What is bladder cancer? 

Bladder is a triangle-shaped organ that is present between hip bones. Urine from kidneys drains into bladder, which is lined with tissue called urothelium. Urothelium is made of cells that stretch when bladder fills with urine and collapses when it’s empty. Average bladder capacity is 350-500ml of urine. 

Bladder cancer happens when certain cells in the tissue lining the bladder mutate or change, becoming abnormal cells that multiply without control. Left untreated, bladder cancer may grow through the bladder walls to nearby lymph nodes and then other areas of the body, including bones, lungs or liver. 

How common is bladder cancer? 

Bladder cancer is the fourth most common cancer affecting men. Men are four times more likely to develop bladder cancer than women. But women who do have bladder cancer typically have advanced forms of the disease because they don’t know about bladder cancer symptoms. 

Bladder cancer typically affects people age 55 and older. On average, people are 73 when they’re diagnosed with bladder cancer. 

What are bladder cancer types? 

Bladder cancer is classified according to its extent of spread and aggressiveness. 

There are various types of bladder cancer with different levels of aggressiveness. Each type is named for the cells that line the wall of bladder where the cancer started. Some commonly encountered examples of bladder tumor are: 

● Transitional cell carcinoma: This cancer starts in transitional cells in the inner lining of bladder wall. About 90% of all bladder cancers are transitional. In this cancer type, abnormal cells spread from the inner lining to other layers deep in bladder or through bladder wall into fatty tissues that surround bladder. This bladder cancer type is also known as urothelial bladder cancer. 

● Squamous cell carcinoma: Squamous cells are thin, flat cells that line the inside of bladder. This bladder cancer accounts for about 5% of bladder cancers and typically develops in people who’ve had long bouts of bladder inflamation or irritation. 

● Adenocarcinoma: Adenocarcinoma cancers are cancers in the glands that line organs, including bladder. This is a very rare type of bladder cancer, accounting for 1% to 2% of all bladder cancers. 

● Small cell carcinoma of the bladder: This extremely rare type of bladder cancer. ● Sarcoma: Rarely, soft tissue sarcomas start in bladder muscle cells. 

Bladder cancer are also classified into noninvasive, non-muscle-invasive or muscle-invasive depending upon level of invasion into deeper tissues. 

● Noninvasive: This bladder cancer may be tumors in a small section of tissue or cancer that’s only on or near the surface of bladder. 

● Non-muscle-invasive:This refers to bladder cancer that’s moved deeper into bladder but hasn’t spread to muscle.

● Muscle-invasive:This bladder cancer has grown into bladder wall muscle and may have spread into the fatty layers or tissues on organs outside of bladder. 

What are the symptoms of bladder cancer? 

Blood in urine is the most common bladder cancer symptom. However, not all patients with blood in urine have bladder cancer. Other conditions can cause blood in urine. Other bladder cancer symptoms include: 

● Visible blood in urine (hematuria) 

● Pain during urination 

● Increased frequency of urination 

● Difficulty in urination 

What causes bladder cancer? 

Several different risk factors that may increase chance of developing bladder cancer include: 

● Cigarette smoke: Smoking more than doubles risk of developing bladder cancer. ● Radiation exposure: Radiation therapy to treat cancer may increase risk of developing bladder cancer. 

● Exposure to certain chemicals: Studies show that people who work with certain chemicals used in dyes, rubber, leather, paint, some textiles and hairdressing supplies may have an increased risk. 

● Frequent bladder infections: People who have frequent bladder infections, bladder stones or other urinary tract infections may be at an increased risk of squamous cell carcinoma. 

● Chronic catheter use: People who have a chronic need for a catheter in their bladder may be at risk for squamous cell carcinoma. 

How to diagnose bladder cancer? 

Bladder cancer is diagnosed with a combination of multiple investigations to know the location, size and type of cancer. 

● Urinalysis: Doctors use a variety of tests to analyse the urine. This also helps to identify infection. 

● Urine cytology for malignant cells: Urine is examined under microscope for signs of cancer. 

● Cystoscopy: This is the primary test to identify and diagnose bladder cancer. For this test, the doctor uses a pencil-sized lighted tube called a cystoscope to view the inside of bladder and urethra. 

If urinalysis, cytology and cystoscopy results show you have bladder cancer, Doctors then do tests to learn more about the cancer, including: 

● Transurethral resection of bladder tumor (TURBT): Doctors do this procedure to remove bladder tumors for additional tests. TURBT procedures may also be a treatment,

removing bladder tumors before the tumors can invade bladder’s muscle wall. This test is an outpatient procedure done under spinal or general anesthesia. 

● MRI: This imaging test uses a magnet, radio waves and a computer to take detailed images of bladder. 

