Bladder Cancer: Symptoms, Risk Factors, and Treatment

02 May,2024

Bladder cancer has become one of the most dreadful diseases in modern times. Statistics show that over 600,000 new cases were diagnosed in 2022, making it the 9th most common cancer worldwide. In the same year, over 220,000 people lost their lives due to the disease. 

Early diagnosis is the key to a successful bladder cancer treatment. Spreading awareness about regular screening can help reduce the number of people scrambling to bladder cancer annually.

Bladder cancer may not be the most talked-about cancer, but it's essential to be informed. This blog post sheds light on bladder cancer, its symptoms, and risk factors so you can take control of your health.

What is Bladder Cancer?

The bladder is a hollow organ that acts as a reservoir for urine. When the cells in the organ start to divide unorganizedly, a cluster of cells (tumor) is formed. This condition is what we call bladder cancer. 

Bladder cancer is classified into different types based on the type of cell that transforms into cancer. The following are the three types of bladder cancer based on cell type:

• Urothelial Carcinoma: Urothelial cells are responsible for expanding and contracting to empty the bladder. Uncontrolled division of these cells results in urothelial carcinoma.
• Squamous Cell Carcinoma: Chronic infections or long-term catheter use can transform squamous cells into cancerous cells, resulting in a rare form of bladder cancer.
• Adenocarcinoma: The glandular cells in the bladder, responsible for secreting mucus, can also give rise to another rare form of bladder cancer.

Bladder cancer is also classified based on location. The two types of bladder cancer based on location are:

• Non-Muscle Invasive Bladder Cancer (NMIBC): This type of cancer is characterized by the absence of cancerous cells in the bladder walls.
• Muscle-Invasive Bladder Cancer: This type of cancer is characterized by cancer spreading to the bladder walls and other organs.

What are the Symptoms of Bladder Cancer?

Bladder cancer affects hundreds of thousands worldwide. Everyone wonders why cancer is such a deadly disease. Well, cancer can be just like any other non-fatal disease if it is diagnosed and treated in an early stage. However, since most cancers do not show any distinguishing characteristics initially, it becomes difficult to detect them. Hence, regular screening is vital for people who are at an added risk of developing cancer.

Being aware of the symptoms is vital for early detection. Some common symptoms that the bladder cancer show are –

• Blood in your urine (hematuria) can be a painless symptom and might appear as pink, red, or rusty-colored urine.
• Changes in urination could include increased frequency, urgency (feeling like you need to go right away), difficulty urinating, or passing small amounts of urine.
• Painful urination (dysuria): You might experience a burning sensation during or after urination.
• Lower back pain is a less common symptom but one to be aware of, especially if it's on one side of your back.
• Other potential symptoms: While less frequent, some people with bladder cancer might experience fatigue, bone pain, or swelling in their feet.

Experiencing any of these symptoms doesn't necessarily mean you have bladder cancer. Other conditions can cause similar symptoms. However, it's crucial to consult an oncologist for proper diagnosis and rule out serious health concerns.

What are the Causes and Risk Factors for Bladder Cancer?

Bladder cancer occurs when there are genetic changes in the cells of the bladder. The exact reason for these mutations is unknown. However, oncologists associate multiple risk factors with bladder cancer. These are –

Smoking

• Smoking is the prime cause of bladder cancer due to carcinogenic chemicals in tobacco.
• These chemicals pass into urine and repeatedly expose the bladder, leading to changes in bladder lining cells and cancer. 
• Smoking is responsible for one-third of bladder cancer cases, and smokers are four times more likely to develop the disease.

