Cancer starts when something goes wrong in the process of cells growing and dying and your cells keep making new cells and the old or abnormal ones don’t die when they should. As the cancer cells grow out of control, they can crowd out normal cells. This makes it hard for your body to work the way it should. There are various types of cancer; this blog focuses on bladder cancer. Bladder cancer starts when cells that make up the urinary bladder start to grow out of control.
Men are at a higher risk than women of getting bladder cancer. According to the American Cancer Society, men have an approximately 1 in 26 chance of developing bladder cancer in their lifetime. For women, this chance is about 1 in 86.
What is Bladder Cancer?
Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder. Most bladder cancers are diagnosed at an early stage when the cancer is highly treatable. But even early-stage bladder cancers can come back after successful treatment. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs. Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. Doctors use this information to determine which treatments may work best for you. The prognosis for bladder cancer ranges from good to poor and depends on the stage and grade of cancer.
Types of bladder cancer include:
- Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. Urothelial carcinoma is the most common type of bladder cancer in the United States.
- Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder. It’s rare in the US but more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections.
- Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. It is very rare.
What is the Main Cause of Bladder Cancer?
Bladder cancer begins when cells in the bladder develop changes (mutations) in their DNA. The changes tell the cell to multiply rapidly and to go on living when healthy cells would die. The abnormal cells form a tumor that can invade and destroy normal body tissue. In time, the abnormal cells can break away and spread (metastasize) through the body. It is still unknown that what are the exact bladder cancer causes. It occurs when abnormal cells grow and multiply quickly and uncontrollably, and invade other tissues.
These are the risk factors of developing bladder cancer:
- Exposure to cancer-causing chemicals
- Chronic bladder infections
- Low fluid consumption
- Being white
- Increasing age
- Eating a high-fat diet
- Family history of bladder cancer
- Previous treatment with a chemotherapy drug called Cytoxan
- Previous radiation therapy to treat cancer in the pelvic area
What are the Symptoms of Bladder Cancer?
There are several bladder cancer symptoms like fatigue, weight loss, and bone tenderness, and these can indicate more advanced disease. You should pay particular attention to the following symptoms:
- Blood or blood clots in the urine
- Pain or burning sensation during urination
- Frequent urination
- Feeling the need to urinate many times throughout the night
- Feeling the need to urinate, but not being able to pass urine
- Lower back pain on 1 side of the body
- Urinary incontinence
- Pain in the abdominal area
Your doctor may diagnose bladder cancer using one or more of the following methods:
- a urinalysis
- an internal examination, which involves your doctor inserting gloved fingers into your vagina or rectum to feel for lumps that may indicate a cancerous growth
- a cystoscopy, which involves your doctor inserting a narrow tube that has a small camera on it through your urethra to see inside your bladder
- a biopsy in which your doctor inserts a small tool through your urethra and takes a small sample of tissue from your bladder to test for cancer
- a CT scan to view the bladder
- an intravenous pyelogram (IVP)
Is Cancer of the Bladder Curable?
Bladder cancer is usually treatable when caught at an early stage but more challenging to address when found later. Recurrence also poses a risk, even with early-stage tumors, so regular surveillance is essential following treatment or surgery.
After bladder cancer diagnosis, your doctor will try to determine if it has advanced and if it has, how far. Doctors use a staging process to describe how far the tumor has penetrated the surrounding tissue and muscle, and to what extent it has spread to other parts of the body or metastasized. The staging process helps the doctor decide on the best way to treat it. Understanding the typical survival rates for the stage of cancer you are diagnosed with can help you make more informed decisions around treatment.
Does Bladder Cancer Spread Quickly?
The bladder wall has many layers, made up of different types of cells. Most bladder cancers start in the urothelium or transitional epithelium. This is the inside lining of the bladder. Transitional cell carcinoma (sometimes also called urothelial carcinoma) is cancer that forms in the cells of the urothelium. When bladder cancer spreads, it first invades the bladder wall, which is made up of four distinct layers. It can take some time for cancer to penetrate all of these layers, but once it has, it can then spread into the surrounding fatty tissues and lymph nodes. Over time, cancer may grow outside the bladder into tissues close by and farther away. Cancer may reach the bones, the lungs, or the liver, and other parts of the body.
The bladder cancer stages include:
- Stage 0 bladder cancer hasn’t spread past the lining of the bladder.
- Stage 1 bladder cancer has spread past the lining of the bladder, but it hasn’t reached the layer of muscle in the bladder.
- Stage 2 bladder cancer has spread to the layer of muscle in the bladder.
