Urinary bladder cancer is an uncontrolled malignant tumor growth arising from the urinary bladder. The urinary bladder is an organ whose main function is the storage of urine before it is expelled from the body.
we are going to understand the causes, symptoms, various diagnostic modalities, and treatment options for early detection, implement prevention measures and better treatment for achieving optimal results from the urinary bladder cancer.
Urinary Bladder Cancer Causes
Urinary bladder is occurs due to interplay of multiple factors involving in causing cancer. Understanding these factors can make an individual to assess his/her risk and take preventive measure to reduce the risk of catching up with the deadly disease.
The main factors for increasing risk of bladder cancer are:
Tobacco Use: Tobacco intake is the most significant risk factor for causing urinary bladder cancer. Chemicals present in tobacco smoke, such as aromatic amines and polycyclic aromatic hydrocarbons (PAHs), can enter the bloodstream and concentrate in the urine, leading to cellular changes in the bladder lining that increase cancer risk.
Occupational Exposures: Prolonged exposure to certain chemicals and carcinogens in the workplace can increase the risk of bladder cancer. Industries such as dye manufacturing, rubber production, leather processing, painting, and chemical manufacturing expose workers to chemicals like aromatic amines, benzidine, naphthylamine, and arsenic, which are known bladder carcinogens.
Age: Bladder cancer risk increases with age, with the majority of cases diagnosed in individuals over the age of 55. Advanced age is often associated with cumulative exposure to carcinogens and changes in cellular repair mechanisms.
Gender: Men are more likely to develop bladder cancer than women, with higher incidence rates reported globally. This difference in risk is partly attributed to higher rates of tobacco use and occupational exposures among men.
Family History and Genetics: Individuals with a family history of bladder cancer have an increased risk of developing the disease. Specific genetic factors and inherited gene mutations, such as alterations in the FGFR3 gene or Lynch syndrome (hereditary nonpolyposis colorectal cancer), can also contribute to bladder cancer risk.
Chronic Bladder Inflammation: Chronic bladder inflammation or irritation due to recurrent urinary tract infections, bladder stones, indwelling catheters, or other causes may increase the risk of developing bladder cancer over time. Inflammation can lead to cellular changes and DNA damage in the bladder lining.
Previous Cancer Treatments: Individuals who have undergone radiation therapy or certain chemotherapy agents for previous cancers, such as pelvic radiation for prostate cancer or chemotherapy with cyclophosphamide, may have an increased risk of developing bladder cancer as a late effect of treatment.
Exposure to Aristolochic Acid: Consumption of herbal remedies or traditional medicines containing aristolochic acid, a potent carcinogen, has been linked to an increased risk of developing urinary tract cancers, including bladder cancer.
Arsenic Exposure: Chronic ingestion of water or food contaminated with high levels of arsenic, often due to environmental pollution or contaminated water sources, is associated with an elevated risk of bladder cancer.
Chronic Bladder Irritants: Long-term exposure to certain chemicals, dyes, solvents, and industrial compounds in the environment or workplace settings may irritate the bladder lining and increase cancer risk.
If any of the factors cannot be removed, or if the risk is high, then a person should consult the healthcare physician to undergo regular screening to detect the cancer in the earliest stage possible.
Next we’ll understand about the various signs and symptoms associated with the disease.
Urinary bladder Symptoms
Symptoms from cancer of urinary bladder from mild and often undetectable symptoms in early disease to severe, crippling in the late stages depending on the organs involved by the cancer.
Early Stage (Stage 0 and Stage I):
- Blood in the urine (hematuria) is the most common early symptom, although it may not always be visible to the naked eye and may require microscopic examination of urine.
- Changes in urinary habits, such as increased frequency of urination or urgency.
- Painful urination (dysuria) or discomfort during urination.
Intermediate Stage (Stage II and Stage III):
- Persistent or recurrent blood in the urine, which may be visible.
- Increased urinary urgency and frequency.
- Pain or burning sensation during urination.
- Pelvic or back pain, especially if the cancer has invaded nearby tissues or organs.
Advanced Stage (Stage IV):
- Severe or continuous hematuria.
- Pelvic or lower back pain that may be persistent and worsen over time.
- Inability to urinate or significant changes in urinary habits.
- Swelling in the legs (edema) due to lymphatic obstruction caused by cancer spread.
- Weight loss, fatigue, and generalized weakness.
- Bone pain, indicating possible spread (metastasis) of cancer to bones.
- Abdominal pain or swelling if cancer has spread to nearby organs such as the liver or intestines.
- Anemia and associated symptoms like weakness, paleness, and shortness of breath in severe cases.
These signs and symptoms although consistent with cancer, may not be specific for it. These may be seen in other conditions associated with urinary bladder or other medical conditions. Consult your doctor to get yourself checked in case you develop any such symptoms.
Various tests done to diagnose the disease and later stage the cancer are described in the next paragraph.
Urinary bladder Cancer Diagnosis
here we are going to understand about various testing options used to detect and stage the disease. These are a battery of test and all the test may not be required in every individual patient. Your doctor will prescribe tests based on your condition and symptoms of the disease.
A thorough medical history and physical examination are conducted initially, followed by urine tests to check for the presence of blood or abnormal cells.
Imaging studies such as ultrasound, CT scans, or MRI scans provide detailed images of the bladder and surrounding structures to assess tumor size and spread.
Cystoscopy is a key diagnostic procedure where a thin, flexible tube with a camera (cystoscope) is inserted into the bladder through the urethra to visualize the bladder lining and obtain tissue samples (biopsy) for further analysis.
