The bladder holds urine from the kidneys and releases it by way of urination. Bladder cancer happens when cells in the bladder start growing out of control.
Bladder cancer is the fourth most common cancer in males and also affects women.
In the year of 2019, the American Cancer Society estimated that about 80,470 people in the United States would be diagnosed with bladder cancer, and around 17,670 would die from it.
Bladder cancer may be either non-cancerous (benign) or cancerous (malignant). Cancerous bladder cancer can be dangerous because it can infect quickly. If not treated, it can harm other parts of the body.
Treatment
Bladder cancer treatment typically involves a combination of methods tailored to the individual’s circumstances. These may include surgery, biological therapy, chemotherapy, and in some cases, radiation therapy. The choice of treatment depends on factors such as the cancer’s place and stage, the patient’s overall health, age, and personal importance.
Surgery
Surgical options vary depending on the extent of the cancer:
Transurethral resection (TUR) is used for early stages (0 and 1), involving the removal of small tumors and abnormal tissue through the bladder.
Cystectomy may be necessary for more advanced cases, where either the entire bladder or cancerous tissue is surgically removed.
Reconstructive surgery can follow a cystectomy to restore urinary function, often using intestinal tissue to create a new bladder or urinary passage.
Biological Therapy
Early-stage bladder cancer may be treated with biological therapy, also known as immunotherapy, which stimulates the immune system to combat cancer cells. Bacillus Calmette–Guerin (BCG) therapy is a common form, involving the introduction of bacteria into the bladder to activate immune cells against cancer. Interferon, another option, boosts immune response and may be used alongside BCG.
Chemotherapy
Chemotherapy employs drugs to destroy cancer cells or shrink tumors, facilitating less invasive surgical procedures. It can be administered intravenously, orally, or directly into the bladder via a catheter next to a TUR. Sometimes, chemotherapy is used before surgery or after surgery to enhance treatment effectiveness.
Radiation Therapy
While less common than other treatments, radiation therapy combined with chemotherapy can be beneficial for bladder cancer that has infiltrated the bladder’s muscular wall, particularly for patients who are not candidates for surgery.
Follow-up Care
Due to its high recurrence risk, bladder cancer often requires ongoing monitoring even after treatment. Regular follow-up visits are recommended to manage and monitor the condition effectively.
Symptoms
Early-stage bladder cancer often presents with the following symptoms:
- Urine contains blood: This is a common early sign, varying from microscopic traces to visibly changing the urine’s color.
- Changes in urination habits: Increased frequency, a hesitant or interrupted flow, and discomfort or burning sensation during urination are common.
As bladder cancer progresses, more advanced symptoms may appear:
- Bone pain
- Backache
- Unexplained weight loss
- Swelling in the feet
- Difficulty urinating
Sometimes these symptoms are similar to the bladder infection. It is crucial to seek medical advice if any symptoms persist or worsen, as early detection and treatment can significantly improve outcomes.
Causes of Bladder Cancer
The exact cause of bladder cancer is not fully understood, but genetic changes, known as mutations, are thought to be involved.
Smoking tobacco and exposure to certain chemicals can cause mutations in the bladder cells, potentially leading to cancer. But these effects can vary from person to person.
While genetics alone are not considered a main reason for bladder cancer, they may influence how the body reacts to tobacco and certain industrial chemicals. This means some individuals may be more susceptible to developing bladder cancer due to genetic factors.
Risk Factors
Scientists have found several factors that can increase the risk of developing bladder cancer. The most significant risk factor is smoking. Persons who smoke have at least 3 times more chances to get bladder cancer than those who don’t smoke.
The bladder cancer risk goes up with age. About 90% of individuals diagnosed with bladder cancer are almost 55 years old, with the average and actual age of identification being 73. Men are more likely to develop bladder cancer than women.
Other Risk Factors Include
- Congenital bladder anomalies: Some people are born with bladder abnormalities that may increase their risk.
- Medical treatments: Previous chemotherapy or radiation therapy can slightly increase the risk.
