Bladder cancer, its stages, and treatment
The bladder is a hollow balloon-like organ in the lower part of our abdomen. It is connected to kidneys by tubes called Ureters. Urine formed in the kidneys travels through these tubes (ureters) and is stored in the bladder. Once the bladder gets full, we get the sensation to urinate and we empty the bladder.
The bladder wall is about 2.76 mm thick. It is made of connecting tissues with elastic fibers. The wall of the bladder has three tissue layers. These layers are named mucosa, sub-mucosa, and muscularis. The muscular layer is made of smooth muscles. Contraction of this muscle expels urine out of the bladder.
The bladder is located in the pelvic cavity. It can hold around 2 cups of urine. The muscles in the bladder wall relax when the bladder is filling with urine. When we urinate, the bladder wall muscles tighten. This helps push urine out through the urethra.
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Bladder Cancer
Tumor and cancer in the bladder develop when the DNA in cells in the bladder mutate or change. This disables the control of cell growth. Sometimes these mutated cells die or are attacked by our immune system. But some mutated cells may escape the immune system and grow out of control. This may form a tumor in the bladder.
A cancerous tumor is formed when the cells of the bladder wall become abnormal and grow uncontrollably. It leads to the formation of the cancerous tumor in the tissues of the bladder. This tumor growth is termed cancer in the bladder.
Cancer in the bladder takes a long time to develop. So it is rare in people under the age of 40. Almost 60% of the new cases are observed in people aged 75 years or more. Bladder cancer in men is more common than in women. A recent study shows that this type of cancer rank is 17th in incidence and 19th in case of mortality in India.
Early diagnosis of bladder cancer is of vital importance. The most commonly observed problems of the bladder are the formation of fluid-filled cysts or abnormal growth of cells (Tumor). Cysts and tumors may be non-cancerous. However, they need to be removed. If Cysts and Tumors are not removed they may become cancerous. Once they become cancerous the treatment becomes complicated.
Bladder cancer symptoms
Following are symptoms of cancer in the bladder.
Blood in Urine
Blood in the urine is called Haematuria. Blood in the urine is one of the most common signs of cancer in the bladder. Excessive growth of cancerous cells in the bladder causes the spread of cancer into the layers of the bladder wall. This develops lesions and causes bleeding. Blood in the urine is the most common symptom of cancer in the bladder.
Dysuria
Painful urination or difficulty while urinating is one of the symptoms of this type of cancer. However, this may also happen due to other reasons like infection and sexually transmitted disease (STD). This pain may originate in the bladder or urethra. The urethra is the tube that carries urine outside of your body.
Frequent Urination
Frequent urination means the urge to urinate more often than usual. You may also feel pain while urinating and discomfort in the bladder. This may happen due to chronic inflammation of the muscle layers of the bladder. So get it checked by a doctor.
Urinary Incontinence
Urinary inconsistency is when you lose control of your bladder. For example, you may lose control of your bladder while exercising, laughing, or sneezing. Urinary incontinence may be due to weak bladder muscles, cancer, enlarged prostate, kidney stones, or infection.
These are few symptoms of cancer in the bladder. But they are not always associated with cancer. So, you need not panic. If you notice any of these symptoms, visit a doctor to rule out the possibility. The disease can affect anyone, but people above age 60, are at greater risk. As the disease advances, the patient often loses control over the bladder or bowel and may show weight loss. This type of cancer in men may result in erectile dysfunction.
Cancer or tumor in the bladder is a silent killer
In the early stages of this cancer, there may not be any pain or other symptoms. Signs of cancer in the bladder may not be there, even if cancer has developed. So, the disease is not detected until it is in an advanced stage. So, it is often called the silent killer.
Causes of cancer of the bladder
The exact cause of this cancer is not known. Generally, all cancers are caused by genetic or environmental factors. Any mutations in the cells of the bladder make them behave abnormally. Following are some of the causes:-
- Exposure to cancer-causing chemicals like Aniline dyes, Benzedrine, Xenylamine, etc.
