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The bladder is a hollow, triangle-shaped organ that is an important part of the urinary tract and is composed of the kidneys, ureters, and urethra. It plays a vital role in the storage and discharge of urine. The urine enters the bladder through a tube known as the ureter, which is connected to a kidney. This is where urine is produced. Urine exits through a tube known as the urethra when you discharge urine. The urinary tract is made up of all of these organs.

Bladder cancer starts when healthy cells (urothelial cells) in the bladder lining mutate and proliferate uncontrollably, resulting in a tumor. The renal pelvis, ureters, and urethra are lined with urothelial cells. Cancer that develops in the ureters and renal pelvis is also considered a type of urothelial cancer, otherwise known as upper tract urothelial cancer.

Types of Bladder Cancer

Bladder cancers are classified into various types depending on the types of cells that are found in cancer. The types of bladder cancer include,

Transitional cell carcinoma is the common kind of bladder cancer, known as urothelial carcinoma, that develops in the bladder's innermost tissue layer. When the bladder is full, these cells can expand, and when the bladder is empty, it can shrink. There are two grades include:

  • Low-grade transitional cell carcinoma recurs after treatment and rarely spreads into the bladder's muscle layer or other body parts.
  • High-grade transitional cell carcinoma recurs after treatment and often spreads to the bladder's muscle layer, other body parts, and lymph nodes. It causes most bladder cancer deaths.

Squamous cell carcinoma starts in squamous cells are thin, flat cells that line the inside of the bladder. It may develop in people who have long-term bladder infections or irritation.

Adenocarcinoma begins in the glandular cells present in the lining of the bladder. It is a rare type of bladder cancer, accounting for 1% of all bladder cancers.

Small cell carcinoma is an extremely rare type of bladder cancer that starts in neuroendocrine cells, and these cancer cells can grow quickly.

Sarcoma is also very rare that starts in the bladder muscle cells.

Medical professionals categorize bladder cancer as being noninvasive, non-muscle-invasive, or muscle-invasive.

  • Non-invasive bladder cancer may consist of tumors in a small portion of tissue or cancer that is only present on or near the surface of your bladder.
  • Muscle-invasive bladder cancer has spread into the bladder wall muscle and may have also affected tissues on organs outside of the bladder.
  • Non-muscle invasive bladder cancer has progressed beyond the bladder but not to the muscles.

Stages of Bladder Cancer

Stage 0a: This stage of cancer is a noninvasive papillary urothelial carcinoma which is grown in the hollow center of the bladder. It does not invade surrounding lymph nodes or distant areas.

Stage 0is: The cancer is noninvasive carcinoma, also known as flat carcinoma in situ, which is present in the inner lining of the bladder. It has not grown toward the hollow region of the bladder, nor has it invaded the bladder wall's connective tissue or muscle.

Stage I: The tumor has grown into the bladder's inner lining, which has not reached muscle in the bladder wall or lymph nodes, or other distant organs.

Stage II: The tumor has grown into the thick muscle wall of the bladder, but it has not grown to the fatty tissue around the bladder. It has not metastasized to the lymph nodes or other organs.

Stage III A: The tumor has grown or developed into the perivesical tissue or uterus, prostate, or vagina but has not metastasized to the lymph nodes or other distant organs.

Stage III B: The tumor has spread to two or more regional lymph nodes or to the common iliac arteries.

Stage IV A: Cancer has metastasized to the pelvic or the abdominal wall, but it has not spread to other body parts or cancer.

Stage IV B: Cancer has metastasized to other body parts. It may or may not be spread to surrounding lymph nodes.

Causes & Risk Factors of Bladder Cancer

Bladder cancer develops due to changes occurring in the DNA of the bladder cells. These changes or mutations in the DNA cells lead to abnormal proliferation. It is unknown what causes bladder cancer. There are various risk factors for developing bladder cancer which include:

Age: Bladder cancer risk increases with your age. People older than 55 have a higher chance of getting bladder cancer.

Gender: Bladder cancer risk is more prone in men than in women.

Smoking: The major risk factor for bladder cancer is cigarette smoking. When you smoke, your body breaks down hazardous chemicals, and some of them are excreted in your urine. These chemicals may harm your bladder's lining, which could raise your risk of developing bladder cancer.

Exposure to chemicals: Chemicals used in the manufacture of textile, rubber, leather, dye, and paint, raises bladder cancer risk because the kidney filters these harmful chemicals from the bloodstream and moves them to the bladder.

Arsenic exposure: When arsenic is consumed in large amounts, which increases the risk of getting bladder cancer.

