Bladder Cancer, as the name suggests, begins in the bladder. A Bladder is a hollow and flexible pouch in your pelvic area that stores urine before it passes out from the body. An individual gets affected by bladder cancer when the cells located inside the bladder grow and multiply uncontrollably and form a tumor. If the growth is not looked after in time, then cancer gets spread to various parts of your body.
Risk factors under your control:
The biggest risk factor for bladder cancer is Smoking, as smokers are 3 times more likely to get bladder cancer than non-smokers. About half of all bladder cancers in men and women are caused due to Smoking.
Bladder Cancer has also been linked with some industrial chemicals. Dye industry chemicals called aromatic amines like benzidine and beta-naphthylamine may cause bladder cancer. People working in other industries who use particular organic chemicals may have more risk of bladder cancer. Industries at higher risk of causing bladder cancer are makers of paint products, printing companies, and makers of rubber, leather, and textiles. Workers who are at an increased risk of developing bladder cancer are printers, painters, machinists, truck drivers as they are exposed to diesel flames, and hairdressers as they have heavy exposure to hair dyes.
According to the US FDA ( Food and Drug Administration), the use of pioglitazone (Actos), the diabetes medicine, is linked with an elevated risk of having bladder cancer. If higher doses are used, then the risk may get higher. There is also an increased risk of urothelial cancers, including bladder cancer, with dietary supplements containing aristolochic acid ( mostly in herbs from the Aristolochia family).
There is also a higher risk of Bladder Cancer as arsenic is present in drinking water in some parts of the world. People can be exposed to arsenic depending on their place and whether the water they are consuming is from a well or from a public water system with arsenic content.
Consuming fewer fluids can lead to bladder cancer, as people who drink more fluids, especially water, have a lower tendency of bladder cancer. This is because their bladder gets emptied more often that keeps chemicals away from lingering in the bladder.
Risk factors out of your control:
Compared to African Americans and Hispanics, White people are twice as likely to develop bladder cancer. There is a slightly lower rate of developing bladder cancer in Asian Americans and American Indians.
As the age increases, so does Bladder cancer's risk, as 9 out of 10 people with bladder cancer are at more than the age of 55.
Men are more likely to get Bladder Cancer as compared to women.
If urinary infections, bladder and kidney stones, or bladder catheters are left as it is for a long time then bladder cancer may develop. Chronic bladder irritation can also lead to bladder cancer, but it is not clear if they are the actual cause of bladder cancer.
Many times, Urothelial carcinomas can form in different areas of the bladder, the lining of the kidney, urethra, and ureters. If you have cancer in the urinary tract's lining, then there is a higher risk of having another cancer, in the same place as before or in another part of the urinary tract. This can happen, even if the previous tumor has been completely removed. This is why people who have bladder cancer need to have a careful follow-up and look out for new cancers.
Belly button and the bladder are connected before birth, known as urachus. This part of the connection could become cancerous if it remains after birth. Cancers that get started in the urachus are mostly adenocarcinoma, which means they are made of cancerous gland cells. More than one-third of the cancer gland cells or adenocarcinoma of the bladder start from urachus. However, this is rare and accounts for less than half of 1% of bladder cancers.
A person’s risk of bladder cancer can also be increased due to a rare birth defect, namely exstrophy. In this condition, the bladder and the abdominal wall in front of the bladder are fused and don’t close completely during foetal development. Due to this, the inner lining of the bladder is exposed outside the body. If surgery is performed right after the birth to close the abdominal wall and the bladder, it can repair it. People who have exstrophy are at higher risk for bladder cancer and urinary infections.
Those people who have a family history of bladder cancer are at a higher risk of having it. This may be because sometimes the family members are exposed to the same chemicals that cause cancer, like tobacco smoke. Family members may also have changes in genes like NAT and GST. Due to these genes, bodies are not able to break down certain toxins, and people are more likely to get bladder cancer.
These are some symptoms or signs that people with bladder cancer may experience. People who have bladder cancer may often not have any of these symptoms, or these symptoms may be present due to different medical conditions other than cancer.
