We all have a general idea about the bladder. It is a part of the urinary system. The bladder is a storage organ in the lower abdomen, its job being to store urine till it collects and leaves the body. In order to do this well, it is endowed with muscular walls which can distend and contract as per the needs of the body.
Urine is first made by the kidneys and is then carried to the urinary bladder through thin tubes called the ureters. As you urinate, the muscles in the bladder are made to contract and the urine thus is forced to flow out of the bladder through another connecting tube called the urethra,and then to the outside of the body.
The bladder is a thick-walled organ, consisting of a thick layer of muscle and a thinner inner layer. The inner layer also known as the urothelium consists of multiple layers of cells, called the transitional or urothelial cells.
What are bladder cancers ?
Bladder Cancers are basically tumours of the URINARY BLADDER.
How is a bladder cancer caused ?
Cigarette smoking is the most common known risk factor for bladder cancer. Approximately half the men and about a quarter of women who are diagnosed with bladder cancer have an established history of smoking.
Certain occupations also carry a greater risk for bladder cancer. Industries that use chemicals called arylamines predispose their workers to a greater risk for cancer. These industries include the dyes, textiles, tires, rubber and petroleum industries as well as those of painting and beauty salons.
What are the types of bladder cancers ?
There are several types of cancer that can initiate in the bladder. These include :
- Urothelial Carcinoma or Transitional Cell Carcinoma (TCC): Urothelial carcinoma, otherwise known as the transitional cell carcinoma (TCC), is generally the most common bladder cancer. These cancers start in the innermost lining of the urinary bladder, ie. in the transitional cells or the urothelial cells.
These urothelial cells are seen in most parts of the urinary tract, like the ureters and the urethra as well. Therefore, patients with bladder cancer may sometimes have similar tumours in those places, so the complete urinary tract needs to be checked for these kinds of tumours. - Squamous Cell Carcinoma: This is a far less common variant than the urothelial (transitional cell) cancer. Nearly all squamous cell carcinomas are invasive.
- Adenocarcinoma: This is also a very rare cancer of the bladder. These adenocarcinomas resemble those of the colon. These are also invasive.
- Small Cell Carcinoma: This is extremely rare. They initiate in the neuroendocrine cells. These small cell cancers are known to grow rapidly and need to be treated immediately with chemotherapy.
- Sarcomas: These include the sarcomas of the muscle cells (rhabdomyosarcomas) of the bladder, but they are rare.
How are bladder cancers classified ?
I) Bladder cancers can be divided into INVASIVE & NON-INVASIVE based on their spread into the wall of the bladder.
The first type, that is the non-invasive cancers are still only in the innermost zone of cells but have not yet grown into the deeper layers. In contrast, invasive cancers have grown and invaded into deeper layers of the bladder wall. These cancers spread faster and are therefore, harder to treat. In metastatic cancers, the cancer cells from the main original tumour have spread to other parts of the body and caused secondary tumours.
II) Bladder cancers can be categorized into 2 subtypes, that is PAPILLARY AND FLAT, based on their shape when they grow.
Papillary carcinomas grow in a papillary pattern (slender, finger-like projections from the inner surface of the bladder toward the lumen of the bladder). Papillary tumors often grow toward the central hollow of the bladder instead of growing into the deeper layers of the bladder.
In contrast, flat carcinomas do not spread into the hollow lumen of the bladder. If the flat tumour is confined to the inner layer of bladder cells, it is called a non-invasive flat carcinoma or as a flat carcinoma in situ (CIS).
However, if both a papillary or flat tumour invade the deeper layers of the bladder, it becomes an invasive urothelial (or transitional cell) carcinoma.
What are the clinical features of bladder cancers ?
The first and most common clinical sign of bladder cancer is painless hematuria, that is blood in the urine that can be seen by the patient. The bleeding is often occasional and short-lived rather than consistently present. It can even change the colour of the urine. Sometimes, the bleeding may be minimal or microscopic, (known as microscopic hematuria) and can only be checked by special tests. However, blood in the urine does not necessitate a definitive diagnosis of bladder cancer. Other conditions like kidney stones, urinary tract infections and even blood-thinning medications may cause urinary bleeding. The other symptoms seen may be painful or uncomfortable urination, increased urgency, increased frequency and a constant need to pass urine. These are general symptoms even for urinary tract infections so then antibiotics should be the first and foremost line of treatment. To differentiate between bladder infections and bladder cancers, bacterial urine culture is a must. It is best to go to a urologist for detailed investigations. Advanced Bladder Cancers lead to complete difficulty in passing urine, lower back or abdominal pain, loss of appetite and weight loss and feeling of tiredness or weakness.
How are bladder cancers diagnosed ?
- A complete Physical Examination of the body is mandatory.
- Urinalysis: One way to test for bladder cancer is to check and examine for blood in the urine (called hematuria). This can be tested by a urinalysis, which is a straight forward test to check for blood and other various substances in a urine sample.
- Urine Cytology: In this test, the doctor looks for cancer cells under a microscope in urine.
- Urine tests for Tumour Markers: Tumour markers in the urine like bladder tumour-associated antigen (BTA) and carcinoembryonic antigen (CEA) can point towards bladder cancer.
- Imaging Tests: To determine the exact extent of disease, additional tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These important diagnostic tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans. An urologist can recommend specific radiographic imaging techniques like an intravenous pylegram (IVP) or a CT urogram. In the IVP, dye or contrast media is combined with conventional x-ray technology to assess the urinary tract system for any abnormalities. In the CT urogram, a CT scan with contrast is used to examine the kidneys, ureters, and bladder. This is the recommended procedure nowadays.
- Cystoscopy: Cystoscopy is the best method of assessing the condition of the bladder and the urethra. A device called the cystoscope, a long narrow tube, is put into the urethra. This cystoscope is now flexible, making this diagnostic procedure with little or no discomfort. The urologist can look through the cystoscope, and record the abnormal features. A biopsy can also be performed in the cytoscopy.
- Biopsy : Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a definitive cancer diagnosis.
How are bladder cancers staged ?
Grade and Stage describe the bladder tumour, helping to provide guidance for the urologist in choosing the best treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the further the cancer has grown further away from its starting point in bladder. Grade refers to what the cancer cells look like, and how much they resemble their cell of origin or differentiation. The higher the grade, the more aggressive the tumour is.
How are bladder cancers treated ?
Bladder cancer is highly treatable when found early. Treatment options depend on the type of cancer, staging of the cancer, and its location.
There are four types of standard treatment for Bladder cancer:
- Surgery : surgical treatments for bladder cancer include transurethral resection, that is total removal of the tumour and its adjoining tissue in surgery. In partial cystectomy, only part of the bladder is removed whereas in complete cystectomy, complete bladder as well as affected lymph nodes have to be removed.
- Radiation Therapy : a cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. Radiation can be used on select patients for bladder preservation or in patients with small cell bladder cancers that are sensitive to chemo-radiation. Radiation therapy can be used post surgery to kill any remaining cancer cells.
- Chemotherapy : another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing.
- Immunotherapy or Biological Therapy : Immunotherapy works by utilizing your own body’s immune system to fight cancer cells. This treatment is given through your urethra and straight into the bladder by a small catheter.
What is the care to be taken after the removal of bladder cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans because of the risk of recurrence of bladder cancer. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
How to find and reach cancer specialists for bladder cancer treatment ?
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Find, reach and choose a cancer specialist for bladder cancer treatment on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
