Facts about bladder cancer

Q1 What is bladder cancer?  

The urinary bladder is part of the urinary tract. It is at the bottom of the tummy (abdomen). It fills with urine and we pass urine out from time to time through a tube called the urethra. The urethra passes through the prostate gland and penis in men. The urethra is shorter in women and opens just above the vagina. Urine is made in the kidneys and contains water and waste materials. A tube called a ureter comes from each kidney and drains the urine into the bladder.

Q2 What causes bladder cancer? 

  • Smoking is the most important risk factor accounting for approximately 35 percent of bladder cancers among women and 55 percent of bladder cancer among men.
  • Occupational chemical exposure: Certain occupations such as metal workers, painters, rubber industry workers, leather workers, textile and electrical workers, miners, cement workers, transport operators, excavating-machine operators, and jobs that involve the manufacture of carpets, paints, plastics, and industrial chemicals. 

Q3 What are the types of bladder cancer?

  • Urothelial carcinoma (also called transitional cell carcinoma). Most common 
  • Squamous cell carcinoma can develop as a result of chronic irritation and inflammation.
  • Adenocarcinoma
  • Small cell carcinoma

Q4 What are the symptoms of bladder cancer?

  • Hematuria (blood in the urine)* — the most common sign of bladder cancer is blood in the urine. 
  • Pain: It is usually the result of locally advanced disease. Pain may be located in the lower abdomen, flank, or lower back. 
  • Voiding symptoms such as burning during urination or a change in urination habits 
  • Advanced cases may also present with fatigue, weight loss, and loss of appetite. 

*Anyone who is over 40 years old and has visible blood in the urine should have a complete evaluation of the kidneys, ureters, bladder, and urethra, especially men who are smokers 

A word of caution 

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q5 How is it diagnosed? 

  • Urine examination and cytology
  • Imaging tests — like ultrasound and CT scan of the whole abdomen
  • Cystoscopy — It is a procedure that is done to examine the lining of the urethra and bladder. A small tube with a camera (cystoscope) is inserted into the bladder through the urethra. If any abnormal tissue is seen, a biopsy can be taken. 

A word of caution 

  • There is a common myth that taking biopsy leads to the spread of cancer cells in the body. This is not true. Taking a biopsy does not lead to the spread of cancer cells in the body.
  • Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly.  
  • Further testing:  If a biopsy confirms bladder cancer, the further test can be done 
  • Blood tests – to assess the state of the liver, and bone marrow
  • Chest X-ray – to check if cancer has spread to the lungs or not. 
  • Sometimes a PET scan – To know the distant spread of disease 

Q6 What is bladder cancer staging?

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread

Stage I:  Limited to the bladder. Cancer has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs

Stage II: Cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs 

Stage III: Cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder (perivesical tissue) or to the prostate in a man or the uterus and vagina in a woman. Or, cancer has spread to the regional lymph nodes

Stage IV: The tumor has spread into the pelvic wall or abdominal wall, or cancer has spread to lymph nodes outside of the pelvis or to other parts of the body.

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of the primary tumor
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body

Q7 How bladder cancer is treated? 

Bladder cancer is often curable if it’s diagnosed at an early stage. 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide the individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • How a treatment will affect your bladder habits 
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

Treatment is broadly divided into three different category 

  • Nonmuscle invasion (Stage 1): Also called superficial bladder cancer 

The initial treatment for this stage of bladder cancer is the surgical removal of cancer through a cystoscope, called transurethral resection of bladder tumor (TURBT). This is often followed by adjuvant (additional) therapy*, which reduces the chances of cancer recurring. 

  • Muscle invasion bladder cancer (Stage II & Stage III): Treatment includes surgery to remove the bladder (radical cystectomy) and the surrounding organs and urine are diverted either through stoma or creation of neobladder. In select situations, chemotherapy may be used before or after the surgery.  
  • Advanced Stage IV (unresectable, recurrence or metastatic): Chemotherapy or targeted therapy 

*Adjuvant therapy: 

Given after TURBT done for stage 1 cancer either in the form of Intravesical chemotherapy or intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) 

It can be given as a single dose or maintenance dose.  

“Intravesical” means that the treatment is put inside of the bladder, usually through a catheter.  This allows a high concentration of the drugs to be applied directly to the areas where tumor cells could remain, potentially destroying these cells and preventing them from re-emerging in the bladder and forming new tumors.