- Chronic bladder problems: Long-term irritation or infections of the bladder can also raise the risk.
- Environmental exposure: Contact with certain chemicals like arsenic or aromatic amines in drinking water, as well as industrial chemicals used in professions like painting, printing, machine operation, and hairdressing, can contribute to bladder cancer risk.
- Race: White individuals have a higher risk compared to African American and Hispanic individuals.
- Low fluid intake: Not drinking enough fluids may also play a role.
- Family history: Having a close relative who has had bladder cancer increases the risk.
- Certain medications and supplements: Drugs like aristolochic acid and pioglitazone (Actos), found in plants like Dutchman’s pipe or birthwort, used in traditional medicine, may also raise the risk. Aristolochic acid has been linked to kidney problems and cancer over the long term.
Diagnosis
To diagnose bladder cancer, a doctor follows several steps:
Initially, the doctor will inquire about medical history and symptoms, conducting a physical examination to gather information.
Cystoscopy
Using a cystoscope—a slender tube equipped with a camera and light—a doctor can visually examine the urethra and bladder. This procedure typically involves a local anesthetic and can be performed in a physician’s office. If necessary, it may require a general anesthetic and take place in a hospital setting.
Imaging Tests
Various imaging tests aid in confirming the diagnosis and determining the cancer’s extent:
- Pyelogram: Contrast dye injected into the bladder outlines it and nearby organs for X-ray visibility.
- CT Scan: This provides detailed images to assess tumor size, shape, and location.
- Ultrasound: Helps assess tumor size and spread to adjacent organs or tissues.
Urine Tests
Several kinds of urine tests assist in diagnosis:
- Urine Cytology: Examines urine samples for cancer tissues, although a negative outcome does not always rule out cancer.
- Urine Culture: Checks for bacterial growth to eliminate infection alternately cancer.
- Urine Tumor Marker Tests: Identifies specific substances released by bladder cancer cells, often used alongside cytology.
Biopsy
During cystoscopy, samples of bladder tissue may be collected for biopsy to determine if cancer is present and its severity. Biopsies can also be guided by a CT scan or ultrasound using a thin needle to extract tissue samples.
These diagnostic procedures are crucial in accurately diagnosing bladder cancer and determining the appropriate treatment plan based on the cancer’s stage and characteristics.
Preventing Bladder Cancer
Taking steps to reduce exposure to certain risk factors can lower the risk of developing bladder cancer.
Healthy Lifestyle Choices
- Avoiding Smoking: Quitting smoking or never starting can significantly decrease the likelihood of bladder cancer. Smoking is a major risk factor.
- Handling Chemicals Safely: Being cautious around chemicals, whether at work or in daily life, can help reduce exposure to substances known to increase bladder cancer risk.
- Hydration: Drinking plenty of water helps maintain bladder health and may dilute potentially harmful substances in the urine.
- Balanced Diet: Eating various fruits & vegetables provides essential nutrients and antioxidants that support overall health, potentially lowering cancer risk.
By adopting these preventive measures, individuals can take proactive steps to promote bladder health and reduce the risk of developing bladder cancer.
Outlook for Bladder Cancer
As stated by the American Cancer Society (ACS), when bladder cancer is detected early at stage 0, the likelihood of living for at least 5 years after identification is 95%.
However, if the cancer spreads to other areas of the body, successful treatment becomes more challenging. For instance, if diagnosed at stage 4, the 5-year survival rate falls to 15%.
Early detection greatly enhances the chances of successful treatment. Even if bladder cancer is diagnosed at later stages, treatment options are available that can still be effective.
Summary
Bladder cancer begins with uncontrollable cell growth in the bladder lining, often linked to smoking and chemical exposures. Early symptoms include blood in urine and changes in urination patterns. Diagnosis involves tests like cystoscopy and imaging to confirm and stage the cancer.
Treatments range from surgery and chemotherapy to biological therapies like BCG. Risk factors include age, smoking, and genetic predisposition. Prognosis varies: early-stage detection offers a high survival rate, while late-stage diagnoses pose greater challenges but still allow for treatment options.
