Bladder Cancer - Public Health Notes

Table of Contents

What is Bladder Cancer?

Bladder cancer is the most common type of urologic cancer and one with the greatest recurrence rate as well.
Bladder cancer occurs when uncontrolled growth of bladder cells occurs. The bladder is an organ in the lower abdomen that has a hollow, balloon-like form and retains urine.
Urothelial cells, which line the interior of bladder, are where bladder cancer typically develops.
Ureters, which connect kidneys to bladder, as well as kidneys themselves, also contain urothelial cells.

Key Facts

Bladder cancer ranks as the tenth most common type of cancer worldwide.
In men, it is the sixth most common cancer, and in women, it is the seventeenth most common cancer.
In 2020, there were over 573,000 newly diagnosed cases of bladder cancer.
More than 200 000 individuals worldwide die from bladder cancer each year, with roughly 600 000 people receiving a diagnosis.
One of the most difficult and expensive cancers to diagnose and treat is bladder cancer.
The likelihood of developing bladder cancer increases with age, especially among older individuals.
The majority, around 90%, of patients diagnosed with this type of cancer are aged 55 or older.
The average age of those diagnosed is 73.

Types of Bladder Cancer

1. Urothelial carcinoma

Urothelial carcinoma, also known as transitional cell carcinoma, is a form of cancer originating in the urothelial cells.
These cells line various organs such as the urethra, bladder, ureters, renal pelvis, and others.
The majority of bladder cancers are classified as urothelial carcinomas.

2. Squamous cell bladder carcinoma

Squamous cell bladder carcinoma involves the presence of thin, flat cells that line the inner surface of the bladder.
This type of bladder cancer comprises approximately 5% of all bladder cancers and is commonly observed in individuals who have experienced prolonged periods of bladder inflammation or irritation.

3. Adenocarcinoma

Adenocarcinoma cancers develop within the glands that line different organs, including the bladder.
This particular form of bladder cancer is extremely rare, accounting for only 1% to 2% of all bladder cancer cases.

4. Small cell carcinoma

Small cell carcinoma of the bladder emerges from neuroendocrine cells, which are similar to nerve cells and release hormones into the bloodstream in response to signals from the nervous system.

Causes of Bladder Cancer

The exact cause of bladder cancer is not fully understood, but it is believed to result from a combination of genetic and environmental factors.
Smoking and exposure to specific chemicals and gases are two major risk factors that are linked with bladder cancer.

Risk factors of Bladder Cancer

1. Cigarette smoke

Smoking cigarettes significantly increases the risk of bladder cancer, more than doubling the likelihood.
The use of pipes and cigars, as well as exposure to second-hand smoke, may also elevate the risk.

2. Radiation exposure

Undergoing radiation therapy for cancer treatment can potentially raise the risk of developing bladder cancer.

3. Chemotherapy

Certain chemotherapy drugs are associated with an increased risk of bladder cancer.

4. Exposure to certain chemicals

Research indicates that individuals working with specific chemicals found in dyes, rubber, leather, paint, certain textiles, and hairdressing supplies may have an elevated risk of bladder cancer.

5. Frequent bladder infections

People who experience recurrent bladder infections, bladder stones, or other urinary tract infections may face an increased risk of squamous cell carcinoma.

6. Chronic catheter use

Individuals who require long-term catheterization for bladder function may be at risk for developing squamous cell carcinoma.

High Risk Groups

1. Gender

The risk of bladder cancer is higher in men compared to women.
As per the American Cancer Society, men have approximately a 1 in 28 lifetime risk of developing bladder cancer, whereas women have about a 1 in 91 risk.

2. Age

Bladder cancer predominantly affects older individuals.
The average age of diagnosis is 73, and 90 percent of patients diagnosed are over the age of 55.

3. Race

Caucasians have a twofold higher incidence of bladder cancer compared to African Americans.
The prevalence of this disease is lower among Hispanics, Asians, and Native Americans.

Signs and Symptoms

Abdominal pain
Blood in the urine
If bladder cancer spreads to the bone, it may cause bone pain or tenderness.
Fatigue
Painful urination
Urinary frequency and urgency
Urine leakage (incontinence)
Weight loss

Stages of Bladder Cancer

1. Stage 0 (noninvasive papillary carcinoma and carcinoma in situ)

Stage 0a, also known as noninvasive papillary carcinoma, manifests as elongated, slender growths that protrude into the bladder lumen, where urine accumulates.
Stage 0is, or carcinoma in situ, represents a flat tumor situated on the inner lining of the bladder tissue. It is always classified as high grade.

2. Stage I bladder cancer

Stage I refers to a form of bladder cancer that is non-muscle-invasive and has progressed into the connective tissue without reaching the muscular layers of the bladder.