Bladder problems: Some bladder problems like kidney and bladder stones, chronic urinary infections, and bladder catheters may increase the risk of bladder cancer. Schistosomiasis infection is caused by a parasitic worm that also increases your chances of developing bladder cancer.

Previous radiation therapy to the pelvis: Individuals who have received radiation therapy to the pelvis may be at a greater risk of acquiring bladder cancer in the future.

Cyclophosphamide use: Bladder cancer is more likely to affect those who have undergone chemotherapy with cyclophosphamide.

Diabetes medication: Bladder cancer risk may be greater for those taking the diabetes medication pioglitazone for longer than a year.

Bladder birth defects: Bladder birth abnormalities may increase the risk of bladder cancer in some individuals. But these issues are uncommon.

Genetic conditions: The following genetic conditions raise your risk of developing bladder cancer includes:

  • Retinoblastoma is mainly caused by a mutation in the RB1 gene, which also raises the risk of bladder cancer and can result in infant eye cancer.
  • Cowden disease is caused by PTEN gene abnormalities, which increases the risk of bladder cancer.
  • Lynch syndrome, which is mostly related to endometrial and colon cancer, is also known as hereditary non-polyposis colorectal cancer. This syndrome may potentially enhance the risk of bladder cancer.

Symptoms of Bladder Cancer

  • Blood in the urine (hematuria)
  • Frequent urination
  • Pain or burning sensation during urination
  • Feeling trouble urinating or having a weak urine stream.
  • Feeling to get up to urinate many times during the night.
  • Urinary incontinence
  • Pain in the abdominal area
  • Back pain

Bladder Cancer Screening

No standard or routine screening tests are suggested for bladder cancer. Hematuria tests have been investigated as a method of screening for bladder cancer. A hematuria test is performed to determine blood in urine by examining it under a microscope or using a special test strip. Cystoscopy and urine cytology are the two tests used to screen for bladder cancer in patients who previously had bladder cancer.

  • Cystoscopy is a procedure that examines the urethra and bladder for abnormalities. A thin, lighted tube (cystoscope) is inserted via the urethra into the bladder, which removes tissue samples.
  • Urine cytology is a lab test examining a urine sample under a microscope for abnormal cells.

Bladder Cancer Diagnosis

A bladder cancer diagnosis is usually made after symptoms appear or if screening tests indicate cancer risk. Various diagnostic procedures and tests for bladder cancer include:

Medical history and physical examination: Your medical professional will check your body to look for general signs of health, such as lumps or anything else that appears unusual. Further, a doctor will record a history of the patient's health habits, diseases, and treatments in the past.

Internal exam: It involves a vaginal or rectum exam. The doctor inserts lubricated, gloved fingers into the vagina or rectum to detect lumps.

Urinalysis: A simple laboratory test to determine the color of urine and its contents, including sugar, protein, and red and white blood cells.

Urine cytology: A laboratory test where a urine sample is examined under a microscope to look for abnormal cells and check for signs of cancer.

Cystoscopy: This is the major test used to detect and diagnose bladder cancer. It allows the medical professional to examine the bladder and urethra to look for abnormalities. A cystoscope (a thin, light-emitting device with a lens) is inserted into the bladder, which removes tissue samples. It might be examined under a microscope for cancer indications.

Transurethral resection of bladder tumor (TURBT) or Biopsy: Medical professionals remove a small amount of tissue and look for cancer indications under a microscope. This surgical procedure is called a biopsy, transurethral bladder tumor resection, or TURBT.

Imaging tests: Various imaging tests are performed to diagnose bladder cancer. Those are:

  • An intravenous pyelogram (IVP), also known as an intravenous urogram (IVU), uses x-rays of the bladder, kidneys, and ureters to determine whether cancer is present in these organs. A contrast dye is injected into a vein. X-rays are taken as the contrast dye passes through the kidneys, ureters, and bladder to detect whether there are any blockages.
  • Computed tomography (CT) scan uses x-rays and computers to produce more accurate cross-sectional images of your body. It can provide extensive information about the size, shape, and location of any tumors in the urinary tract, such as the bladder. It displays enlarged lymph nodes that contain cancer.
  • Magnetic resonance imaging (MRI) scan uses radio waves and strong magnets to create detailed images of the soft tissues in the body. It is extremely useful for detecting cancer that has migrated beyond the bladder into surrounding tissues or lymph nodes.
  • Positron emission tomography (PET) scan: This test produces images of your organs and tissues inside the body. Your doctor may perform a PET scan to look for bladder cancer that has spread.
  • Ultrasound involves using sound waves to create an image of the internal organs. It can help to detect the size of bladder cancer and whether it has spread beyond the bladder to surrounding organs or tissues.
  • A chest x-ray may be performed to determine whether the bladder cancer has spread to the lungs. This test is not required if a chest CT scan has been performed.
  • Bone scans use radioactive material to check for signs of bladder cancer spreading to your bones.

