Bladder Cancer

Bladder cancer is a relatively rare form of cancer that affects the lining of the bladder. It is characterised by the uncontrolled growth of cells in the bladder, leading to the formation of tumours. While bladder cancer can affect anyone, it is more prevalent in men. It is essential to be aware of the signs and symptoms of bladder cancer, as early detection can significantly improve treatment outcomes. In this article, we will discuss the various aspects of bladder cancer, including its types, symptoms, and treatment options.

What is Bladder Cancer?

Bladder cancer is a type of cancer that originates in the bladder, a hollow organ in the lower abdomen that stores urine. It occurs when cells in the bladder begin to grow abnormally and form tumours. The most common type of bladder cancer is urothelial carcinoma, also known as transitional cell carcinoma, which develops in the urothelial cells lining the inside of the bladder. If left untreated, bladder cancer can spread through the bladder walls to nearby lymph nodes and other organs, such as the bones, lungs, or liver.

There are several types of bladder cancer, each with its characteristics and prognosis. The main types include:

• Transitional cell carcinoma: This is the most common type of bladder cancer. It originates from the urothelial cells that line the inside of the bladder and can also affect other parts of the urinary tract.

• Squamous cell carcinoma: This type of bladder cancer begins in the thin, flat squamous cells that line the bladder. It is often associated with chronic irritation or infection, particularly in regions where schistosomiasis is prevalent.

• Adenocarcinoma: Adenocarcinoma starts in the glandular cells found in the bladder lining. These cells are responsible for producing mucus and other substances.

• Small cell carcinoma of the bladder: This rare type of bladder cancer originates from neuroendocrine cells in the bladder. It is known for its aggressive nature and rapid progression.

• Sarcoma: Although not as common as the other types, sarcomas can also develop in the bladder. They arise from the connective tissue in the bladder wall.

In addition to these types, doctors may also categorise bladder cancer based on its invasiveness:

• Noninvasive bladder cancer: Cancer that has not invaded the bladder wall.

• Non-muscle-invasive bladder cancer: Cancer that has invaded the bladder wall but not reached the muscle layer.

• Muscle-invasive bladder cancer: Cancer that has spread through the lining of the bladder and into the muscle wall of the bladder or beyond it.

The early signs of bladder cancer include:

• Blood in the urine (haematuria)

• Changes in bladder habits (frequent urination, painful urination, and an urgent need to urinate)

• Pelvic pain

• Back pain

• Bone pain

• Difficulty urinating

• Unexplained weight loss

• Swelling in feet

• Loss of apetite

The symptoms of bladder cancer can vary from person to person, and some individuals may not experience any symptoms in the early stages of the disease. Common symptoms of bladder cancer include:

• Blood in urine (haematuria): This can be visible, turning the urine pink, red, or brown, or it may be detected only under a microscope.

• Frequent urination: Patients often report an increased urge to urinate more frequently than usual. This symptom may occur during both day and night, often accompanied by a sense of urgency that can be distressing.

• Painful urination (dysuria): This pain can vary in nature, feeling sharp, burning, or aching, and it may be persistent or intermittent.

• Lower abdominal pain: Discomfort or pain in the lower abdomen or pelvic region is also common. The intensity of this pain can vary, and it may be associated with other urinary symptoms.

• Urinary incontinence: Some individuals experience urinary incontinence, which is the inability to control urination, leading to leakage. This symptom can occur alongside frequent urination or urgency, adding to the distress of the condition.

• Back pain: Pain in the lower back or flank area can also develop as the cancer progresses. This symptom may be caused by tumour growth affecting surrounding structures and can indicate a more advanced stage of the disease.

• Weight loss and fatigue: Unexplained weight loss and persistent fatigue may occur, signalling systemic changes in the body. These symptoms can indicate a more advanced stage of cancer.

• Swelling in the legs or feet: Fluid accumulation leading to swelling in the legs or feet may be observed. This can happen due to lymphatic obstruction or as a result of advanced disease, further complicating the clinical picture.

Bladder cancer is staged based on how far it has spread. The various stages of bladder cancer include:

• Stage 0: Cancer is found only in the bladder lining. Stage 0a indicates non-invasive papillary carcinoma, and stage 0is indicates carcinoma in situ (non-invasive flat carcinoma).

• Stage 1: Cancer has grown to the lamina propria (a layer of tissue just beneath the bladder lining) but not into the muscle layer of the bladder wall.

• Stage 2: Cancer has grown into the muscle layer of the bladder wall but is still confined within the bladder.

• Stage 3: Cancer has grown through the muscle layer of the bladder and into the tissue outside the bladder. Stage 3a indicates that cancer has spread to the fatty tissues surrounding the bladder. Stage 3b indicates that cancer has spread to nearby organs or lymph nodes.

• Stage 4: Cancer has spread to distant parts of the body (metastasised). Stage 4a indicates that cancer has spread to the lymph nodes above the pelvis or to distant parts of the body. Stage 4b indicates more widespread metastasis.

