non-smoker, do not start. Join support groups if required.
Taking precautions around chemicals: If the job is around chemicals, all necessary safety instructions should be taken to avoid exposure.
Choosing a variety of fruits and vegetables: A diet rich in variety of colorful fruits and vegetables may help reduce cancer risk as they contain antioxidants (cancer-preventing chemicals).
How is bladder cancer diagnosed?
What are the tests and procedures for detecting bladder cancer?
Cystoscopy: The inside of the bladder is examined by passing a thin tube with a camera and light at the end (cystoscope) through the urethra (the tube through which you urinate).
Before the cystoscopy, a local anaesthetic gel is applied to your urethra to avoid any pain and the gel also aids in passage of the cystoscope easily. The procedure is relatively simple and usually takes about 5 minutes.
Transurethral Resection of Bladder Tumor (TURBT): In case of unusual findings in the cystoscopy, a sample of the tumour (biopsy) is taken and sent to the lab for testing of cancer. This procedure is Transurethral Resection of Bladder Tumor (TURBT).
Imaging scans: A CT or an MRI scan may be conducted if the specialist feels the need for a detailed picture of your bladder. A pyelogram, X-ray of the urinary bladder by injecting a dye into either the vein (Intravenous pyelogram (IVP)) or directly into the urinary tract via a thin tube (catheter) (Retrograde pyelogram) is done to highlight the presence of any tumours in the bladder.
What are the stages of bladder cancer?
Diagnostics tests determine the stages of cancer.
Staging is a measurement of cancer spread with lower stage being smaller and having a better success rate. Grading is a measurement of the likelihood of cancer spread and is described using the number ranging from G1 to G3.
TNM system of staging is most widely used and TNM is known as –
T (Tumour) – how far has the main tumour grown into the bladder
N (Lymph Nodes) – if the cancer has spread into nearby lymph nodes
M (Metastasized) – if the cancer has spread into another body part (metastasis), such as the lungs.
Based on the determination of T, N, and M stages, the doctor determines an overall cancer stage from 0 to the Roman numeral IV to show disease progression. Here’s what each stage means:
Stage 0: Cancer growth in center of the bladder and hasn’t spread into the tissues or muscle of the bladder wall itself. It also hasn’t spread to the lymph nodes or other organs.
Stage I: Cancer growth through the inner lining of your bladder, but not the muscle of bladder wall or to your lymph nodes or distant organs.
Stage II: Cancer growth through connective tissue and into the muscle layer of the bladder but not the fatty tissue around the bladder.
Stage III: Cancer growth in the layer of fatty tissue surrounding the bladder. And may also be in the prostate, uterus, or vagina. May also have spread to one lymph node in the pelvis, but not into distant organs.
Stage IV: Includes any of the following:
- Cancer spread from bladder into the pelvic or abdominal wall, not present into the lymph nodes or distant organs.
- The cancer has spread to nearby lymph nodes but has not reached distant organs.
- Cancer is now in lymph nodes or distant sites like your bones, liver, or lungs.
What are the treatment options in bladder cancer?
Treatment options depend largely on the stage of bladder cancer, its type as well as the grade of cancer. Bladder cancer treatment may include:
Surgery – For removing cancer cells.
Chemotherapy in the bladder (intravesical chemotherapy) – for treating cancers confined to the lining of the bladder with high risk of recurrence or progression to higher stage.
Chemotherapy for the whole body (systemic chemotherapy) – increasing chances for cure in a person undergoing bladder removal, or as a primary treatment where surgery isn’t an option.
Radiation therapy – Destroying cancer cells, often as a primary treatment where surgery is non optional or undesirable.
Immunotherapy – Triggering the body’s immune system to fight cancer cells, either in bladder or throughout the body
Targeted therapy – To treat advanced cancer when other treatments don’t work.
A combination of treatments may be suggested by the doctor and their team.
Coping with bladder cancer:
Concerns about living with bladder cancer returning may leave one helpless about the future. Taking steps of manage the stress may help ensure that the bladder cancer won’t recur.
A routine maybe fixed after some time, but until then, the following steps may help:
Following scheduled steps of treatment and going to each appointment. Ask the doctor for a scheduled follow-up tests with a personalized schedule. Prepared to have some anxiety before each follow-up cystoscopy exam, owing to fear of cancer coming back. This shouldn’t prevent them from going to the appointment. Plan ways to cope with any concerns. Writing thoughts in a journal, talking with a friend or use relaxation techniques, such as meditation might help.
It is of utmost importance to take care of yourself, so that you are prepared to fight cancer if it comes back. Adjusting the diet to include plenty of fruits, vegetables and whole grains. Exercising for at least 30 minutes most days of the week and getting enough sleep to feel rested.
Talking with other bladder cancer survivors helps.
References
- Saginala K, Barsouk A, Aluru JS, Rawla P, Padala SA, Barsouk A. Epidemiology of Bladder Cancer. Med Sci (Basel). 2020 Mar 13;8(1):15.
- Mishra V, Balasubramaniam G. Urinary bladder cancer and its associated factors – An epidemiological overview. Indian J Med Sci 2021;73(2):239-48.
- Bladder Cancer. December 2023. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bladder-cancer/diagnosis-treatment/drc-20356109
- Minesh Khatri. What Is Bladder Cancer? December 2023 WebMD. https://www.webmd.com/cancer/bladder-cancer/understanding-bladder-cancer-basic-information
- Bladder Cancer. December 2023. NHS UK. https://www.nhs.uk/conditions/bladder-cancer/treatment/