Exposure to Chemicals

• According to previous studies, exposure to certain industrial chemicals constitutes the second most significant risk factor for bladder cancer. 
• These studies estimate that approximately 25% of bladder cancer cases may be attributed to chemical exposure. 
• Chemicals such as aniline dyes, 2-naphthylamine, 4-aminobiphenyl, xenylamine, benzidine, and o-toluidine have been hazardous. 
• Furthermore, occupations involving the manufacturing of dyes, textiles, rubbers, paints, plastics, and leather tanning have been identified as a risk factor for bladder cancer. 
• Therefore, businesses and industries must take proactive measures to mitigate the risks associated with handling these chemicals and materials.

Other Risk Factors

• Chances of bladder cancer increase if you have received radiation therapy for treating previous cancers.
• Anti-cancer drugs such as cyclophosphamide, cisplatin, or ifosfamide can increase the likelihood of bladder cancer.
• Though bladder cancer can develop at any age, the risk increases as you age. Most people who have bladder cancer are over 55 years of age.
• Bladder cancer predominantly affects men.
• Chronic or repeated urinary infections or inflammations can increase the chances of squamous cell bladder cancer. This type of cancer has a strong association with chronic bladder inflammation caused by schistosomiasis in some parts of the world.
• If you have had bladder cancer in the past, you are at a higher risk of developing it again. Furthermore, if one of your blood relatives, such as a parent, child, or sibling, has a bladder cancer history, you may have an increased risk of the disease.
• A family history of Lynch syndrome can increase the occurrence of cancer in the urinary system, colon, uterus, ovaries, and other organs.

How is Bladder Cancer Diagnosed?

Cancer is a frightening diagnosis, especially when it reaches advanced stages. But the good news is that many bladder cancers can be effectively treated if caught early. Regular screenings are crucial for high-risk individuals. 

Diagnostic tests that help diagnose bladder cancer are –

• Urine Lab Tests are often the first step in diagnosing bladder cancer. Your urine sample is examined for blood cells (hematuria) and other abnormal cells that may indicate the presence of cancer.
• Cystoscopy: This procedure allows doctors to directly visualize the inside of your bladder using a thin, lighted tube called a cystoscope inserted through the urethra. During the procedure, the doctor might: 
  • Look for abnormalities like tumors or inflammation.
  • Take a tissue sample (biopsy) for further analysis.
• Transurethral Resection of a Bladder Tumor (TURBT) is a minimally invasive procedure that can be diagnostic and therapeutic. During a cystoscopy, the doctor uses special instruments inserted through the cystoscope to remove all or part of a suspicious tumor. The removed tissue is then examined under a light microscope to confirm the presence and type of cancer.
• A biopsy involves taking a tiny tissue sample from the bladder lining or a suspicious tumor during a cystoscopy or TURBT procedure. A pathologist examines the biopsied tissue under a microscope to establish if cancerous cells are present and their type.
• Imaging Tests provide detailed images of your urinary system to assess the extent of cancer spread (staging). Standard imaging tests used for bladder cancer include: 
  • CT Scan (Computed Tomography): Creates detailed cross-sectional images of your abdomen and pelvis to identify enlarged lymph nodes or tumor spread.
  • MRI (Magnetic Resonance Imaging) uses powerful magnetic fields and radio waves to capture clear images of the bladder, surrounding organs, and potential cancer spread.
  • IVU (Intravenous Urogram): X-ray imaging of your urinary system after injecting a contrast dye into your vein. It can reveal abnormalities in the bladder, ureters, and kidneys.

How is Bladder Cancer Treated?

Your oncologist will decide the best treatment approach based on the stage and type of bladder cancer. Non-muscle-invasive bladder cancer can be managed by chemotherapy, TURBT surgery, and immunotherapy. For muscle-invasive bladder cancer, the treatment plan includes chemotherapy, immunotherapy, surgery (cystectomy), radiation therapy, or trimodal therapy.

Surgery

Different types of surgeries are available to treat bladder cancer. Your surgical oncologist will choose the appropriate type of surgery based on your cancer stage, overall health, and individual needs. 