- Having a history of cancer in the family
- Chronic bladder infection
- Low fluid consumption
- Age above 60 years
- Having previous treatment of chemotherapy drugs
- Having previous treatment of radiation therapy to treat cancer in the pelvic area
Diagnosis of cancer in the bladder
Doctors perform the following tests for the diagnosis of cancer in the bladder.
Physical examination
A general body check will be done by the doctor. He will look for signs of cancer like lumps. The doctor will take a look at your health habits. He will also ask you about previous illnesses suffered and the treatment that you have taken for it.
Internal examination
The doctor will examine the vagina or rectum. He may inserts gloved and lubricated fingers into the vagina and rectum to feel the presence of any lumps.
Urine analysis
A routine check of urine analysis will be advised to you. The tests you need to perform are color and pH of urine, and contents of sugar, protein, red blood cells, and white blood cells, etc.
Urine cytology
Problems with the kidney, urinary tract, and bladder affect the appearance, concentration, and content of your urine. Your body removes waste and toxins caused by illnesses. These toxins are removed through the urine. So your urine sample will be observed under the microscope, to visualize the presence of abnormal cells, if any.
Ultrasound Imaging
Imaging using ultrasound is also called sonography. This procedure uses high-frequency sound waves to visualize the interior of your tummy. It looks at your entire urinary system and bladder. You will be asked to drink plenty of water an hour before the ultrasound test. Your bladder is required to be full with urine before ultrasound imaging. If your bladder is not fully filled with urine, the ultrasound image may not show a tumor or cyst. So drink lots of water one hour before the test. Then only bladder walls can be seen clearly. If there is any tumor it will be seen in the ultrasound image.
CT Scan
It is also called CT Urogram. It is a test that uses CT Scan and a special dye. Doctors advise these tests so that they can examine the structures of your urinary tract. A special dye called a contrast medium is injected into a patient’s vein. It may also be given orally. Then several pictures of the inside of the body are taken from different angles. A computerized program combines all these pictures to get a 3-D image. This image shows abnormalities or tumors in the bladder. The size of the tumor can be measured in a CT scan. CT scan can also identify enlarged lymph nodes. So spread of the cancer in the body can be easily determined.
Cystoscopy and TURBT for the tumor in the bladder
Cystoscopy can see the internal area of the bladder through a camera. A tiny tube-like camera (cystoscope) is inserted into the bladder, through the urethral opening. Cystoscopy performs dual functions. The doctor can see inside the bladder and can also remove the tumor by surgery. The camera is also equipped with surgical tools (resectoscope) to remove any abnormal tissue sample. This procedure is called TURBT (Transurethral resection of bladder tumor). It is a very common procedure for Bladder Cancer Treatment. The Urology Surgeon removes any tumor seen on the bladder wall. The removed abnormal tissue of the bladder is sent for biopsy. It will be further analyzed under a microscope by the pathologist to check for the signs of cancer. This is called a Biopsy.
Stages of cancer in the bladder
There are 5 main stages numbered from Stage 0 to Stage 4. Stage 0 is the very early stage whereas stage 4 is the most advanced stage of cancer in the bladder.
Stage 0 of the Cancer
This is an early stage of cancer. A tumor is found on the inner lining of the bladder. These cancer cells can be easily removed by the TURBT procedure. Stage 0 cancer does not invade tissues and muscles of the bladder. This type of cancer is also called non-invasive papillary urothelial carcinoma. Chances of cure are high in this stage.
Stage 1 of the Cancer
Further growth of cancer deeper into the connective tissue of the bladder wall, is termed stage 1 cancer. Cancer has grown through the inner lining of the bladder and into the lamina propria.
Stage 2 of the Cancer
This is a muscle-invasive stage. Cancer has spread into the thick muscle wall of the bladder. Cancer grows into the muscles of the bladder wall. This is positively a dangerous stage.
