Bladder cancer - Introduction

Before getting into what is bladder cancer, let’s understand the bladder first. The bladder is the hollow flexible organ present in the lower pelvic area of the body. The bladder stores the urine wastes that are produced by the kidneys. Kidneys produce urine, which passes through the ureter tubes and then reaches the bladder. And when you urinate, at that time the bladder forces the urine to move out of the bladder to the urethra tubes. 

Now, coming back to the main topic here, bladder cancer, the cells which form the bladder start growing uncontrollably, turning into tumors. And with time these tumors spread to many other parts of the body, resulting in cancer that is bladder cancer. 

Different types of bladder cancer. 

There are 5 types of bladder cancer. 

Urothelial carcinoma: –

So far, this is the most common type of bladder cancer, in which tumours are formed in the urothelial cell layer by the cancerous cells. The urothelial cell layer is nothing but the inner lining of the bladder. However, urothelial cells are not only found in the bladder but also in the ureter inner line and in the kidneys as well. This is the key reason why the entire urinary tract is screened to find out this type of cancer. Urothelial carcinoma or UCC accounts for nearly 90% of bladder cancers. 

Squamous cell carcinoma: –

Squamous cells are the flat cells that are found on the skin. Squamous cells are seen in the bladder lining and develop because of inflammation and irritation. And over time, these squamous cells become cancerous. This type of bladder cancer accounts for around 4 percent of all bladder cancers. 

Sarcoma: –

Sarcoma is one of the rarest bladder cancers that start forming in the bladder’s muscular cells first. 

Small cell carcinoma: –

This kind of bladder cancer is formed in the nerve-like cells in the bladder. This is also a very rare type of bladder cancer but it grows rapidly and needs immediate treatment starting with chemotherapy. 

Adenocarcinoma: –

This type of cancer is found very rarely and accounts for about 2 percent of all bladder cancers. The cancerous cells of adenocarcinoma develop generally from glandular cells. 

Bladder cancer can be also categorised as – 

Non-invasive: –

This type of bladder cancer includes the non-invasive papillary carcinoma and CIS or Carcinoma in situ. This non-invasive papillary carcinoma is a tumour-like structure that is found on a small area of a tissue that can be easily removed. And this stage is known as the stage Ta. This type of bladder cancer is usually found near the bladder surface that is known as the stage Tis. 

Non-muscle-invasive: –

This type of bladder cancer generally grows into lamina propria instead of growing like a muscle, also known as stage I. Non-invasive-muscle bladder cancer is also known as the superficial cancer. 

Muscle-invasive: –

This type of bladder cancer is the one that has already grown into bladder wall muscle and looks like fatty layers sometimes surrounding the organs or tissues outside the bladder.  

Bladder cancer in men and women

Bladder cancer is one of the most common types of cancer that affects men and DMAB people or people designated male at birth. People DMAB and men are 4 times more likely to acquire this type of cancer as compared to women and people DFAB or people designated female at birth. Both people DFAB and women may sometimes have advanced forms of bladder cancer. According to the BCAN or Bladder Cancer Advocacy Network, it has been found that women do not pay much attention to the blood that comes out with their pee or hematuria, which is the first and one of most noteworthy symptoms of bladder cancer and this is because they generally associate blood coming out with their pee with the other common gynaecological problems. 

Bladder cancer usually affects people who are aged 55 or more. On average, people around 72-73 years old are mostly diagnosed with this type of cancer. In fact, men and DMAB people who are white in complexion are 2 times more likely to get this type of cancer than DMAB people and men who are black. 

Signs and symptoms of bladder cancer 

The most common bladder cancer symptoms and signs are as follows: – 

• Lower back pain
• Urge to urinate frequently but not able to pass the urine
• Blood clots or blood present in the urine
• Feeling like urinating several times during the night time specially
• Burning sensation and pain during urination 
• Having trouble in urinating and having a weak or low urine stream 

These signs and symptoms are mostly caused by a UTI or Urinary track Infection, an overactive bladder, an enlarged prostate in men, or bladder stones. Still, it is necessary to get them checked by a specialist so that the actual reason for the cancer can be found out and treated at the right time. 

Symptoms of advanced or end-stage bladder cancer: – 

Symptoms of fully grown or enlarged bladder cancers that have spread to many other parts of the body already are as follows: –  

• Not being able to urinate
• Loss of appetite
• Weight loss
• Bone pain
• Swelling in the foot
• Feeling weak and tired always
• Lower back pain mostly on one side of the back 

It is not mandatory that if you have these symptoms it means you are having bladder cancer but yes, it is suggested to go and get it checked by a doctor as soon as possible if you face any of these things.   

Causes & Risk Factors of bladder cancer: – 

There are many risk factors that can increase the chances of having bladder cancer. 