• One type is TURBT, which stands for transurethral resection of bladder tumors. This technique is used for both diagnosing the disease and treating non-muscle invasive bladder cancer. The surgery involves removing tumors that exist on the inner layers of the bladder and have not spread to other parts of the body. The surgeon may use an electric wire loop or high-energy laser to cut or burn the cancer.
• Another type of surgery is cystectomy, which involves removing part or all of the bladder. This type of surgery is typically recommended for muscle-invasive bladder cancers. When the surgeon removes the bladder, prostate, seminal vesicles, and surrounding lymph nodes, it is known as radical cystectomy.

Chemotherapy

Cancer drugs are often the first treatment used to fight cancer. For bladder cancer, there are two ways to receive chemotherapy: Intravesical Chemotherapy and Systemic Chemotherapy. 

• Intravesical chemotherapy is a local treatment. A uro-oncologist inserts a catheter into the bladder through the urethra to deliver the chemotherapy drugs directly to the tumor. However, this chemotherapy only kills the cancer cells on the surface, not those inside the bladder wall or that have spread to other organs. Mitomycin-c, gemcitabine, docetaxel, and valrubicin are commonly used drugs for intravesical chemotherapy.
• Systemic chemotherapy is an intravenous treatment that delivers drugs directly into the bloodstream. It allows the drugs to travel throughout the body to reach cancer cells anywhere. Carboplatin, doxorubicin, methotrexate, cisplatin, fluorouracil (5-FU), vinblastine, mitomycin, and gemcitabine are common drugs used for systemic chemotherapy. These drugs may be used alone or in combination for bladder cancer treatment.

Radiation Therapy

Have you heard of X-rays? Well, radiation oncologists can use X-rays to treat bladder cancer, too. 

• Radiation therapy, or radiotherapy, is a treatment modality that uses high-energy X-rays to disrupt cancer cells. 
• Radiation oncologists are responsible for administering the radiation. 
• External beam radiation therapy (EBRT) is a type of radiotherapy that is given by a machine outside the body. 
• Internal beam radiation therapy involves placing an implant inside the body that emits high doses of radiation. 
• Generally, radiation therapy is not given alone as a primary treatment but in combination with chemotherapy or after surgery to eliminate any remaining abnormal cells.

Immunotherapy

Immunotherapy is a biological therapy that has emerged as a breakthrough in cancer treatment. It utilizes the body's immune system to fight cancer. The therapy is designed to boost the immune system's ability to identify, recognize, and kill cancer cells. It can be administered in two ways: intravesical immunotherapy and systemic immunotherapy. 

• In intravesical immunotherapy, a weakened form of Bacillus Calmette-Guerin (BCG) is used as an immunotherapy drug. The drug is directly given to the bladder through catheters. BCG attaches to the bladder lining and activates the immune system, leading to the destruction of cancer cells. If the treatment with BCG alone is ineffective, it can be combined with Interferon, another type of immunotherapy.
• Systemic immunotherapy is typically preferred for advanced stages of bladder cancer. Drugs like nivolumab, avelumab, and pembrolizumab are administered intravenously. These drugs help the immune system to recognize and destroy cancer cells.

Targeted Therapy

• Targeted therapy is a cancer treatment that identifies specific genes and proteins in cancer cells. 
• The drugs used in targeted therapy have the potential to block the action of proteins and enzymes responsible for cancer cell growth.
• If you are being treated for bladder cancer, some common drugs that may be used in targeted therapy are enfortumab vedotin, ramucirumab, erdafitinib, and sacituzumab govitecan. 
• However, it's important to note that not all tumors have the same targets. Therefore, genomic tests are necessary to check for specific genes and proteins in your tumor.

What are the Recent Developments in Bladder Cancer Treatment?

Bladder cancer research is taking place in various medical institutions and hospitals worldwide. Every year, scientists are discovering more about the causes of the disease, how to detect it early, and how to treat it more effectively.

