What is the bladder
The urinary bladder is a hollow muscular sac in the pelvis just above and behind the pelvic bone. It has flexible and muscular walls that stretch to contain urine and squeeze it to send it out of the body. Urine is liquid waste made by the pair of kidneys which is then carried to the the bladder by channels called ureters. Urination happens when the muscles in the bladder contract , and the urine is forced out of the bladder through a tube called the urethra.
What is bladder cancer
Bladder cancer occurs when the cells of the bladder begin to grow uncontrolled. As the number of cells increases, they form a tumor and eventually spread to other parts of the body. Read more of the stages of bladder cancer.
The causes of bladder cancer are not definite but genetic history, genetic mutations due to the use of tobacco or exposure to chemicals may be counted as important risk factors. Smokers are more likely to develop bladder cancer than nonsmokers. Other risk factors are:
- Bladder defects at birth
- Side-effects of chemotherapy and radiation therapy
- Chronic bladder infections and irritations
- Exposure to chemicals, including aromatic amines and arsenic in water
- Low fluid consumption
- Family genetic history of bladder cancer
- Being male and white
Types of bladder cancer
There are different types of bladder cancer but the most common are:
Urothelial carcinoma (Transitional cell carcinoma)
This is by far the most common type of bladder cancer. This form starts in the urothelial cells which line the inner lining of the bladder. These cells also line parts of the urinary tract. TCC can occur in the lining of the kidneys and the ureters. Anyone who receives diagnosis of TCC usually undergoes assessment of the whole urinary tract.
TCCs are prominent and are not very quick to spread which depends on whether they remain in the lining of the bladder which is known as the epithelium, or even if they have spread further into the lamina propria or muscle layer. TCCs become harder to treat as they become more obtrusive and they are of two kinds:
- Papillary carcinomas develop as slight projections from the inner surface of the bladder towards the hollow focus. They are non-intrusive papillary malignant growths. The low-grade forms have favorable results with a less probability of danger.
- Level carcinomas develop on the internal layer of the bladder cells and are known as level carcinoma in situ.
There are other less common varieties of bladder cancer and they are as follows:
Squamous cell carcinoma:
About 1 or 2 percent of bladder malignancies are of this type. They occur in the squamous cells, the thin lining cells that usually make up the outside of the skin. The are malignant and intrusive. The lining epithelium of bladder, at places, changes into squamous type in some chronic infections that predisposes to cancer.
Approximately 1 percent of bladder diseases are of this type. They occur in the bodily fluid discharging organs found in the bladder. It resembles colon cancers and most types are intrusive in nature. Sometimes associated with some developmental abnormalities of urinary bladder.
Small cell carcinoma:
Fewer than 1 percent of bladder cancer are of the variety. It originates at the nerve-like cells called neuroendocrine cells. They spread rapidly and require treatment with chemotherapy.
This is the most uncommon variety of bladder cancer that starts in the muscle cell of the bladder.
Symptoms of bladder cancer
Early signs of bladder cancer are to do with the urinary problems. The following are the symptoms of bladder cancer in brief:
- Blood in the urine
- Pain or discomfort during urination
- Frequent urination
- Feeling the need to urinate throughout the night
- Feeling the need to urinate but not being able to pass urine
- Lower back pain on one side of the body
Stages of bladder cancer
If diagnosis is confirmed, further tests are recommended and they include CT and MRI scans, chest X-rays, and bone scans.
Staging determines how far the cancer has spread and the treatment options best to kill cancer cells.
Stage 0: Cancer cells occur on the outer surface of the inner lining of the bladder and it is called ‘carcinoma in situ’
Stage 1: Cancer occurs within the inner lining but has spread to the lamina propria but not to the muscular wall
Stage 2: Cancer has spread to the muscular wall but has not spread from the bladder
Stage 3: Cancer has invaded through the wall to the tissue surrounding the bladder, including potentially the prostate, uterus or vagina or lymphnodes.
Stage 4: Cancer has invaded pelvic bones/ abdominal wall or has spread to other bones or other organs such as the lungs or liver.
Treatment of bladder cancer
The primary treatment modalities for bladder cancer are surgery, chemotherapy, and radiation therapy. These may be combined to treat the tumor more effectively. Treatment also depends on the location and stage of the cancer, the patient’s overall health, age, and preferences.
Surgical treatment for bladder cancer are available at all stages of bladder cancer:
A transurethral resection (TUR) is advised at the initial suspicion of bladder cancer. The surgical knife is inserted in the bladder and the surgeon removes the abnormal tissues and it is subjected for histopathological examination. It provides information about the approximate depth of tumor and helps decision making. Radiation waves are used to kill the remaining cancer cells. Sometimes a surgical procedure to remove the bladder may be required if the tumor do not respond well to radiation or is unlikely to respond. Read more on surgery for bladder cancer.
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 is administered in many cycles, and after a period of treatment, the body is allowed to rest and recover. Read more on chemotherapy in the treatment of bladder cancer.
Radiation uses high energy waves to damage cancer cells and kill them by preventing them from multiplying or dividing. It is a local treatment modality just as surgery is. In recent times, the use of radiation as a solitary procedure has been replaced with it used in combination with chemotherapy which is more effective. Read more on treatment of bladder cancer with radiation therapy.
Follow-up for bladder cancer
Regular monitoring of bladder cancer after treatment regime is finished is important as chances of recurrence is very high. Check-ups need to be one every 3 to 6 months. Sometimes bladder cancer does not go away and becomes chronic.
Diagnosis of bladder cancer
After a review of the symptoms, medical history and a physical examination, the doctor confirms diagnosis with a series of tests and procedures:
A cystoscope is a narrow tube that contains a camera and lighting system that is inserted into the bladder through the urethra under local anesthesia. The doctor examines the inside of the urethra and the bladder using the cystoscope. The device also collects cell samples or a biopsy for testing.
The following imaging tests help confirm diagnosis and determine whether cancer has spread to other parts of the body:
- Pyelogram: This is a contrast dye injected into the bladder either by a vein or by a direct catheter. The dye outlines the bladder and associated organs, making any tumors visible on the X-rays.
- CT scan: This helps determine the shape, size and position of any tumors that might be in the bladder, kidney or ureters.
- Ultrasound and sonography: There determine the size and the spread of the tumor.
The urine is examined to spot traces of cancer cells:
Urine cytology: The sample of the urine is examined but negative results do not always guarantee no cancer.
Urine culture: Urine sample is placed in a growth medium and monitored for signs of bacterial growth. The bacteria can be identified and the diagnosis may show an infection rather than cancer.
Urine tumor marker tests: The urine sample is examined for specific substances that are released by bladder cells; these tests are usually carried out alongside urine cytology.