In case you have discolored urine and notice that it may contain blood, then make an appointment with your doctor and get it checked. If you notice other signs or symptoms mentioned above, make sure to make an appointment with your doctor.
Here are the tests and procedures that are mainly used to diagnose bladder cancer:
In this procedure, a scope is used to examine the inside of your bladder. In cystoscopy, the doctor inserts a cystoscope a small narrow tube through your urethra. There is a lens on the cystoscope that allows the doctor to examine structures or growth inside of your urethra and bladder and check signs of any disease. This procedure can be done in the hospital or the doctor’s office.
This procedure involves the removal of a sample of tissue for testing. The doctor may pass a special tool during cystoscopy through the scope into your bladder and collect a cell sample for testing.
The above procedure is sometimes used to treat bladder cancer and is called transurethral resection of bladder tumor.
In this test, a urine sample is examined and analyzed under a microscope to check the cancer cells.
These are the imaging tests that allow the doctor to examine the urinary tract structures. In CT urogram, a contrast dye is injected through the patient's hand vein that flows into kidneys, ureters, and bladder. When the dye is injected, X-Rays taken during this time provide a comprehensive view of the urinary tract, and the doctor can identify the area that might have cancer.
This is an X-Ray exam that is done to get a comprehensive look at the upper urinary tract. In this test, the doctor threads a catheter/thin tube through the urethra in your bladder to insert contrast dye into your ureters. This dye then flows into your kidneys, and X-Ray images are captured.
Once it has been confirmed that the patient has bladder cancer, the doctor may recommend additional tests to find out whether cancer has spread to the lymph nodes or to other areas of your body. Tests may include:
The doctor uses information on these procedures to assign the stage of cancer. Roman numerals indicate bladder cancer stages from 0 to IV. The cancer is confined to the bladder’s inner layers in the lowest stages and has not grown enough to affect the muscular bladder wall. Stage IV is the highest stage that indicates that cancer has spread to the lymph nodes or to other organs in the body's distant areas.
Bladder cancers are also graded based on how the cancer cells appear under a microscope. This classification is known as a grade, and doctors may grade bladder cancer as either high grade or low grade
Low-grade bladder cancer: In this grade of cancer, the cells are more normal in appearance and organization and are well-differentiated. This type of tumor grows more slowly, and there are fewer chances to invade the bladder's muscular wall compared to high-grade tumors.
High-grade bladder cancer: High-grade bladder cancer cells look abnormal and are poorly differentiated. They do not look like normal-appearing tissues. This type of tumor grows more aggressively as compared to low-grade tumors and may spread to the muscular wall of the bladder and other organs and tissues.
Surgery is performed to remove the tumor and some of the surrounding healthy tissues during the operation. There are various types of surgeries done for bladder cancer. Health care teams suggest specific surgeries based on the stage and grade of the disease. Some of the surgical options of treating bladder cancer are
The TURBT procedure is used for diagnosis, staging, and treatment. During this procedure, a cystoscope is inserted by a surgeon through the urethra into the bladder. The tumor is then removed by the surgeon using a laser, or fulguration ( High-energy electricity), or a tool with a small wire loop. Before the process begins, the patient is given anesthesia to block the awareness of pain.
TURBT can eliminate cancer in people who have non-muscle-invasive bladder cancer. To lower the risk of cancer relapse, doctors may also recommend additional treatments, like immunotherapy or intravesical chemotherapy. People who have muscle-invasive bladder cancer may require additional treatments like surgery to remove the bladder, or less commonly the radiation therapy could be recommended.
In Radical cystectomy, there is removing the whole bladder and nearby organs and tissues. In men, there is a possibility that the urethra and prostate may be removed. In women, ovaries, fallopian tubes, uterus, and part of the vagina may be removed. In the case of all patients, lymph nodes in the pelvis are removed, which is known as pelvic lymph node dissection. The most accurate manner to find cancer that has spread to the lymph nodes is an extended pelvic lymph node dissection. In some specific cancers, it can rarely happen that only a part of the bladder is removed, and this is known as a partial cystectomy. For people suffering from muscle-invasive disease, this surgery may not be apt.