Stage 3 of the Cancer
In this stage, cancer growth passes through the muscle into the fat layer surrounding the bladder. It may spread to other nearby organs like the prostate, uterus, or vagina and also in the neighboring lymph nodes.
Stage 4 of the Cancer
The tumor has spread into the pelvic wall or abdominal wall. Cancer may also spread to lymph nodes outside of the pelvis or to other parts of the body. The cancer spreads to other parts of the body such as the bones, lungs, or liver. It crosses the wall of the abdomen and spreads to distant lymph nodes too.
Another way of classification of types of cancer in the bladder is as follows
Non-muscle invasive cancer
In this stage, the disease is superficial and limited to the inner lining of the bladder wall. Chances of cure are high in this stage.
Muscle invasive cancer
Cancer has penetrated deep into the wall of the bladder however it has not yet spread out of the bladder.
Metastatic or advanced cancer
In this stage, cancerous cells are found in other organs of the body like lungs and bones. Chances of cure are minimal in this stage.
Doctors put the cancer cells under the microscope. Diagnosis of cancer is done. Then only the doctors classify the type of cancer. Three types of this cancer are known as Urothelial Carcinoma, Squamous Cell Carcinoma, and Adenocarcinoma.
Bladder cancer treatment options
Various bladder treatment options are available. Following are the treatment options:-
- Surgery like TURBT
- Intravesical chemotherapy using medicines like Mitomycin C
- Radiation therapy for cancer
- BCG treatment for cancer in the bladder
- Immunotherapy for cancer using BCG
Your doctor will decide the best treatment suitable for you based on symptoms, stage of cancer, and your overall health.
TURBT surgery for cancer in the bladder
Surgery is a common treatment for most bladder cancer patients. But surgery depends on the stage of cancer. TURBT is very effective in Stage 0 and Stage 1 of cancer in the bladder. Cancer has not yet penetrated the muscles of the bladder and can be removed by surgery.
This type of cancer surgery is called Trans Urethral Resection of Bladder Tumor (TURBT). This procedure is done under general anesthesia. TURBT takes up-to 90 minutes depending on the number and size of the tumor. TURBT is usually done during cystoscopy examination of the bladder.
A camera locates the tumors inside the bladder. Resectoscope is used to cut the tumor away from the lining of the bladder. The wounds are sealed using a mild electric current. About two days of hospitalization is required for TURBT. The patient is put on a catheter for a period of three to seven days.
Bladder tumor removal by TURBT
Bladder Cancer Chemotherapy
Chemotherapy is the use of drugs to treat cancer. The chemotherapy is done in two ways.
Intravesical Chemotherapy
It is a very simple and painless procedure. Mitomycin C (MMC), Gemcitabine, and Valrubicin are some of the common chemotherapy drugs used by doctors. Always take treatment as advised by your specialist doctor.
A soft tube is inserted into the urethra. The chemotherapy drug mixed with saline water is put inside the bladder through this tube. The patient is asked to lie down on the hospital bed for 20 minutes each on his stomach, back, left side, and right side position. This way the drug spreads all over inside the bladder. So the drug remains in the bladder for two hours. After this, the patient is asked to pass urine and go home. This procedure is named Intravesical Chemotherapy.
Bladder Cancer Chemotherapy by intravesical route is used when the disease is at very initial stages. It is also done after TURBT. This chemotherapy cancer treatment with MMC is the most commonly practiced treatment option for cancer in the bladder.
Systemic Chemotherapy
The chemotherapy drug may be given in the form of injection into blood circulation through intravenous or intramuscular administration. Chemo drug is also given in pill form. This procedure is called Systemic Chemotherapy.
BCG Treatment
BCG treatment for bladder cancer is another procedure for cancer treatment. It is also called Immunotherapy for Bladder Cancer. BCG therapy is preferred by a large number of doctors.