Urinary Bladder Cancer Treatment
Treatment options differs based on the stage of cancer, general health condition of the patient and also on preference of the patient for one or other therapy. Surgery is usually the mainstay of treatment. Bladder conservation by both non-surgical or by surgical options are preferred as they maintain the normal urinary void mechanisms.
various treatment modalities for treatment of disease focussing on bladder conservation/preservation are:
Transurethral Resection of Bladder Tumor (TURBT):
- TURBT is a common initial treatment for early-stage bladder cancer (non-muscle invasive bladder cancer, NMIBC).
- During TURBT, a cystoscope is inserted through the urethra to remove cancerous tissue from the bladder lining using a special wire loop or laser.
- This procedure helps in diagnosing the extent of cancer (staging) and may also be therapeutic by removing visible tumors.
Intravesical Therapy:
- Following TURBT, intravesical therapy involves instilling medications directly into the bladder to destroy remaining cancer cells and reduce the risk of cancer recurrence.
- Immunotherapy: Bacillus Calmette-Guérin (BCG) therapy is a common immunotherapy used for high-risk NMIBC. BCG stimulates the immune system to attack and destroy cancer cells in the bladder lining.
- Chemotherapy: Intravesical chemotherapy using drugs like mitomycin C or gemcitabine may also be used, especially in patients who cannot tolerate BCG therapy.
Partial Cystectomy:
- In selected cases of localized bladder cancer where tumors are limited to a specific area of the bladder wall, a partial cystectomy may be performed.
- During partial cystectomy, the surgeon removes only the part of the bladder containing cancer while preserving the majority of the bladder.
- This approach aims to maintain bladder function and urinary continence while effectively treating the cancer.
Endoscopic Laser Therapy:
- Laser ablation or photodynamic therapy (PDT) using lasers can be used to treat small, localized bladder tumors, particularly for patients who are not surgical candidates or prefer minimally invasive treatments.
- Laser therapy destroys cancer cells by delivering targeted energy to the tumor site without the need for extensive surgery.
Radiation Therapy:
- External beam radiation therapy (EBRT) or brachytherapy (internal radiation therapy) may be considered for selected cases of bladder cancer, either as a primary treatment or in combination with other therapies.
- Radiation therapy is often used for patients who are not candidates for surgery or for those with advanced bladder cancer requiring bladder preservation.
More radical approaches to Bladder cancer treatment when conservation of organ is not possible include:
Radical Cystectomy:
- Radical cystectomy is the surgical removal of the entire bladder, nearby lymph nodes, and surrounding organs if the cancer has spread beyond the bladder wall or is at a high risk of recurrence.
- In men, this procedure often includes removal of the prostate and seminal vesicles. In women, the uterus, ovaries, fallopian tubes, and part of the vagina may also be removed.
- In some cases, a urinary diversion procedure is performed simultaneously to create a new way for urine storage and elimination.
Urinary Diversion:
After radical cystectomy, urinary diversion procedures are performed to create a new pathway for urine to leave the body. There are several types of urinary diversion techniques:
- Ileal Conduit: A segment of the small intestine (ileum) is used to create a stoma on the abdominal wall. Urine drains continuously into an external pouch (urostomy bag) attached to the stoma.
- Neobladder Reconstruction: A new bladder (neobladder) is created using a segment of the intestine. This neobladder allows the patient to store urine internally, mimicking natural bladder function. Patients need to learn self-catheterization to empty the neobladder regularly.
- Continent Cutaneous Reservoir (Indiana Pouch, Kock Pouch): Similar to neobladder reconstruction, a continent pouch is created internally using intestinal segments. Patients can empty this reservoir by catheterization through a stoma on the abdominal wall, avoiding the need for an external pouch.
Chemotherapy:
- Adjuvant chemotherapy may be recommended after radical cystectomy to reduce the risk of cancer recurrence or to treat any residual cancer cells that may have spread beyond the bladder.
- Neoadjuvant chemotherapy, given before surgery, may also be considered in some cases to shrink tumors and improve surgical outcomes.
Radiation Therapy:
- External beam radiation therapy (EBRT) or brachytherapy (internal radiation therapy) may be used in combination with chemotherapy (chemoradiation) for certain patients who are not surgical candidates or to improve local tumor control.
- Radiation therapy may also be used as palliative treatment to relieve symptoms and manage pain in advanced bladder cancer cases.
After treatment, regular follow-up with your doctor are crucial to detect the recurrence of cancer, any side effects (early or late) related to treatment.
Ongoing support, rehabilitation services, and regular follow-up care are essential components of comprehensive bladder cancer management after bladder removal.
Urinary bladder Cancer Survival Rates
Survival rates are typically presented as percentages. For example, a 5-year survival rate of 80% means that 80 out of 100 people diagnosed with bladder cancer are alive 5 years after diagnosis.
Survival rates are based on data from large groups of people with bladder cancer. They provide a general outlook but do not predict individual outcomes. Many factors can influence your personal prognosis, including cancer stage, treatment response, overall health, and lifestyle factors.
Generally, survival rates are higher for earlier stages and lower for advanced stages. Five year survival rates for bladder cancer are as follows
97-98%% for carcinoma in situ of the bladder alone, 71-75% for early stage localized bladder cancer (cancer is in the bladder only), 39-45% for regional bladder cancer (cancer has spread beyond the bladder to nearby lymph nodes or organs) and Only 8-10% for metastatic bladder cancer (cancer has spread beyond the bladder to a distant part of the body).
Understanding survival rates empowers you to make informed decisions, stay proactive in your treatment journey, and focus on factors within your control to improve outcomes.