Bladder cancer develops when there are abnormal changes in the cells lining the bladder. These changes can be caused by various factors, including:

• Genetic mutations: Alterations in the DNA of bladder cells can lead to uncontrolled cell growth, resulting in the formation of tumours.

• Exposure to harmful chemicals: Contact with certain chemicals at work or home, such as those used in the dye, rubber, and paint industries, may increase the risk of developing bladder cancer.

• Smoking: Cigarette smoking is a significant risk factor for bladder cancer. Smokers are three times more likely to develop bladder cancer compared to non-smokers.

• Chronic bladder irritation: Long-term irritation of the bladder lining, caused by conditions such as recurrent urinary tract infections, bladder stones, or long-term catheter use, may increase the risk of bladder cancer.

• Age: The risk of bladder cancer increases with age, with most cases occurring in people over 60 years old.

Several factors can increase the risk of developing bladder cancer, including:

• Smoking

• Exposure to certain chemicals (such as dye, rubber, leather, textile, and paint industries)

• Age (over 60 years)

• Gender (more common in men)

• Family history

• Chronic bladder irritation (conditions that cause long-term irritation of the bladder lining, such as recurrent urinary tract infections, bladder stones, or long-term catheter use)

• Previous radiation therapy to the pelvic area

• Certain medications (e.g., cyclophosphamide, pioglitazone)

• Exposure to arsenic in drinking water

• Low fluid consumption

Bladder cancer and its treatment can lead to various complications that may affect a patient's quality of life. Some of the most common complications include:

• Urinary incontinence: Surgery to remove the bladder (cystectomy) can lead to urinary incontinence, which is the inability to control urine flow. Patients may need to use a urostomy bag or undergo reconstructive surgery to create a new way for urine to exit the body.

• Sexual dysfunction: Surgery, radiation therapy, and chemotherapy can all cause sexual dysfunction in both men and women. Men may experience erectile dysfunction, while women may experience vaginal dryness, pain during intercourse, or reduced libido.

• Recurrence: Bladder cancer has a high recurrence rate, even after successful treatment. Regular follow-up care is essential to detect and treat any recurrences early.

• Metastasis: Advanced bladder cancer can spread (metastasise) to other parts of the body, such as the lymph nodes, bones, lungs, or liver. Metastatic bladder cancer is more challenging to treat and can lead to additional complications.

• Emotional distress: Dealing with a cancer diagnosis, treatment side effects, and lifestyle changes can cause significant emotional distress for patients and their loved ones.

While not all cases of bladder cancer can be prevented, certain lifestyle choices and preventive measures can help reduce the risk. Here are key strategies to consider:

• Avoid tobacco products: Quitting smoking and avoiding tobacco in all forms is one of the most effective ways to reduce the risk of bladder cancer. Tobacco contains harmful chemicals that can damage the bladder lining and increase cancer risk.

• Stay hydrated: Drinking plenty of fluids, especially water, helps dilute harmful substances in the urine and promotes regular urination. This can reduce the time that potential carcinogens are in contact with the bladder lining.

• Maintain a healthy diet: A diet rich in fruits, vegetables, and whole grains may lower cancer risk. Foods high in antioxidants, such as berries and leafy greens, can help combat oxidative stress and inflammation.

• Limit exposure to chemicals: Reducing exposure to certain industrial chemicals, such as aniline dyes and other aromatic amines, can lower risk. If you work in industries that use these substances, follow safety protocols and wear protective gear.

• Regular exercise: Engaging in regular physical activity can help maintain a healthy weight and improve overall health. Obesity has been linked to an increased risk of several types of cancer, including bladder cancer.

• Manage chronic conditions: If you have conditions such as diabetes or chronic bladder infections, work with your doctor to manage them effectively. Keeping these conditions under control may help lower cancer risk.

• Consider regular check-ups: For individuals at higher risk, such as those with a history of bladder cancer or significant exposure to risk factors, regular check-ups and screenings can aid in early detection and prevention strategies.

• Limit alcohol consumption: Excessive alcohol intake has been associated with an increased risk of several cancers. Limiting alcohol consumption may help reduce bladder cancer risk.

Diagnosing bladder cancer involves a comprehensive approach that includes a thorough medical history, physical examinations, and a variety of diagnostic tests. These include:

• Medical history and physical examination: The doctor will enquire about symptoms such as blood in urine, urinary frequency, and any relevant risk factors, including smoking history and exposure to chemicals. The physical exam may focus on the abdomen and pelvic area to identify any abnormalities.

• Urinalysis: Urinalysis is a preliminary test that analyses a urine sample for the presence of blood, abnormal cells, or other substances indicative of cancer. Haematuria, or blood in urine, is a common sign of bladder cancer and can prompt further investigation.

