Bladder cancer: Causes, symptoms, and treatment

In bladder cancer, cancerous cells develop in the organ that collects urine from the kidneys before eliminating it from the body through urination.

Bladder cancer is the fourth most prevalent cancer in men. Men have a 1 in 27 chance of developing it. Women have a 1 in 89 chance of getting it. The numbers of cases affecting men have been stable in recent years, but those affecting women have fallen.

In 2018, the American Cancer Society expects that there will be around 81,190 new cases and 17,240 deaths from bladder cancer. Of these, 72 percent will be men.

Bladder cancer happens when abnormal cells develop in the bladder. They can be benign or malignant. Malignant cancers can be life-threatening as they can spread quickly. Untreated, they can damage tissues and organs and spread to other parts of the body.

Advances in science and medicine, however, mean that effective treatment is possible, especially if a diagnosis occurs in the early stages.

Fast facts on bladder cancer

Here are some key points about bladder cancer. More detail is in the main article.

Around 90 percent of people who receive a diagnosis of bladder cancer are aged over 55 years.

Smokers are around three times more likely to develop bladder cancer than non-smokers.

Symptoms may be similar to those of less severe illnesses, such as a bladder infection.

Half of all cases are found when the cancer is still only in the bladder, but 4 percent of diagnoses are made after bladder cancer has spread to distant tissues.

Treatment includes surgery, chemotherapy, immunotherapy, and radiation therapy, alone or in combination.

Some lifestyle factors can reduce the risk of developing bladder cancer.

What is bladder cancer?

Urine sample
Blood in the urine is the most common symptom of bladder cancer.

Bladder cancer usually starts in the transitional epithelium, the cells that line the bladder.

Around half of all cases are diagnosed at an early stage, when the cancer is highly treatable. Without treatment, however, it can be life-threatening.

The risk of bladder cancer increases with age, and around 90 percent of people who receive a diagnosis are aged over 55 years. The average age at diagnosis is 73 years.

There are different types of bladder cancer, but most cases are urothelial, or transitional cell carcinoma (TCC).

Transitional cell carcinoma

Most bladder cancers are transitional cell carcinoma (TCC). This form starts in the urothelial cells, which line the inside of the bladder.

These cells also line other parts of the urinary tract, so TCC can also occur in the lining of the kidneys and the ureters, too. Anyone who receives a diagnosis of TCC will usually undergo an assessment of the whole urinary tract.

TCCs can be invasive or non-invasive, depending on whether they remain in the lining of the bladder, known as the epithelium, or if they have spread deeper into the lamina propria or muscle layer.

The more invasive the cancer, the harder it is to treat.

TCCs are further divided into two types:

Papillary carcinomas: These grow in thin projections from the inner surface of the bladder toward the hollow center. They are non-invasive papillary cancers. Very low-grade, non-invasive types tend to have a very good outcome, as they have a low likelihood of malignancy.

Flat carcinomas: These do not grow toward the hollow part of the bladder. If they remain in the inner layer of bladder cells, they are known as a non-invasive flat carcinoma or a flat carcinoma in situ (CIS).

Other types

Several other types of cancer that can start in the bladder. They are all much less common than TCC.

They include:

Squamous cell carcinoma: About 1 to 2 percent of bladder cancers are of this type. It occurs in the squamous cells, the thin, flat cells like those that make up the surface of the skin. Most squamous cell cancers are invasive.

Adenocarcinoma: About 1 percent of bladder cancers are of this time. It occurs in the cells of the mucus-secreting glands found in the bladder. It has similarities to colon cancer. Most adenocarcinomas of the bladder are invasive.

Small cell carcinoma: Fewer than 1 percent of bladder cancers are of this type. It starts in the nerve-like cells called neuroendocrine cells. This form often grows quickly and requires treatment with chemotherapy.

Sarcoma: This is a rare form of bladder cancer that originates in the muscle cells of the bladder.

