Bladder Cancer: The Facts We Need to Know

Sometimes, for whatever reason, the body’s cells grow or change abnormally. In most cases, changes in bladder cells lead to benign (non-cancerous) tumors or common conditions like urinary tract infections (UTIs). On rare occasions, though, these changes result in bladder cancer. Here are some facts you should know if you’ve recently been diagnosed, or you’re worried you might be at risk for developing bladder cancer:

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Types of Bladder Cancer

Urothelial Carcinoma

Urothelial carcinoma starts in the urothelial cells found in the bladder’s lining. Urothelial carcinomas are usually diagnosed early. Approximately 90% of bladder cancers belong to this subgroup.

Squamous Cell Carcinoma

Squamous cell carcinoma can appear anywhere on the body. It’s most common in areas that are repeatedly exposed to UV light (like the sun), but it can also form in the bladder. It occurs when abnormal squamous cells form in the bladder’s lining in response to persistent inflammation or irritation. Approximately 4% of bladder cancers are caused by abnormal squamous cells.

Adenocarcinoma

Adenocarcinoma arises from glandular cells. The body’s mucus-secreting glands are made up of glandular cells, but in adenocarcinoma, the cells are atypical ones that are not normally found in the bladder. Less than 2% of bladder cancers are adenocarcinoma.

Risk Factors for Bladder Cancer

Anyone can develop bladder cancer, but it’s more common in men and is usually diagnosed in people who are aged 65 and over. There are a few factors that increase the likelihood a person will develop bladder cancer, regardless of age or sex:

  • Smoking
  • Having a job that requires exposure to chemicals
  • Suffering from chronic (repeated) bladder irritation
  • Being exposed to radiation, arsenic, or the chemotherapy drug cyclophosphamide

Signs & Symptoms

The signs of bladder cancer aren’t unique to the condition, and they usually indicate something much less serious. If you have some of the symptoms listed below, don’t panic, but seek medical assessment promptly. It’s unlikely you have bladder cancer, but it’s better to be safe than sorry.

  • Frequent urination (needing to urinate more often than usual)
  • Urgent urination (having sudden, intense urges to urinate)
  • Pain or burning while urinating
  • A weak flow of urine
  • Pain in the lower back or pelvis (most often on one side of the body)
  • Blood or blood clots in the urine (hematuria)

Diagnosis

Doctors use a variety of tests to diagnose bladder cancer. Your doctor may use some or all of the diagnostic tests outlined below. They may also use other tests to rule out conditions that have similar symptoms.

  • Urinalysis: The doctor collects a urine sample for assessment under a microscope. The sample is assessed for the presence of abnormal bacteria, blood, or tumor cells.
  • Intravenous pyelogram (IVP): In IVP, a dye is injected into a vein. The dye gradually moves through the urinary tract, and the doctor uses an X-ray or CT scan to highlight abnormal growths in the bladder.
  • Cystoscopy: The doctor uses a small, flexible tube with a light and camera at the end to visually assess the bladder. It sounds invasive, but a cystoscopy is a common and safe procedure. The procedure doesn’t hurt.
  • Biopsy: A biopsy is when a small sample of an abnormal growth or surrounding tissue is collected and sent to a lab for analysis. The biopsy can be done during the cystoscopy. Most often, the doctor uses a technique called transurethral resection of bladder tumor (TURBT) to collect the sample. The TURBT can determine how far into the bladder wall the tumor has grown.

Grading & Staging

Cancer is graded on a scale from one to three. A grade of one indicates that the cancer is low-grade. A grade of three indicates that the cancer is high-grade.

Low-grade cancers are characterized by cells that are abnormal but not arranged much differently than normal cells. Low-grade cancers are considered less severe - they tend to grow and spread more slowly.

High-grade cancers are characterized by cells that are abnormal and are arranged in an erratic or completely random way. High-grade cancers are more severe - they usually grow and spread rapidly.

 

Cancers are staged from zero to four.

  • Stage 0: The tumor is only on the bladder’s lining and hasn’t penetrated deeper. The tumor may be mushroom-shaped or flat.
  • Stage 1: The tumor has spread to the bladder’s connective tissue.
  • Stage 2: The cancer has spread to the bladder’s muscle layer.
  • Stage 3: The tumor has spread to nearby tissues, but not the pelvic or abdominal walls, or the cancer has spread to a pelvic lymph node.
  • Stage 3B: The cancer has spread to more than one pelvic lymph node or one lymph node that’s further away, in a common iliac lymph node.
  • Stage 4A: The tumor has penetrated the pelvic or abdominal walls, or the cancer has spread to lymph nodes that are further away from the bladder than the common iliac lymph nodes.
  • Stage 4B: Metastatic bladder cancer - bladder cancer that has spread to another part of the body.

Treatment

There are different treatments for bladder cancer. The doctor will choose the treatment that’s most likely to result in the best possible outcome depending on the patient, grade, and stage.

  • Immunotherapy: For low-grade bladder cancer, the first line of defense may be an immunotherapy drug. Immunotherapy may also be used in high-grade cancer when chemotherapy isn’t working.
  • Chemotherapy: For low-grade cancer, chemotherapy drugs may be introduced directly into the bladder. For high-grade cancer, chemotherapy is often used alongside radical cystectomy to increase the likelihood of success.
  • Radiation therapy: Radiation therapy uses external radiation to treat bladder cancer. It may be used alone, alongside chemotherapy, or after tumor removal (by TURBT).
  • Surgery: Surgery is the main treatment for bladder cancer. There are four types:
    • Transurethral resection of bladder tumor (TURBT), where the tumor is removed through the urethra. This surgery can only treat low-grade, early-stage cancer that hasn’t spread.
    • Cystectomy, where part or all of the bladder is removed. This surgery is used to treat cancer that has penetrated the bladder’s muscle layer.
    • Pelvic lymph node dissection (PLND), where the pelvic lymph nodes are removed. This procedure is carried out alongside a cystectomy.
    • Urinary diversion with radical cystectomy, where urine is rerouted to exit the body without passing through the bladder, and the bladder is removed entirely.

Outlook

The prognosis for bladder cancer can vary widely. If you’ve been diagnosed with bladder cancer, ask your doctor what you can expect in the future. The outlook depends on the grade, stage, size, location, and type of tumor.

In general, 77% of people will live at least 5 years after they’re diagnosed with bladder cancer. 70% will live at least 10 years, and 65% will live at least 15 years.

*All information acquired from the CCS and Cancer.Net.