Overview
Bladder cancer starts when cells of the urinary bladder start to multiply out of control. Over time, these cancer cells form a tumour and can be seen spreading to other parts of the body. Bladder cancer usually begins in the cells (urothelial cells) that line the inside of your bladder. Men are at a higher risk of developing bladder cancer than women.
Smoking is the most significant risk factor for bladder cancer; studies show that smokers are three to four times more likely to get the disease than non-smokers. The most common symptom of bladder cancer is bleeding in the urine (haematuria).
Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is the most common type of bladder cancer. Other types of cancer can also start in the bladder; however, these are less common.
Squamous cell carcinoma: Nearly all squamous cell carcinomas of the bladder are invasive.
Adenocarcinoma: Only about 1% of bladder cancers are adenocarcinomas. Nearly all adenocarcinomas of the bladder are invasive.
Small cell carcinoma: Less than 1% of bladder cancers are small-cell carcinomas. These cancers grow quickly and are usually treated with chemotherapy.
Sarcoma: Sarcomas start in the muscle cells of the bladder, but they are very rare.
Symptoms
Bleeding in the urine is the classic symptom of bladder cancer. Apart from bleeding, there are several other signs and symptoms that point towards bladder cancer:
Causes
Following are some of the risk factors associated with the development of breast cancer:
Cigarette smoking: Cigarette smoking alone is reported to cause about 50% of all bladder cancers. The longer and heavier the exposure, greater are the chances of developing bladder cancer.
Age: The risk of developing bladder cancer develops with age. About 90% of people with bladder cancer are over age 55.
Gender: Men are more prone to developing bladder cancer, and this probably due to a higher incidence of smoking and exposure to toxic chemicals
Family history: A close relative with a history of bladder cancer may increase the predisposition for the development of this disease.
Toxic chemicals: Exposure to toxic chemicals such as arsenic, phenols, aniline dyes, and arylamines increase the risk of bladder cancer. Dye workers, rubber workers, aluminium workers, leather workers, truck drivers, and pesticide applicators are at the highest risk.
Previous cancer treatments: Radiation therapy (given for prostate or cervical cancer) and chemotherapy with certain drugs increases the risk for development of bladder cancer.
Chronic infections: Long-term chronic infections of the bladder and irritation due to stones or foreign bodies also predispose to bladder cancer.
Diagnosis
Following are some of the major diagnostic methods used in diagnosing bladder cancer:
Urinalysis: A simple urine test that can confirm that there is bleeding in the urine and this can alert the doctor to conduct further tests. It is usually one of the first tests that a physician suggests.
Urine cytology: A health care professional performs the test on a urine sample to detect malformed cancerous cells that may pass into the urine from cancer. Many early bladder cancers may be missed by this test so a negative or inconclusive test does not effectively rule out the presence of bladder cancer.
Ultrasound: An ultrasound examination of the bladder can detect bladder tumours. It also helps in detecting other causes of bleeding, such as stones in the urinary system or prostate enlargement, which may be the cause of the symptoms or may coexist with a bladder tumour. An X-ray examination helps in ruling out other causes of symptoms.
CT scan/MRI: A CT scan or MRI provides better details than an ultrasound exam and may detect smaller tumours in the bladder than cannot be detected by an ultrasound.
Cystoscopy and biopsy: This is probably the single most important investigation for bladder cancer. In some cases, the bladder tumours are missed on imaging investigations (ultrasound/CT/MRI) and urine cytology. Therefore, it is recommended that all patients with bleeding in the urine, without an obvious cause, should have a cystoscopy performed by a urologist as a part of the initial evaluation.
During a cystoscopy, a health care provider passes a thin tube-like optical instrument with a camera and a light source through the urethra into the bladder and the inner surface of the bladder is visualized on a video monitor. Small or flat tumours that may not be visible on other investigations are visible by this method.
The biopsy is collected during the cystoscopy, which is later sent to a laboratory to be examined under a microscope. The tumour cells look different under the microscope than normal cells. This method effectively diagnoses the presence and type of bladder cancer.
Treatment
There are several treatment options for bladder cancer. However, the treatment planning is made based on several factors, including the type of cancer, the grade of the cancer and stage of the cancer.
Surgery: Surgery is performed to remove the cancer cells and there are different types of surgery for bladder cancer surgery.
1. Transurethral resection of bladder tumour (TURBT): During the procedure, a surgeon passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Alternatively, a high-energy laser may be used. There are no incisions or cuts. This procedure is usually followed by a one-time injection of cancer-killing medication into the bladder to destroy the remaining cancer cells.
2. Cystectomy: It is a surgical procedure that removes all (radical cystectomy) or a part (partial cystectomy) of the bladder. In men, radical cystectomy involves the removal of the bladder, prostate and seminal vesicles and in women, radical cystectomy involves the removal of the bladder, uterus, ovaries and a part of the vagina.
When the bladder is removed completely, there needs to be urine diversion or in other words, a new way created for the urine to leave the body. This is when neobladder reconstruction is considered. Neobladder is a reservoir built from a part of the patient’s intestine and attached to the urethra. This neobladder functions almost like the original bladder.
Chemotherapy: Chemotherapy uses drugs to kill cancer cells. Two or more drugs are used in combination to treat bladder cancer. Chemotherapy is either delivered intravenously to kill the remaining cancer cells or directly into the bladder to treat the superficial bladder cancer, where the cancer cells would have affected the bladder lining only.
Radiation therapy: Radiation therapy uses powerful energy beams of powerful energy, such as X-rays and protons, to kill the cancer cells. Radiation therapy is delivered in combination with chemotherapy or surgery for better outcomes.
