What is bladder cancer?
Bladder cancer is a type of cancer that begins in the cells of the urinary bladder. It is the most common type of urinary tract cancer, generally affecting older people. This type of cancer typically starts in the lining of the bladder and can spread to surrounding tissues if not detected and treated early.
Causes and Risk Factors of Bladder Cancer
As with many types of cancer, it can be challenging to determine the exact cause of bladder cancer. There are, however, several risk factors that make it more likely to develop. These include:
- Tobacco Use: Smoking is the most significant risk factor. Chemicals in tobacco smoke can be absorbed into the bloodstream and excreted in the urine, exposing the bladder lining to carcinogenic (cancer-causing) substances.
- Chemical Exposure: Prolonged exposure to certain chemicals, such as those found in dyes, paints, and industrial chemicals, may increase the risk. Painters, hairdressers, metalworkers, textile workers, and farmers are professions with high chemical exposure.
- Age and Gender: Bladder cancer is more common in older individuals, with the risk increasing with age. Men are also more likely to develop this type of cancer than women.
- Chronic Bladder Inflammation: Conditions that cause chronic bladder inflammation, such as urinary tract infections and bladder stones, may increase the risk.
- Family History: A family history of bladder or other urinary tract cancers can slightly increase the risk.
- Previous Cancer Treatments: Individuals who have had previous radiation therapy or chemotherapy for other cancers may have a higher risk of developing bladder cancer.
Symptoms of Bladder Cancer
Early detection is essential for successful treatment. There are several symptoms of bladder cancer. However, they are similar to those of other conditions. When any of the following symptoms are present, it does not mean you have cancer, but evaluation by a urologist is essential to determine the exact cause.
- Blood in Urine (Hematuria): This is the most common symptom. Urine may appear pink, red, or dark-colored due to the presence of blood.
- Frequent Urination: An increased need to urinate, often accompanied by discomfort or pain.
- Painful Urination: A burning sensation or pain during urination.
- Back or Pelvic Pain: Pain in the lower back or pelvis can sometimes be associated with advanced cancer that has spread.
- Changes in Urinary Habits: Sudden or unexplained changes in urinary habits, such as urgency or difficulty urinating.
If bladder cancer is suspected based on symptoms or risk factors, several diagnostic tests may be performed:
- Urinalysis: Testing a urine sample for blood, infection, or abnormal cells.
- Cystoscopy: A thin tube with a camera is inserted through the urethra to examine the bladder lining.
- Biopsy: If abnormal tissue is found during cystoscopy, a small sample may be examined under a microscope.
- Imaging Tests: CT scans, MRIs, or ultrasounds may be used to determine the extent of cancer and whether it has spread.
Staging of Bladder Cancer
Staging is done to determine the extent of the cancer, which guides treatment decisions. Bladder cancer is categorized into different stages based on the size of the tumor, its invasion into surrounding tissues, and whether it has spread to nearby lymph nodes or distant organs (metastasized).
The two main types of bladder cancer staging are Non-Muscle Invasive Bladder Cancer (NMIBC) and Muscle Invasive Bladder Cancer (MIBC).
Non-Muscle Invasive Bladder Cancer (NMIBC)
NMIBC refers to early-stage cancer that has not invaded the bladder's muscular wall. It is often found in the innermost layer of the bladder lining (urothelium). NMIBC is further categorized into three stages:
- Ta (Stage 0): Cancer is limited to the innermost layer of the bladder lining. It has not invaded the bladder wall or other tissues.
- T1: Cancer has grown into the connective tissue layer beneath the urothelium but has not reached the muscle layer.
- CIS (Carcinoma In Situ): Also known as flat carcinoma, CIS indicates high-grade cancer that affects a larger area of the bladder lining without invading the deeper layers. It is considered an aggressive form of NMIBC.
Muscle Invasive Bladder Cancer (MIBC)
MIBC is a more advanced stage of cancer where the tumor has penetrated the bladder's muscular wall. It is more likely to spread to nearby lymph nodes and distant organs. MIBC is staged using the TNM system, which stands for Tumor, Node, and Metastasis:
- T2: Cancer has invaded the muscular layer of the bladder wall.
- T3: Cancer has spread to the connective tissue and may involve nearby structures, such as the prostate, uterus, or vagina.
- T4: Cancer has extended to adjacent organs, such as the pelvic wall, prostate, uterus, or abdominal wall.
- N1: Cancer has spread to nearby lymph nodes.
- N2: Cancer has reached the lymph nodes located slightly further away from the bladder.
- M1: Cancer has metastasized to distant organs, such as the lungs, liver, or bones.
Bladder Cancer Treatment
The treatment approach for bladder cancer depends on the cancer stage, overall health, and patient preferences. Common treatment options include:
- Surgery: For early-stage cancers, a transurethral resection of the bladder tumor (TURBT) may be performed to remove the tumor. In more advanced cases, partial or complete bladder removal (cystectomy) may be necessary. If a cystectomy is performed, urine produced by the kidneys is routed through a bag worn outside the body. Sometimes, a new bladder structure can be constructed of out pieces of intestine.
- Chemotherapy: Medications can be administered directly into the bladder (intravesical chemotherapy) or throughout the body (systemic chemotherapy) to destroy cancer cells.
- Radiation Therapy: High-energy rays target and kill cancer cells. This may be used before or after surgery or in cases where surgery isn't an option.
- Immunotherapy: This treatment helps the immune system recognize and attack cancer cells. Bacillus Calmette-Guérin (BCG) is a common immunotherapy used for NMIBC.
- Targeted Therapy: Some drugs are available that target specific molecules involved in cancer growth and progression.
- Clinical Trials: Experimental treatments may be available through clinical trials for patients with advanced or hard-to-treat bladder cancer.
While it's not always possible to prevent bladder cancer, certain lifestyle choices can reduce the risk:
- Quit Smoking: If you smoke, quitting is one of the most effective ways to lower your risk.
- Stay Hydrated: Drinking lots of fluids may help dilute potentially harmful substances in the urine.
- Healthy Diet: A diet rich in fruits, vegetables, and whole grains, and low in processed meats may lower the risk.
- Protect Against Chemical Exposure: If you work with chemicals, follow safety protocols to minimize exposure.
Bladder Cancer Survival Rate
Cancer survival rates are typically reported as 5-year survival rates. This is the percentage of people who are alive five years after diagnosis. It’s important to remember that survival rates are averages. An individual’s survival rate can vary widely based on the type of cancer, stage of cancer, and overall health.
- Localized (Early Stage) Bladder Cancer: The 5-year survival rate for localized cancer (confined to the bladder) is relatively high, ranging from 70% to 90%, depending on the specific stage and grade.
- Regional (Advanced) Bladder Cancer: The 5-year survival rate decreases to around 35% to 60% when this type of cancer has spread to nearby lymph nodes or tissues.
- Metastatic (Advanced) Bladder Cancer: For bladder cancer that has metastasized to distant organs, like the liver or bones, the 5-year survival rate is lower, typically ranging from 5% to 15%.
New treatments and medical care advancements continue to improve, leading to better survival rates. If you or a loved one has been diagnosed with bladder cancer, it’s important to keep in mind that statistics should not be interpreted as absolutes. Each patient's case is unique, and some individuals may exceed the average survival rates.
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