Bladder Cancer Treatment

Depending on the individual's age, type of bladder cancer, the extent (stage) of cancer, overall health, and the patient's preference, the doctor may recommend the treatment options. Surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy are the major treatment types for bladder cancer.

Surgery removes the tumor and some surrounding healthy tissue. There are different types of surgery used for bladder cancer, including:

  • Transurethral resection (TUR) is a procedure where a cystoscope (thin, light tube) is introduced into the bladder through the urethra. It either removes cancer or uses high-energy electricity to burn it away, and this process is known as fulguration.
  • A radical cystectomy removes your entire bladder and nearby tissues and organs. In men, it removes the prostate and seminal vesicles. In women, a radical cystectomy may remove the uterus, ovaries, and part of the vagina.
  • A partial cystectomy removes only the part of the bladder that contains a single cancerous tumor, otherwise known as a segmental cystectomy.
  • Urinary diversion: It is a type of surgery that makes a new way for the body to store and pass urine.
  • Adjuvant therapy: Healthcare Providers may follow surgery with chemotherapy or radiation therapy to kill any cancer cells surgery may have missed. It is known as adjuvant therapy.

Radiation therapy uses high-energy X-rays and protons to damage the DNA of cancer cells and shrink tumors, and this damage inhibits malignant cells from proliferating. In external-beam radiation therapy, radiation is directed at the cancerous part of the body using a machine outside the body.

Chemotherapy uses medications to kill rapidly growing cancer cells and is given through a vein in your arm. It may be given in combination with two or more chemotherapy drugs.

Targeted therapy can identify and target the genes or proteins involved in cancer cell proliferation and multiplication by preventing cancer growth. Some targeted treatments are only effective in patients whose cancer cells have specific genetic mutations.

Immunotherapy uses our disease-fighting immune system to fight cancer. It can identify and destroy any abnormal cells and prevent some cancerous growth.

Bladder Cancer Prognosis

Bladder cancer prognosis depends upon various factors, such as

  • Age
  • Types of bladder cancer
  • Depth of tumor and stage
  • Size and grade of the tumor
  • Number of tumors
  • Recurrence of bladder cancer
  • Lymph or blood vessels with cancer
  • Patient's general and overall health

Prevention of Bladder Cancer

  • Quit smoking habit
  • Avoid or limit chemical exposure
  • Drink plenty of fluids, especially water
  • Eat a healthy diet with vegetables and fruits
  • Report any symptoms to your doctor immediately

Bladder Cancer FAQs

1. Who is most affected by bladder cancer?

Bladder cancer mostly affects older people above 55. Smoking people are also at higher risk of getting bladder cancer.

2. Is stage 2 bladder cancer curable?

Stage 2 bladder cancer has developed into the thick muscle wall of the bladder, but it has not grown to the fatty tissue around the bladder and has not metastasized to the lymph nodes or other organs. Hence, it is often curable.

3. Does my bladder cancer spread quickly?

No, Bladder cancer grows and spreads slowly. Only high-grade bladder cancers spread to the bladder's muscle layer, other body parts, and lymph nodes. It can recur after the treatment.

4. Can a CT scan show my bladder cancer?

Yes, a CT scan uses x-rays and computers to produce more accurate cross-sectional images of your body. It displays the size, shape, and location of any tumors in the urinary tract, such as the bladder.

5. Can bladder cancer return after the removal of the bladder?

Yes, Low-grade bladder cancer usually comes back, and recurrences need to be treated with a technique known as a transurethral resection for bladder tumor, or TURBT. In this procedure, the physician can remove a small amount of tissue and examine it for cancer indications.

6. How do I test for my bladder cancer?

There are several types of diagnostic tests and procedures used to check for bladder cancer after evaluating a patient’s symptoms. Diagnostic tests include urinalysis, urine cytology, imaging tests, and cystoscopy.

7. What is the major cause of bladder cancer?

Smoking is the major risk factor for bladder cancer because tobacco contains cancer-causing (carcinogenic) chemicals. It passes into your bloodstream and is filtered by the kidneys into your urine.


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