● CT Scan: This test is done to see if cancer has spread outside of bladder. ● PET scan: A PET scan is done in intermediate to high risk bladder cancer to rule out any spread in the body. 

All the above investigations are used to stage the disease. Staging cancer helps plan treatment and develop a potential prognosis or expected outcome. 

Bladder cancer can be either early stage (confined to the lining of bladder) or invasive (penetrating bladder wall and possibly spreading to nearby organs or lymph nodes). 

The stages range from TA (confined to the internal lining of bladder) to IV (most invasive). In the earliest stages (TA, T1 or CIS), the cancer is confined to the lining of bladder or in the connective tissue just below the lining, but hasn’t invaded the main muscle wall of bladder. 

Stages II to IV denote invasive cancer: 

● In Stage II, cancer has spread to the muscle wall of bladder. 

● In Stage III, the cancer has spread to the fatty tissue outside of bladder muscle. ● In Stage IV, the cancer has metastasised (spread) from bladder to lymph nodes or to other organs or bones. 

A more sophisticated and preferred staging system is TNM, which stands for tumor, node involvement and metastases. In this system: 

● Invasive bladder tumors can range from T2 (the tumor spreads to main muscle wall below the lining) all the way to T4 (it spreads beyond bladder to nearby organs or pelvic side wall). 

● Lymph node involvement ranges from N0 (no cancer in lymph nodes) to N3 (cancer in many lymph nodes, or in one or more bulky lymph nodes larger than 5 centimetres). ● M0 means that there isn’t any spread outside of pelvis. M1 means that it has metastasised outside of pelvis. 

How is bladder cancer treated? 

There are several types of bladder cancer treatment. Doctors may use any or all of these treatments and may combine treatments. 

Surgery 

Surgery is the most common bladder cancer treatment. 

Doctors chose surgical options based on the cancer stage. For example, many times, TURBT, the procedure used to diagnose bladder cancer, can treat bladder cancer that hasn’t spread. Doctors remove the tumor using high-energy electricity or laser.

Radical cystectomy is another treatment option. This surgery removes bladder and surrounding organs. It’s done when people have cancer that’s spread outside of their bladder or there are several early-stage tumors throughout their bladder. 

In men this surgery removes prostates and seminal vesicles. In women doctors may remove ovaries, their uterus and part of their vagina. This is combined with a urinary diversion surgery to divert urine outside. 

Doctors may follow surgery with chemotherapy or radiation therapy to kill any cancer cells surgery may have missed. This is called adjuvant therapy. 

Chemotherapy 

These are cancer-killing drugs. Doctors may use intravesical therapy to deliver chemotherapy drugs directly to bladder via a tube inserted into urethra. Intravesical therapy targets cancer without damaging healthy tissue. 

Immunotherapy 

Immunotherapy is a treatment that uses immune system to attack cancer cells. There are different types of immunotherapy: 

● BCG: This is a vaccine that helps boost immune system. 

● PD-1 and PD-L1 inhibitor therapy: PD-1 and PD-L1 are proteins found on certain cells of body’s immune responses and some cancer cells. When these two proteins connect, the connection keeps T-cells from killing cancer cells. In inhibitor therapy, the two proteins can’t connect, leaving the way clear for T-cells to kill cancer cells. 

Radiation therapy 

Radiation may be an alternative to surgery. Doctors may combine radiation therapy with TURBT and chemotherapy. This treatment is an alternative to bladder removal surgery. Doctors consider factors such as tumor growth and tumor characteristics before recommending this treatment. 

How can I prevent bladder cancer? 

You may not be able to prevent bladder cancer, but it may be helpful to know the risk factors that may increase the chance of developing bladder cancer. Bladder cancer risk factors may include: 

● Smoking cigarettes: Cigarette smoking more than doubles the risk of developing bladder cancer. Smoking pipes and cigars or being exposed to second-hand smoke also increases that risk. 

● Cancer treatments: Radiation therapy is the second-most common risk factor. People who have certain chemotherapy drugs may also develop an increased risk of bladder cancer. 

● Exposure to certain chemicals: People who work with chemicals, such as aromatic amines (chemicals used in dyes), are at an increased risk. Extensive exposure to rubber, leather, some textiles, paint and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk. 

● Infections: People who have frequent bladder infections, bladder stones or other urinary tract diseases may have an increased risk of developing bladder cancer.

● Past bladder cancer: People with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors. 

Is bladder cancer a fatal illness? 

Left untreated, bladder cancer may spread to other parts of body. Cancer that’s metastasised, or spread, may affect how long you’ll live with bladder cancer. Like many types of cancer, early detection and treatment increase the chance of living longer with bladder cancer. Approximately 96% of people who received treatment for early-stage cancer were alive five years after diagnosis. Overall, 77% of people with bladder cancer were alive five years after diagnosis.