Bladder cancer is a form of cancer that arises from the bladder. The bladder is a muscular sac-like organ in our lower abdomen that holds urine before it leaves our bodies.
Cancer is an abnormal, uncontrolled division and growth of a particular cell type in our bodies, which have the potential to invade and destroy normal tissue.
Bladder cancer can exist in a few different forms depending on what type of cell it is made up of. These types are sometimes influenced by whatever caused the cells to begin dividing. To better understand this disease, we are going to highlight the possible types, signs and symptoms, diagnostic methods, causes, risk factors, and treatment methods.
Types of bladder cancer
- Urothelial carcinoma, often also referred to as transitional cell carcinoma, is the most common type of bladder cancer.1 It arises from the urothelial cells, which are the cell type that lines most of our urinary tract
- Squamous cell carcinoma occurs much less often than urothelial carcinoma and accounts for only about 2-5% of all bladder cancers.2 This type of cancer can be caused by bladder infestation with the worm Schistosoma haematobium
- Others like adenocarcinoma and rhabdomyosarcoma are far less common bladder cancers than the first two but still occur in some populations
Stages of bladder cancer
The staging of bladder cancer is a way to describe the size, degree of invasion into surrounding tissues, and general severity of a tumor. There are several methods and classifications such as the TNM staging system.3 It is sometimes simply classified as low-grade or high-grade
Causes of bladder cancer
Smoking is the single most important preventable risk factor for the development of bladder cancer. In the United States, approximately 50% of bladder cancer diagnoses are attributed to smoking. and is said to be rising as a cause in some developing countries
Chemotherapy and radiotherapy are methods used for the treatment of most cancers. However, both these methods work against cancers by causing damage to the cancer cells enough to kill them or stop them from multiplying. Because these treatments are often not organ selective, sometimes they may damage normal cells in other organs of the body and place the cells in those organs at risk of transforming into cancer cells
Infestation with the worm Schistosoma haematobium is strongly associated with bladder cancer. It is the leading cause of the disease second to tobacco use. It is the major cause of bladder cancer in the Middle East and parts of Africa.4
Mutations are changes that occur in a person's DNA that lead to certain functions or traits. Mutations can be inherited; passed down from your parents, or totally new. These mutations can lead to abnormal growth of cells and cancers
Signs and symptoms of bladder cancer
- Bloody urine: Most people with bladder cancer may notice blood in their urine as one of the first signs. This might appear as bright red or dark brown urine and may contain clots. This is often painless
- Change in urinary habits: Another seemingly innocent symptom is a change in a person's regular urinary habits like painful urination, increased frequency, or a feeling of urgency to go even when one’s bladder is not full
- Lower limb swelling: As cancer grows, it might put pressure on the structures around it which may include blood and lymphatic veins that transport blood and other fluids from your legs to your heart. Compressing those veins could lead to the accumulation of blood and fluid, and cause the legs to swell
Management and treatment for bladder cancer
Surgery is a common treatment of bladder cancer. This is especially used for tumors that are large or have invaded much of the bladder muscle. It is almost always followed by another treatment method like chemotherapy or radiation
Treatment with anticancer medications is often preceded by surgical removal of the tumor. Immunotherapy with the Bacillus Calmette-Guerin (BCG) vaccine5 is often used for early-stage bladder cancers and works by activating the body’s immune system to fight the cancer cells.
Radiation is a less preferred method of therapy for bladder cancer that is used in an attempt to avoid totally removing the bladder. It is associated with a high rate of disease recurrence if done alone6. However, this method is still in use in some settings
Diagnosis of bladder cancer
Urine tests: Urinalysis, urine culture, urine cystoscopy, and urine tumor marker tests are all non-invasive investigations that help detect bladder cancer. They can also be used to gauge disease progression
Blood tests: Certain chemicals produced by some cancer cells can be detected in the blood. These markers are used for diagnosis and also to estimate the stage of the disease, or to measure the efficacy of treatment
Imaging: Imaging tests such as ultrasound and CT scans are helpful in visualizing the size of cancer, and where it has spread to
Biopsy: A biopsy is a procedure that involves taking the cancer cells and studying them under a microscope. This gives valuable information that helps doctors to understand what types of cells they are, what type of cancer it is, and possible treatments
The risk factors of bladder cancer are conditions that make you more likely than the general population to develop the disease
- Tobacco use
- Occupations that expose you to compounds like aromatic amines and polycyclic aromatic hydrocarbons ( exposure is common in dyes, textiles, or crude oil industries)
- Congenital bladder deformities
- Chronic inflammation of the bladder
How common is bladder cancer?
The American Cancer Society estimates that in 2023, there were approximately 82,290 new cases of bladder cancer in the United States.7 It affects more men than women
How can I prevent bladder cancer?
- Avoid tobacco
- Avoid occupational exposure to compounds like amines
- Regular health checks
- Maintaining a low BMI
When should I see a doctor?
You should see a doctor if you notice blood in your urine, flank pain, pelvic pain, or change in urinary habits like passing less urine, more frequent bathroom visits, or lower extremity swelling. People that have had bladder cancer in the past or have a family member who has had bladder cancer should undergo regular screening
Bladder cancer is a tumor that arises from the cells of the urinary bladder. It is relatively common and has a high rate of recurrence. There are a few different types of bladder cancer; urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma. The disease progression is measured by staging and grading methods. There are several causes of bladder cancer, the most important of which is smoking. Other causes are genetic mutations and parasitic infestation of the bladder. Diagnosis consists of urine and blood tests, and some imaging tests. Treatment is mainly surgical, in combination with chemotherapy and radiotherapy. Bladder cancer is a devastating disease that can be prevented by living a tobacco-free lifestyle with a healthy diet, exercise, and regular health checks with your healthcare provider
- What is bladder cancer? [Internet]. [cited 2023 Apr 21]. Available from: https://www.cancer.org/cancer/bladder-cancer/about/what-is-bladder-cancer.html
- Martin JW, Carballido EM, Ahmed A, Farhan B, Dutta R, Smith C, et al. Squamous cell carcinoma of the urinary bladder: Systematic review of clinical characteristics and therapeutic approaches. Arab J Urol. 2016 Sep;14(3):183–91.
- Bladder cancer staging | bladder cancer stages [Internet]. [cited 2023 Apr 21]. Available from: https://www.cancer.org/cancer/bladder-cancer/detection-diagnosis-staging/staging.html
- Gaber DA, Wassef RM, El-Ayat WM, El-Moazen MI, Montasser KA, Swar SA, et al. Role of a Schistosoma haematobium specific microRNA as a predictive and prognostic tool for bilharzial bladder cancer in Egypt. Sci Rep [Internet]. 2020 Nov 2 [cited 2023 Apr 21];10(1):18844. Available from: https://www.nature.com/articles/s41598-020-74807-1.
- Intravesical therapy for bladder cancer [Internet]. [cited 2023 Apr 21]. Available from: https://www.cancer.org/cancer/bladder-cancer/treating/intravesical-therapy.html
- Bladder cancer treatment & management: approach considerations, treatment of non–muscle-invasive disease (Ta, t1, cis), treatment of muscle-invasive disease(T2 and greater). 2023 Apr 4 [cited 2023 Apr 21]; Available from: https://emedicine.medscape.com/article/438262-treatment#d13
- Key statistics for bladder cancer [Internet]. [cited 2023 Apr 21]. Available from: https://www.cancer.org/cancer/bladder-cancer/about/key-statistics.html