• Cystoscopy: Cystoscopy is a critical diagnostic procedure involving the insertion of a thin, flexible tube equipped with a camera (cystoscope) into the bladder through the urethra. This allows the doctor to directly visualise the bladder lining and identify any tumours or abnormalities.

• Ultrasound: Ultrasound uses sound waves to create images of the bladder. It can help detect any abnormalities, including tumours or other issues affecting the bladder.

• Computed tomography (CT) scan: A CT scan provides detailed cross-sectional images of the bladder and surrounding organs. This imaging technique can help identify the presence of tumours and assess their size and extent.

• Magnetic resonance imaging (MRI): MRI offers high-resolution images and is particularly useful in evaluating the extent of the cancer and its impact on nearby tissues. It helps in staging the cancer and planning treatment.

• Biopsy: If abnormal cells are found during cystoscopy, a biopsy may be performed. This involves taking a small tissue sample from the bladder lining, which is then examined under a microscope to determine if cancer cells are present and to assess the type and grade of cancer.

• Urinary cytology: Urinary cytology involves examining urine for the presence of cancer cells. A urine sample is analysed to identify abnormal cells that may indicate bladder cancer.

• Fluorescence in situ hybridisation (FISH): FISH tests for specific genetic changes in cells from urine samples. It helps identify chromosomal abnormalities associated with bladder cancer, aiding in diagnosis and risk assessment.

• NMP22 test: The NMP22 test detects elevated levels of the nuclear matrix protein NMP22 in urine, which may indicate bladder cancer. This non-invasive test can be useful for early detection.

The treatment and management of bladder cancer depend on several factors, including the cancer’s stage, grade, and the patient’s overall health. Some of the common treatment options include:

• Transurethral resection of bladder tumour (TURBT): TURBT is often the first treatment for non-muscle invasive bladder cancer. It involves using a cystoscope to remove tumours from the bladder wall. This procedure can also help with diagnosis by obtaining tissue samples for further analysis.

• Cystectomy: In more advanced cases or for muscle-invasive bladder cancer, a partial or radical cystectomy may be necessary. A partial cystectomy involves removing only the affected part of the bladder, while a radical cystectomy removes the entire bladder along with surrounding lymph nodes and tissues.

• Immunotherapy: Bacillus Calmette-Guérin (BCG) is an immunotherapy treatment that stimulates the immune system to attack cancer cells. It is often used after TURBT to reduce the risk of recurrence in non-muscle-invasive bladder cancer.

• Chemotherapy: Chemotherapy medications can be administered directly into the bladder to kill cancer cells. This method is also used to reduce the risk of recurrence after TURBT. For muscle-invasive or advanced bladder cancer, systemic chemotherapy may be recommended. This treatment involves the use of medications that circulate throughout the body to target cancer cells.

• Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. It can be employed as a primary treatment for patients who cannot undergo surgery, or it may be used post-surgery to target residual cancer.

• Targeted therapy: Targeted therapy focusses on specific characteristics of cancer cells. For instance, some treatments target genetic mutations or proteins that contribute to cancer growth. These therapies are generally used for advanced bladder cancer and may be combined with other treatments.

Living with bladder cancer involves several challenges and adjustments, but with the right support and strategies, patients can manage their condition effectively. Here are a few points to consider:

• Patients may experience physical changes such as urinary symptoms, including blood in the urine, increased frequency, and urgency of urination. Talking to your doctor and seeking support from family and friends can help navigate these challenges.

• For those who undergo urostomy surgery, adjusting to a stoma and urostomy bag takes time. Support from healthcare teams and family members is crucial during this period.

• Learning to use a catheter and managing incontinence or bladder control issues can be challenging but manageable with the right resources.

• Treatments for bladder cancer can also cause sexual problems, such as erectile dysfunction in men and pain during sex or lubrication issues in women. Discussing these concerns with your doctor before treatment can help in planning appropriate care.

If you suspect you might have bladder cancer or are experiencing symptoms, it is crucial to see a doctor promptly. Key signs that warrant immediate medical attention include blood in the urine, increased frequency and urgency of urination, and frequent urination at night, especially if these symptoms are accompanied by other signs such as pain or discomfort. Early detection of bladder cancer symptoms is essential for successful treatment and improved bladder cancer survival rates.

• Bladder cancer is a serious condition that affects the cells lining the bladder, with urothelial carcinoma being the most common type.

• Early signs of bladder cancer include blood in the urine, frequent urination, painful urination, and back pain.

• Risk factors for developing bladder cancer include smoking, exposure to certain chemicals, chronic bladder inflammation, and a family history of the disease.

• Bladder cancer treatment depends on the stage and grade of the cancer, and may include surgery, chemotherapy, immunotherapy, and radiation therapy.

• Living with bladder cancer involves managing physical changes, emotional challenges, social adjustments, and financial considerations.

• Prompt medical attention is crucial if you experience symptoms that could indicate bladder cancer, as early detection significantly improves treatment outcomes and survival rates.