What is Bladder Cancer?
Bladder cancer is a malignancy that originates in the tissues of the bladder, an organ responsible for storing urine before it is excreted from the body. It is one of the most common types of cancer affecting the urinary system. The bladder is a hollow, muscular organ located in the pelvis, and it is lined with a layer of cells known as the urothelium. Bladder cancer typically begins in these urothelial cells and can affect various parts of the bladder.
Types of Bladder Cancer
Bladder cancer can be classified into several types based on the cell of origin and its appearance under the microscope:
- Urothelial Carcinoma (Transitional Cell Carcinoma): This is the most common type of bladder cancer, accounting for about 90% of cases. It originates in the urothelial cells that line the bladder. It can be superficial (confined to the inner lining) or invasive (penetrating deeper into the bladder wall).
- Squamous Cell Carcinoma: This type of bladder cancer starts in the squamous cells, which are thin, flat cells that can form due to chronic irritation or inflammation. It is less common in Western countries but more prevalent in parts of the Middle East and Africa where schistosomiasis (a parasitic infection) is endemic.
- Adenocarcinoma: Adenocarcinoma originates in glandular cells, which are responsible for producing mucus. This type is rare and tends to be more aggressive compared to urothelial carcinoma.
- Small Cell Carcinoma: This is a rare and aggressive form of bladder cancer that resembles small cell lung cancer. It tends to grow and spread rapidly.
- Sarcoma: A very rare type that arises from the connective tissues of the bladder, such as smooth muscle or fibrous tissue.
Causes and Risk Factors
Bladder cancer arises from genetic mutations in bladder cells, but several risk factors can increase the likelihood of developing the disease:
- Tobacco Use: Smoking or using tobacco products is the most significant risk factor for bladder cancer. Carcinogens in tobacco can damage the cells of the bladder lining.
- Chemical Exposure: Occupational exposure to certain chemicals, such as those used in dye, rubber, and textile industries, can increase the risk of bladder cancer.
- Chronic Bladder Irritation: Conditions that cause chronic irritation of the bladder lining, such as recurrent urinary tract infections or bladder stones, may contribute to cancer risk.
- Schistosomiasis: A parasitic infection common in parts of Africa and the Middle East can cause chronic irritation and increase the risk of squamous cell carcinoma of the bladder.
- Age and Gender: Bladder cancer is more common in older adults and is significantly more prevalent in men than women.
- Previous Cancer Treatments: Past treatments for other cancers, such as radiation the*rapy involving the pelvic area, can increase the risk of developing bladder cancer.
- Family History: A family history of bladder cancer can increase an individual’s risk, suggesting a possible genetic predisposition.
Signs & symptoms of Bladder Cancer
- Hematuria (Blood in Urine): The most common symptom, which may be visible (gross hematuria) or detectable only through microscopic examination (microscopic hematuria). The blood can appear as pink, red, or cola-colored urine.
- Frequent Urination: Increased frequency of urination, often accompanied by a sense of urgency.
- Painful Urination: Discomfort or pain during urination, which may be caused by irritation or infection in the bladder.
- Pelvic Pain: Pain or discomfort in the lower abdomen or pelvic area, which can be a sign of advanced disease.
- Back Pain: Persistent pain in the lower back, which may indicate that the cancer has spread beyond the bladder.
- Unexplained Weight Loss: Significant weight loss without a clear reason, which can be associated with cancer progression.
What are the stages of Bladder Cancer
- STAGE 0: Cancer is present in the centre of the bladder.
- STAGE I: Cancer has spread to the inner lining of the bladder.
- STAGE II: The cancer has spread to the connective tissue in the bladder and into the muscle layer of the bladder.
- STAGE III: Cancer is now is present in the fatty tissue that surrounds your bladder & it may also have spread to the prostate, uterus or vagina (for females)
- STAGE IV: The cancer has spread into your pelvic or abdominal wall, to nearby lymph nodes & has spread to distant sites like the bones, liver, or lungs.
Diagnosis of Bladder Cancer
Diagnosing bladder cancer typically involves several steps:
- Medical History and Physical Examination: The doctor reviews the patient’s symptoms and medical history and performs a physical examination to assess signs of disease.
- Urinalysis: A laboratory analysis of urine can reveal the presence of blood or abnormal cells.
- Cystoscopy: A procedure where a thin, flexible tube with a camera (cystoscope) is inserted through the urethra to examine the bladder’s interior and collect tissue samples for biopsy.
- Biopsy: A procedure where a small sample of bladder tissue is removed and examined under a microscope to confirm the presence of cancer and determine its type and grade.
- Imaging Tests: Various imaging techniques, such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI), may be used to assess the extent of the cancer and check for spread to other organs.
Treatment options for Bladder Cancer
Treatment for bladder cancer depends on the type, stage, and location of the cancer, as well as the patient’s overall health:
Surgery:
- Transurethral Resection of Bladder Tumor (TURBT): A procedure to remove tumors from the bladder using a cystoscope.
- Partial Cystectomy: Removal of part of the bladder, often used for localized cancers.
- Radical Cystectomy: Removal of the entire bladder and nearby tissues, often including the prostate or uterus, and sometimes surrounding lymph nodes.
Radiation The*rapy:
High-energy rays are used to target and kill cancer cells, typically used when surgery is not an option or as an adjunct to other treatments.
Chemothe*rapy:
Medications that kill cancer cells or stop their growth, used before surgery to shrink tumors or after to reduce the risk of recurrence.
Immunothe*rapy:
Treatments that stimulate the body’s immune system to attack cancer cells, often used for advanced or recurrent bladder cancer.
Intravesical The*rapy:
Medications are placed directly into the bladder through a catheter to treat superficial bladder cancer and prevent recurrence.