- Stage 3 bladder cancer has spread into the tissues that surround the bladder.
- Stage 4 bladder cancer has spread past the bladder to the neighboring areas of the body.
What is the Most Common Treatment for Bladder Cancer?
Treatment options for bladder cancer depend on several factors, including the type of cancer, the grade of cancer, and stage of cancer, which are taken into consideration along with your overall health and your treatment preferences. A combination of treatment approaches may be recommended by your doctor and members of your care team.
Bladder cancer surgery
Approaches to bladder cancer surgery might include:
- Transurethral resection of bladder tumor (TURBT). TURBT is a procedure to diagnose bladder cancer and to remove cancers confined to the inner layers of the bladder — those that aren’t yet muscle-invasive cancers. During the procedure, a surgeon passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away cancer. Alternatively, a high-energy laser may be used. As part of the TURBT procedure, your doctor may recommend a one-time injection of cancer-killing medication (chemotherapy) into your bladder to destroy any remaining cancer cells and to prevent cancer from coming back. The medication remains in your bladder for some time and then is drained.
- Cystectomy. Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, your surgeon removes only the portion of the bladder that contains a single cancerous tumor. A radical cystectomy is an operation to remove the entire bladder and the surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, a radical cystectomy may involve the removal of the uterus, ovaries, and part of the vagina. Radical cystectomy can be performed through an incision on the lower portion of the belly or with multiple small incisions using robotic surgery.
- Neobladder reconstruction. After a radical cystectomy, your surgeon must create a new way for urine to leave your body (urinary diversion). One option for urinary diversion is neobladder reconstruction. Your surgeon creates a sphere-shaped reservoir out of a piece of your intestine. This reservoir, often called a neobladder, sits inside your body and is attached to your urethra. The neobladder allows most people to urinate normally.
- Ileal conduit. For this type of urinary diversion, your surgeon creates a tube (ileal conduit) using a piece of your intestine. The tube runs from your ureters, which drain your kidneys, to the outside of your body, where urine empties into a pouch (urostomy bag) you wear on your abdomen.
- Continent urinary reservoir. During this type of urinary diversion procedure, your surgeon uses a section of the intestine to create a small pouch (reservoir) to hold urine, located inside your body. You drain urine from the reservoir through an opening in your abdomen using a catheter a few times each day.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination.
Chemotherapy drugs can be given:
- Through a vein (intravenously): Intravenous chemotherapy is frequently used before bladder removal surgery to increase the chances of curing cancer. Chemotherapy may also be used to kill cancer cells that might remain after surgery.
- Directly into the bladder (intravesical therapy): During intravesical chemotherapy, a tube is passed through your urethra directly to your bladder. The chemotherapy is placed in the bladder for a set period before being drained. It can be used as the primary treatment for superficial bladder cancer, where the cancer cells affect only the lining of the bladder and not the deeper muscle tissue.
Radiation therapy uses beams of powerful energy, such as X-rays and protons, to destroy the cancer cells. Radiation therapy for bladder cancer usually is delivered from a machine that moves around your body, directing the energy beams to precise points. Radiation therapy is sometimes combined with chemotherapy to treat bladder cancer in certain situations, such as when surgery isn’t an option or isn’t desired.
Immunotherapy is a drug treatment that helps your immune system to fight cancer.
Immunotherapy can be given:
- Directly into the bladder (intravesical therapy). Intravesical immunotherapy might be recommended after TURBT for small bladder cancers that haven’t grown into the deeper muscle layers of the bladder. This treatment uses bacillus Calmette-Guerin (BCG), which causes an immune system reaction that directs germ-fighting cells to the bladder.
- Through a vein (intravenously). Immunotherapy can be given intravenously for bladder cancer that’s advanced or that comes back after initial treatment.
Targeted therapy drugs focus on specific weaknesses present within cancer cells. By targeting these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted therapy may be an option for treating advanced bladder cancer when other treatments haven’t helped.
In certain situations, people with muscle-invasive bladder cancer who don’t want to undergo surgery to remove the bladder may consider trying a combination of treatments instead. Known as trimodality therapy, this approach combines TURBT, chemotherapy, and radiation therapy.
Bladder cancer is a life-threatening disease but with treatment, cure and improvement are possible. Hopefully, this article gave you some insight into bladder cancer.
If you want to explore more into the workings of the urinary system you can read I MARRIED A DICK DOCTOR by MEDELINE ZECH RUIZ. This book is engaging and explains understandably the workings of our urinary and sexual organs.