3. Stage II bladder cancer

Stage II, also referred to as muscle-invasive bladder cancer, signifies that the cancer has infiltrated the muscle layers of the bladder after spreading through the connective tissue.
Individuals with this stage may face a potential risk of developing squamous cell carcinoma.

4. Stage III bladder cancer

Stage III bladder cancer, also known as locally advanced bladder cancer, can be further categorized into two sub-stages: IIIA and IIIB.
In stage IIIA, the cancer has infiltrated the bladder muscles, bladder wall, and the layer of fat surrounding the bladder.
It may have also spread to reproductive organs, but it has not reached the lymph nodes.
Alternatively, it could involve the spread to a single lymph node in the pelvic region, away from the major arteries called the common iliac arteries.
In stage IIIB, the cancer has extended to multiple lymph nodes in the pelvis, excluding those near the common iliac arteries.
It may also involve the presence of cancer in at least one lymph node near the common iliac arteries.

5. Stage IV bladder cancer

Stage IV bladder cancer consists of two sub-stages: IVA and IVB.
In stage IVA, the cancer has spread either to the abdominal wall or pelvic wall.
Alternatively, it may have metastasized to lymph nodes located above the major arteries in the pelvis (common iliac arteries).
In stage IVB, the cancer has disseminated to other parts of the body, such as the lungs, bones, or liver.
Stage IV is also referred to as metastatic bladder cancer, wherein cancer cells have traveled through the lymphatic system or bloodstream, forming tumors in distant locations.

Screening of Bladder Cancer

Hematuria Test:

A hematuria test examines urine for the presence of red blood cells, indicating potential causes such as cancer or other conditions.
It involves microscopic observation or the use of a specialized test strip. The test may be repeated periodically.

Urine Cytology:

Urine cytology is a laboratory examination of a urine sample under a microscope to identify abnormal cells.

Urine Tumor Marker Tests:

Urine tumor marker tests analyze urine in the laboratory to detect specific substances produced by bladder cancer cells or the body’s response to bladder cancer.
These tests aid in diagnosing certain types of bladder cancer.

Cystoscopy:

Cystoscopy is a procedure that utilizes a thin, illuminated tube called a cystoscopy to visually inspect the bladder and urethra for abnormal areas.
Biopsy samples may be taken during the procedure.

Diagnosis of Bladder Cancer

Urinalysis: Healthcare providers perform urine tests to rule out infection.
Cytology: Providers examine cells under a microscope for cancer indications.
Cystoscopy

If the above tests i.e. urinalysis, cytology, and cystoscopy confirm bladder cancer, additional tests are conducted:

Transurethral resection of bladder tumor (TURBT)

Providers remove bladder tumors for further examination. TURBT may also serve as a treatment to remove tumors before they invade the bladder muscle wall.
This outpatient procedure is done under spinal or general anesthesia.

MRI (Magnetic Resonance Imaging) test

This imaging technique uses a magnet, radio waves, and a computer to generate detailed bladder images.

CT (Computed Tomography) scans

Providers may perform this test to determine if cancer has spread beyond the bladder.

Chest X-ray

This test helps identify signs of bladder cancer metastasis to the lungs.

Bone scan

Similar to a chest X-ray, bone scans detect signs of bladder cancer spreading to the bones.

Prevention

Quitting smoking has been demonstrated to reduce the risk of bladder cancer by approximately 40% within just 1-4 years, and the risk returns to baseline levels within 20 years.
Precautions should be implemented to minimize chemical exposure (such as aerosols and contact) among individuals working in industries like manufacturing, shipping, firefighting, and hairstyling.
There is a controversial debate about the potential of a diet rich in fruits and vegetables to prevent bladder cancer.
Physical activity has a modest protective effect against bladder cancer, and its impact may be enhanced when utilized as part of a weight-loss program.
Administering the anthelminthic drug praziquantel through mass drug administration can aid in disease control and significantly reduce the risk of developing bladder cancer.

Treatment of Bladder Cancer

Surgery is performed to eliminate cancer cells.
Intravesical chemotherapy, administered directly into the bladder, is used to treat bladder cancers that are limited to the bladder lining but have a high risk of recurrence or progression.
Systemic chemotherapy, which targets the entire body, is employed to improve the chances of a cure in individuals undergoing bladder removal surgery or as the primary treatment option when surgery is not feasible.
Radiation therapy is utilized to destroy cancer cells, often as the main treatment choice when surgery is not possible or preferred.
Immunotherapy stimulates the body’s immune system to combat cancer cells, either within the bladder or throughout the body.
Targeted therapy is employed to treat advanced cancer when other treatments have proven ineffective.