Laparoscopy or robotic cystectomy is also performed and in this surgeon makes numerous small cuts or incisions instead of one large incision that is done in traditional surgery. Telescopic equipment is then used with or without robotic assistance to remove the bladder and the surrounding tissue. This type of procedure requires an experienced surgeon who is proficient in minimally invasive surgery. Numerous studies are being performed to determine whether robotic or laparoscopic cystectomy is safe as a standard surgery to eliminate bladder cancer.
after the bladder is removed, the doctors create a new way to pass urine out of the body. The first way of doing this is by using a section of the small intestine or colon to redirect urine to a stoma or ostomy, which is an opening outside of the body. The patient needs to wear a bag attached to the stoma to accumulate and discard the urine.
Many times surgeons use a part of the large or small intestine to create a urinary reservoir, which acts as a storage pouch inside the body. In some patients, The surgeons can connect the pouch with the urethra to create something known as the Indiana pouch or neobladder, which allows the patients to pass the urine out of the body in a normal manner. However, in this case, a thin tube known as a catheter may need to be inserted in case the neobladder is not completely emptied of urine. Patients with neobladder will not get the urge to urinate anymore and have to urinate on a fixed schedule. For some patients, a pouch made of the small intestine is created inside the abdomen internally and is connected to the belly button or abdomen's skin through a small stoma. In this case, patients do not require wearing a bag, and they can drain the internal pouch several times a day by inserting a catheter in a small stoma and removing it immediately.
A patient’s quality of life can get affected when he/she has to live without a bladder. It is important to find treatment so that all or a part of the bladder can be kept. For patients with muscle-invasive bladder cancer, treatment may involve radiation therapy or chemotherapy as a substitute for removing the bladder.
Bladder Cancer is treatable if diagnosed at an early stage but can be challenging to cure if found later. Regular surveillance is important after treatment or surgery as bladder cancer recurrence is risky even with tumors of early stage.
The most important risk factor for bladder cancer is smoking, as smokers are three times more likely to get bladder cancer as compared to non-smokers. Smoking is the cause of about half of bladder cancer in men as well as women.
High-grade bladder cancer can become life-threatening and is likely to grow and spread quickly. This grade of cancer needs to be treated with radiation, surgery, or chemotherapy. Low-grade cancers are usually non-aggressive, and there is a low chance that they can become high-grade.
Blood in the urine may often be misdiagnosed as post-menopausal bleeding, UTI, or cystitis, even after reporting the problem to doctors. This is why bladder cancer may not be diagnosed for years.
There is usually no pain or other symptoms aside from bleeding during the early stage of bladder cancer. However, blood in the urine does not mean there is a tumor in the bladder as less severe conditions like an infection can cause it. Early signs of bladder cancer can be changes in urination.
Bladder cancer usually spreads to the pelvis's lymph nodes surrounding the bladder, known as perivascular lymph nodes. Later, it can spread to lymph nodes close to major blood vessels that go into the legs and pelvis.
If the patients have irritative bladder symptoms, then it is a matter of concern. If the patient faces consistent frequency, pain, and urgency, it must be analyzed. It is important to know that if there is the absence of hematuria, it does not rule out bladder cancer.
Losing weight is a common sign in many types of cancers, including bladder cancer.
Bladder cancer causes lower back pain in a more advanced form. This pain is mostly on one side of the back but maybe located centrally. This pain starts when tumors increase in size or cancer cells start spreading to other parts of the body.
If you are holding urine for extremely long periods, you are prone to urinary tract infections due to bacteria's build-up. This can also increase the risk of kidney disease, and, in rare cases, the risk of bladder bursting can be a deadly condition.
Bladder cancer affects the bladder's lining, which is a hollow organ in the lower abdomen to store urine. There is the growth of cancerous cells in this organ, and they affect the normal function of the bladder and can spread to other surrounding organs.
There is a general 77% 5-year survival rate for people who have bladder cancer. The 10-year survival rate is about 70%, and the 15-year survival rate is 65%. This survival rate depends on factors like stage and type of bladder cancer.
Urologist, Uro Recostructive and Uro Oncosurgeon with 12+ years of experience.