• Age: – The risk of acquiring bladder cancer increases as one gets older or you can say with age. Nearly 90 percent of all bladder cancers are seen in senior citizens. But today, there are many advanced options for bladder cancer treatment in elderly people. 
• Gender: – Men are more likely to have bladder cancer than women. 
• Smoking: – Smoking or using tobacco increases the risk of acquiring bladder cancer by three times. Nearly half of the bladder cancers are caused due to smoking. 
• Workplace: – People working in places where chemicals like aromatic amines and dyes are used are at more risk of having bladder cancer. 
• Drinking water having arsenic in it: – Consuming drinking water having arsenic in it increase the chances of having bladder cancer. 
• Drinking less fluid: – Less intake of water can cause toxic chemicals to get deposited in the bladder, increasing the risk of having bladder cancer. 

If you think that you are suffering from any of these risk factors or symptoms then it is suggested to immediately get in touch with the doctor or a urologist more specifically to verify and check whether it is bladder cancer or not. 

Different Bladder Cancer Stages 

There are five different stages of bladder cancer – From stage 0 to stage 4. And the TNM system is basically used for staging bladder cancer. TNM is the abbreviated form of Tumour, Node & Metastasized. In the TNM system of staging, doctors will first see how much the tumour has grown in the bladder, whether the cancer has already spread in the lymph nodes near the bladder, and whether the cancer has already spread to the other parts of the body or not. 

Stage 0 Bladder Cancer: – 

In this stage of bladder cancer, the cancer has just started growing in the centre of the bladder. In this stage, the cancer has not yet reached the muscle walls and tissues of the bladder. 

Stage 1 Bladder Cancer: – 

In stage 1, the bladder cancer has already grown and reached the inner lining of the bladder. But it has not yet reached the lymph nodes or muscle walls near the bladder. 

Stage 2 bladder cancer: – 

The cancer in this stage has already grown through the bladder’s inner tissue and muscle layers. 

Stage 3 bladder cancer: – 

In stage 3 of bladder cancer, the cancer has already spread in the bladder’s fatty tissues and to the outside of the prostate, vagina, or urethra but not to the distant or nearby organs. 

Stage 4 bladder cancer: – 

In stage 4, the bladder cancer has fully grown and spread to the nearby organs and pelvic region. In some cases, the cancer may also get spread to the distant organs like lungs, liver, and bones in this stage.  

The stage of bladder cancer helps in determining the appropriate treatment that should be given to the patient. 

Bladder Cancer Diagnosis

There are various steps for diagnosing bladder cancer. 

Examining urine sample or urinalysis: – 

The urine sample of the patient is collected for checking or diagnosing the presence of the bladder cancer cells in the urine. 

Urine cytology: – 

Urine cytology is the test for examining the urine of the patient for the presence of abnormal cells in the bladder. It is used along with the other tests and examinations for diagnosing bladder cancer or cancer in the urinary tract. If you are facing issues like blood coming out from the urine then the doctor may recommend you the urine cytology test. 

Cystoscopy: – 

In cystoscopy, a narrow tube is inserted with a camera via the urethra. This process enables the doctor to see the inside of the bladder and urethra. 

Biopsy or TURBT that is transurethral resection of a bladder tumour: – 

During cystoscopy, tools are used for removing some samples of the inner lining of the bladder to test for the cancer. This process is also known as the TURBT or transurethral resection of the bladder tumour. TURBT is used for diagnosing bladder cancer and determining the type of tumour and the depth to which the tumour has grown to the inner bladder layers. Any added microscopic cancerous change is also diagnosed in this process and is known as CIS or carcinoma in situ. 

Imaging tests: – 

Different imaging tests are performed like MRI that is Magnetic resonance imaging, PET or Positron emission tomography, CT urogram, X-ray, and bone scan for determining the extent and current state of the bladder cancer. These kinds of tests help doctors in determining the cancer stage and also help to give the appropriate treatment at the right time. 

Treatment of Bladder cancer in India

The treatment that needs to be given to a bladder cancer patient will depend on the current stage of the cancer and the extent to how much it has already spread in the body. In other words, treatment of bladder cancer by stage is given. The different cancer treatments may include chemotherapy, immunotherapy, radiation therapy, targeted drug therapy, and surgery. Here are the treatment options for bladder cancer in India explained in detail. 

Surgery for bladder cancer: – 

The surgery for cancer is performed based on the extent of the spread of the cancer and considering the patient’s health condition. Also, there are different types of surgery for bladder cancer that are performed again based on the same factors. These forms of surgeries include: –

TURBT or the Trans-Urethral Bladder Tumour Resection: –

In this form of surgery, a cystoscopy that is a narrow tube-like structure with a camera and a light is actually inserted straight into the patient’s bladder through the urethra at the time of surgery. And at the end of this cystoscope, there’s a thin wire loop that is attached, which is used for removing the irregular tissues and burning the laser or fulguration that is the high-energy electricity tumour. For TURBT surgery, local anaesthesia is given to the patient and this is commonly suggested to the bladder cancer patients having early stages of non-muscle invasive bladder cancer.