BCG therapy involves injecting bacteria called Bacillus Calmette-Guerin (BCG) into your bladder. This procedure makes use of tuberculosis bacteria that are very weak to cause any infection.
BCG treatment strongly stimulates our immune system to fight against cancer cells. BCG immunotherapy causes the immune cells of the body to concentrate in the bladder and kill the abnormal cells. Immunotherapy increases fighter cells in the body that kills cancer cells in the bladder as well as though out the body.
Radiotherapy for cancer in the bladder
This procedure uses radiation to kill cancer cells. But it is not used as primary treatment. When surgery is not possible due to some reasons, radiotherapy may be used.
Bladder cancer treatment side effects
It is not essential that all of the side effects will occur. Following are side effects of intravesical chemotherapy and BCG therapy:-
- Burning sensation in the bladder
- Blood in the urine. Sometimes bleeding may get worse and you may find blood clots in urine. This may be an indication of infection. If the symptoms get severe, contact your doctor. You may need to take extra medications to control the infection.
- Fever
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Mouth sores
- Constipation
- Fatigue
Tumor or cancer may recur after TURBT surgery. So, you may have to undergo TURBT surgery again. As the surgery leaves the scar on the inner wall of the bladder, your bladder control may decrease. You may leak urine or feel an urgency in urination or frequent urination.
Other side effects that you face are similar to any other surgery, as the reaction to anesthesia, bleeding, and infection.
You may be prescribed pain-killer medicines to control the pain after surgery.
Bladder cancer survival rate
The survival rate directly depends on the type and stage of cancer. If the cancer is at stage 0 or 1 and has not penetrated muscles, then the 5-year survival rate is 96%.
In the muscle-invasive stage, the 5-year survival rate drops to 70%.
If the disease has spread to other organs, the 5-year survival rate may range from 36% to 7%. However, you need to understand that these cancer survival rate values are just estimates. Talk to your doctor if you have any doubts about this information.
FAQs about bladder cancer
Is cancer in the bladder curable?
The most common question asked by urologists is “Is bladder cancer curable?” The prognosis for this type of cancer is affected by the stage and grade of the tumor. This type of cancer is curable if the disease is diagnosed at a very early stage. It is curable if cancer has not spread to other organs of the body.
In the early stages of cancer in the bladder chemotherapy or surgery will relieve the symptoms of the disease. Even if the cancer is superficial, the prognosis for cancer depends on the number of tumors, size of tumors, and whether the tumor has grown at the same site from where it was removed previously.
What is low-grade bladder cancer?
Low-grade cancer has tumors that are very slow in growth. The cancerous cells in low-grade bladder cancer resemble the normal cells. Here, the chances of cells penetrating the bladder wall deep into the muscles and connective tissue are very less. Therefore, low-grade cancer in the bladder is curable and is not responsible for a death.
What is the best treatment for cancer in the bladder?
The treatment of bladder cancer is decided by the doctor based on the symptoms of the patient and the stage of cancer.
What to expect after bladder tumor removal?
After TURBT you may feel pain while urinating and also blood may be present in urine. However, you will be discharged from the hospital in about two days. You need to take a rest and can resume your usual activities within a week.
Conclusion about bladder cancer treatment
This type of cancer is a more common disease in the older population. Most new cases are diagnosed above the age of 60. The disease is more common in men than in women. People who smoke, are at higher risk of developing bladder cancer. Early-stage diagnosis will help you to recover completely and you can live a normal life.
If not treated early, complications may arise. In such cases, the cancerous bladder may be removed. In such a case, an alternative pathway for excreting urine is created (Urinary diversion) and urine is collected in a plastic bag. Sometimes, doctors have to create a new bladder (neobladder) using a section of your bowel and making a sac-like structure and then it is connected to the urethra. However, this surgery is complicated and is not suitable for everyone.
Reference
Immunotherapy for cancer in the bladder