Treatment

The main forms of treatment for bladder cancer are surgery, chemotherapy, biological therapy, and radiation therapy. A combination may be used.

Treatment will depend on the location and stage of the cancer, the patient’s overall health, age, preferences, and their support system.

Surgery

Surgical options are available for all stages of the disease.

A transurethral resection (TUR) can treat stage 0 and 1 bladder cancer. A cutting tool is inserted into the bladder, and the surgeon removes small tumors and abnormal tissue and burns away any remaining cancerous cells.

If the cancer is larger or has spread deeper into the bladder, a form of cystectomy can be carried out. A partial cystectomy removes the portion of the bladder that contains cancer cells.

A radical cystectomy will remove the entire bladder and possibly the surrounding lymph nodes, the prostate and seminal vesicles, and the uterus, ovaries, and part of the vagina.

Reconstructive surgery will be needed to provide a new way for the body to store and remove urine.

A piece of the intestine may be used to create one of the following:

A urinary conduit, a tube to take the urine from the kidneys to a pouch (urostomy bag) on the outside of the body

A cutaneous continent urinary diversion, a small reservoir for urine that can be drained through a hole in the abdomen using a catheter

A neobladder, a reservoir that is attached to the urethra, allowing normal urination, possibly with the help of a catheter.

Chemotherapy

chemotherapy room
Chemotherapy is a method of using drugs to kill cancer cells, or to shrink tumors so that they can be operated on with less invasive surgery.

Chemotherapy uses drugs to target and kill cancer cells or to shrink tumors so that they can be operated on with less invasive surgery. It can be used to treat cancer before or after surgery, and the drugs can be administered orally, intravenously or into the bladder with a catheter (following a TUR).

Chemotherapy is normally given in cycles, and after each period of treatment there is a period of rest to allow the body time to recover.

However, chemotherapy and affect other cells in the body, leading to several side effects.

These include:

nausea and vomiting

constipation or diarrhea

fatigue

increased bleeding or bruising

increased risk of infection

loss of appetite

hair loss

mouth sores

The effects depend on the quantity of drugs used and how they are taken. If administered directly to the bladder, the side effects are usually milder. Side effects normally resolve once a course of treatment has finished.

Biological therapy

Early-stage cancer can be treated by encouraging the immune system to fight the cancer cells. This is known as biological therapy or immunotherapy.

The most common form of biological therapy is Bacillus Calmette-Guerin therapy (BCG). This bacterium is related to the bacterium that causes tuberculosis (TB). In BCG therapy, a catheter is used to insert this bacterium into the bladder.

The bacterium attracts and activates immune system cells, which are then able to fight any bladder cancer cells that are present. This treatment is normally given once a week for 6 weeks. It often begins shortly carrying out a TUR.

The side effects of BCG can be similar to those caused by flu. They include fever, fatigue, and a burning sensation in the bladder.

Interferon is another biological therapy option. The immune system makes this protein to fight infection, and a synthetic version can be used to fight bladder cancer, sometimes in combination with BCG.

In 2014, a study published in Nature showed how an antibody drug, atezolizumab (Tecentriq) can make it easier for the immune system to find and destroy cancer cells. In 2016, was approved as a therapy by the US Food and Drug Administration (FDA).

Radiation therapy

Radiation therapy is used but less frequently than other treatments. It is often used alongside chemotherapy. Radiation therapy can help kill cancer that has invaded the muscular wall of the bladder. It may be helpful for people who cannot have surgery.

External beam radiation therapy focuses high-energy radiation from a source outside the body on the cancer. The treatment usually consists of short, 30-minute sessions, 5 days a week for several weeks.

Side effects depend on the dosage and the area targeted by the beams.

Symptoms include:

bladder symptoms, such as discomfort, frequency, or blood in the urine

diarrhea

fatigue

nausea and vomiting

skin irritation in the targeted areas

Follow-up

If bladder cancer occurs once, there is a high risk that is will come back, so regular monitoring is usually recommended every 3 to 6 months.

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