Cystectomy: –

A part of the bladder cancer or the entire bladder cancer is removed in cystectomy. This is given to patients with invasive bladder cancer. Different types of cystectomy are there and are given to bladder cancer patients depending on the extent of cancer.

Radical cystectomy: –

In radical cystectomy surgery, the whole bladder as well as the nearby lymph nodes of the bladder are removed. This process of surgery is performed when the bladder cancer has already penetrated and spreaded in the muscle walls and has grown enough big as well. Well, in males, radical cystectomy involves the removal of the nearby organs during the surgery along with the removal of the seminal and prostrate vesicles. And in case of women, the ovaries, fallopian tubes, and the uterus are removed along with a part of the vagina. Then the surgeon makes another path to pass the urine from the patient’s body.

Partial cystectomy: –

Partial cystectomy is also known as the segmental cystectomy. In this form of bladder cancer surgery, a part of the muscle layer in which the cancer has penetrated along with a part of the bladder is removed. A big advantage of this type of surgery is that once the patient has recovered from this surgery, the patient retains the bladder and is able to urinate normally.

Urinary diversion: –

To create an alternative and reliable way for transferring and storing urine, this reconstructive surgery or urinary diversion is performed. Considering the medical condition of the patient, different forms of diversion operations can be performed like: –

Incontinent diversion: –

In this form of urinary diversion, the surgeon removes a part of the intestine and then connects it to the ureters for creating a passageway to allow the urine to pass out from there out of the body. The urine passes out from this opening known as the stoma, via the skin, in front of the abdomen, via this passageway, and from the kidneys right out of the body. The urine continuously comes out in small amounts and is collected into a small bag that is put over the stoma. There is no regulation put over the urine flow in this form of urinary diversion.

Continent diversion: –

In this approach, part of the large or small intestine is used for creating a pouch that will function in the body as the urinary reservoir. Also, one end of that pouch is seen connected to the stoma. And in that pouch, you can see a valve is produced that allows storage of urine. Most patients prefer this method of urinary diversion as there’s no need for any bag at the outside of the body. And, by inserting the catheter into the stoma, it becomes easy to drain away the urine. 

Neobladder: – 

In this approach, the surgeon creates a neobladder or a new bladder from a part of the intestine and then is attached to the urethra. And this method routes back the urine into the urethra and then restores urination. This helps the patient to normally pass out the urine. 

Bladder cancer Chemotherapy: – 

This treatment option involves the use of medications to kill the bladder cancer cells by not allowing the cells to divide and spread. This process can be performed simultaneously with an anticancer drug and a mixture of many drugs or combined drugs. Chemotherapy for bladder cancer is of two types: –  

• Intravesical chemotherapy: – this process is given to patients having early stages of bladder cancer. It is directly delivered into the bladder by a chemotherapic medication. 
• Systemic chemotherapy: – in this type, medications are given as tablets or are inserted through the muscle or vein from which the medications penetrate the bloodstream to spread all across the body.  

Bladder cancer Radiation therapy: – 

High-energy x-rays are used in this therapy for stopping and destroying the cancer cells from building. There are 2 forms of radiation therapy. 

• External beam therapy: – It is the most preferred radiation therapy that makes use of a system outside the patient’s body for directing radiation directly to bladder cancer. 
• Internal beam radiation therapy or brachytherapy: – This form of radiation therapy involves radioactive implants that are inserted directly into the cancer or near the cancer like seeds, needles, or catheters. 

Radiation therapy on its own or in combination with chemotherapy can be used following the TURBT surgery to kill the residual cancer cells if any or as a part of advanced stage of the pre-treatment of bladder cancer or for alleviating symptoms such as bleeding due to advanced cancer, and pain. 

Bladder cancer Immunotherapy: – 

Immunology is the therapy or treatment in which drugs are given to the patients to help their immune systems to fight the cancerous cells in the bladder. This therapy can be given directly in the veins or into the bladder itself. 

Targeted therapy for bladder cancer: – 

Targeted drugs focus on some specific weak points of the cancerous cells in the bladder and target these cells to make them weak and kill them. This therapy is mainly recommended to patients who are suffering from the advanced stages of bladder cancer and when no other therapy or treatment option can work. 

Though there are no such major side effects of these treatments but still if you are thinking of what can be the bladder cancer treatment side effects, then you can discuss this with your doctor before starting with any of the treatment procedures.