Surgery

• Surgery is one treatment option for bladder cancer. 
• Some surgeons are using a more advanced and minimally invasive technique known as a robotic cystectomy.
• This approach involves using robotic arms that the surgical oncologist controls from a console in the operating room.
• It allows the surgeon to operate through small incisions, leading to shorter hospital stays and faster recovery times for patients.

Intravesical Therapy

• Researchers are also exploring intravesical therapy as a potential treatment option for bladder cancer. 
• They are examining various drugs to determine if they can reduce the cancer recurrence chances after surgery. 
• The aim is to find new and safer drugs that can replace the current ones. 
• Additionally, there is a need for new drugs to treat bladder cancer that do not respond to BCG therapy. 
• Researchers are testing different combinations of drugs and administering them in various ways, such as adding a gel to keep the drugs in contact with cancer cells for a more extended period. 

Photodynamic Therapy 

• Researchers are exploring the potential of photodynamic therapy (PDT) as a treatment option for early-stage bladder cancer. 
• PDT involves administering a light-sensitive drug into the blood that gradually accumulates in the cancerous cells over a few days. 
• A specialized laser light is directed at the bladder's inner lining through a cystoscope. 
• This light transforms the drug in the cancer cells into a new chemical that can destroy them.
• The benefit of PDT is that it can eliminate cancer cells with minimal damage to the surrounding healthy cells. 
• However, one limitation is that the chemical must be activated by light, which means this method can only treat surface-level bladder lining cancers. 
• This treatment cannot reach cancers that have spread to other organs or grown deeper into the bladder wall.

Targeted Therapy

• Targeted therapy drugs, which function differently from standard chemotherapy drugs, are already being used to treat various types of cancer. 
• Some of the drugs currently under study for bladder cancer are rogaratinib, lapatinib, and erlotinib. 
• Other drugs that target the blood vessels responsible for tumor growth are known as anti-angiogenesis drugs. Examples of such medications include bevacizumab, sorafenib, cabozantinib, and pazopanib. 
• These are already in use for treating other cancer types and are now being researched for their efficacy against bladder cancer.

Gene Therapy

• Gene therapy, a novel treatment method, is being tested as a potential option for treating bladder cancer. 
• One form of gene therapy involves using modified viruses to introduce or alter genes in cancer cells or other cells in the body. 
• The virus is injected into the bladder and infects the bladder cancer cells. 
• Upon infection, the virus injects a gene into the cells, which can help immune system cells attack the cancer.

What is the Survival Rate of Bladder Cancer?

With the help of advancements in cancer treatment, the death rate for bladder cancer has been decreasing. Studies reported a decline of over 2% annually from 2016 to 2020.

Oncologists measure the success of cancer treatment in terms of survival rate. Bladder cancer has a 5-year relative survival rate that determines the percentage of people who survive for five years after being diagnosed with the same type and stage of bladder cancer compared to the general population. 

5-year survival rates for bladder cancer are -

• 97% for carcinoma in situ, which means there are abnormal cells in the tissue lining inside the bladder. 
• 71% for localized bladder cancer, which is when cancer is only in the bladder.
• 39% for regional bladder cancer, which is when cancer has spread outside the bladder to neighboring lymph nodes or organs. 
• 8% for metastatic bladder cancer, which is when cancer has proliferated beyond the bladder to distant body parts.

It is evident through data that the chances of successful treatment and survival are higher when the cancer is localized and not metastasized. Hence, it is essential for people who are at risk of developing bladder cancer to get regularly screened. When diagnosed in the early stages, the chances of survival are as high as 97%.

To Conclude

Early diagnosis is crucial for successful cancer treatment. Failure to treat cancer in a timely manner can lead to fatal outcomes. Bladder cancer treatment is decided based on the stage and type of the disease. Generally, a combination of radiation, chemotherapy, and surgery is recommended for managing bladder cancer. Oncologists also use advanced techniques like immunotherapy and targeted therapy to achieve better results