Bladder cancer
Bladder cancer is a type of cancer that arises in the inner lining of the bladder, primarily involving transitional cells, specifically referred to as urothelial carcinomas. It is significantly more prevalent in men and typically affects individuals over the age of 55, with lifestyle factors such as smoking and exposure to certain chemicals elevating the risk. Common symptoms include blood in the urine, pain or burning during urination, and frequent urges to urinate, often only presenting at advanced stages. Diagnosis involves a range of tests including urinalysis, urine cytology, cystoscopy, and imaging studies like CT scans.
Treatment options vary depending on the stage of the cancer, with superficial cases often managed through minimally invasive procedures like transurethral resection, while more invasive cancers may require radical surgery or chemotherapy. Despite treatment, bladder cancer has a high recurrence rate, necessitating ongoing monitoring. The prognosis varies significantly based on the extent of disease spread, with five-year survival rates ranging from 96% for localized cases to just 8% for those with distant metastasis. Understanding bladder cancer entails recognizing its complex nature, risk factors, and the importance of early detection for improved outcomes.
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Bladder cancer
ALSO KNOWN AS: Transitional cell carcinoma
RELATED CONDITIONS:Kidney cancer
DEFINITION: Bladder cancer is a cancer that forms in the inner lining of the bladder.
Risk factors: Researchers do not entirely understand the causes of bladder cancer; however, several carcinogens, family history, and prior diagnosis of bladder cancer remain the chief causes. Smokers are at the most significant risk for developing bladder cancer, as well as people with exposure to certain chemical dyes in the rubber- and leather-processing, textile, and printing industries.
Etiology and the disease process: The wall of the bladder is lined with cells called transitional cells and squamous cells. In 2024, the American Cancer Society published that most bladder cancers begin in transitional cells called urothelial or transitional cell carcinomas. Only 3 percent of bladder cancer patients had squamous cell carcinomas. Cancer that is only in cells in the lining of the bladder is called superficial (non-muscle invasive) bladder cancer and often recurs after treatment.
Cancer that begins as a superficial tumor may grow through the lining and into the bladder's muscular wall. This invasive cancer may extend through the bladder wall into a nearby organ such as the uterus, vagina, or prostate gland or into nearby lymph nodes, in which case cancer cells may have spread to other lymph nodes or other organs such as the lungs and liver or to the bones.
Incidence: In 2024, the American Cancer Society estimated that 83,190 people in the United States would be diagnosed with bladder cancer by the end of this year. Occurring primarily in men and women over 55, new bladder cancer cases were expected for 63,070 men and 20,120 women. This ranks bladder cancer as the fourth most common type of cancer in men and the eleventh most common in women. Caucasians get bladder cancer twice as often as African Americans and Hispanics. People with family members who have bladder cancer, as well as people who have previously had bladder cancer, are more likely to get the disease.
Symptoms: Bladder cancer often causes no symptoms until it reaches an advanced state that is difficult to cure. The most common symptom of bladder cancer is blood in the urine (hematuria). Some patients experience pain or burning during urination or a frequent urge to urinate.
Screening and diagnosis: Screening tests include a medical interview, a physical examination, urinalysis, urine cytology, and cystoscopy. The urinalysis determines if the urine contains abnormalities such as blood, protein, sugar, and solids. Urine cytology is a microscopic examination of urine to detect abnormal cells that have sloughed off the bladder wall and been released in the urine. If necessary, cystoscopy is performed with a very narrow tube with a light and camera inserted through the urethra to examine the inside of the bladder. If bladder cancer is suspected, a physician may order a computed tomography (CT) scan, pyelography, or biopsy. The CT scan is helpful for a three-dimensional view of the bladder and urinary tract to determine if any masses or tumors exist in the bladder or if the cancer has spread to other organs. Pyelography involves injecting a special dye into a vein or the urethra and examining a series of timed-interval X-rays of the urinary system to determine if abnormalities exist. The biopsy is typically performed during cystoscopy, and abnormal cells can be detected with a microscope.
Staging refers to the size of the cancer and the extent to which it has invaded the bladder wall and spread to other parts of the body. High-grade tumors are significantly more aggressive and life-threatening than low-grade tumors. According to the National Cancer Institute, in 2018, approximately 70 to 80 percent of bladder cancer was found to be superficial bladder cancer in situ, which is a highly aggressive, early manifestation of bladder cancer.
Treatment and therapy: The physician may treat superficial bladder cancer with transurethral resection (TUR) by inserting a cystoscope into the bladder through the urethra and using a tool with a small wire loop on the end to remove the cancer to burn away any remaining cancer cells with an electric current. For invasive bladder cancer or cancer involving a large portion of the bladder, surgery is performed to remove the entire bladder, nearby lymph nodes, part of the urethra, and the nearby organs that may contain cancer cells. In some cases of low-grade cancer, only part of the bladder is removed in a procedure called segmental cystectomy.
Radiation therapy uses high-energy rays to kill localized cancer cells to shrink the tumor before surgery or if surgery is not an option. Chemotherapy uses one drug or a combination of drugs to kill cancer cells. Superficial bladder cancer can be treated with local chemotherapy once per week for several weeks. A catheter is inserted through the urethra and remains in the bladder for several hours. If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, chemotherapy may be used to treat the entire body.
Biological therapy uses the body's natural immune system to fight cancer by inserting a catheter with a solution containing live, weakened bacteria to kill cancer cells in the bladder.
Since the 2010s, Immunotherapies have become increasingly employed against cancer. As of the 2020s, there were various types of immunotherapies. Several of these include:
- Immune checkpoint inhibitors, or drugs that keep immune system responses from being too strong.
- T-cell transfer therapy involves taking immune cells from a cancer tumor, modifying them in a lab to fight the tumor more effectively, and re-introducing them.
- Monoclonal antibodies: proteins manufactured to attach to specific elements of cancer cells. These allow a patient's immune system to detect and destroy cancer cells better.
Prognosis, prevention, and outcomes: Bladder cancer has one of the highest recurrence rates of all cancers. If treated once, patients must continue a course of follow-up screenings. In 2024, the American Cancer Society determined 5-year Relative Survival Rates by assessing the extent of cancer spread:
- In situ alone: 96%
- Localized: 71%
- Regional: 39%
- Distant: 8%
- All stages combined: 78%
Bibliography
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