Bladder Cancer

Overview

Bladder cancer is a type of cancer that originates in the cells of the bladder, which is a hollow muscular organ in the lower abdomen responsible for storing urine. It most commonly starts in the urothelial cells lining the inside of the bladder, but can also occur in the kidneys and ureters. Bladder cancer is typically diagnosed at early stages, which are highly treatable. However, even with successful treatment, there is a risk of recurrence, so long-term follow-up tests are necessary. The type of bladder cancer depends on the type of cell where it begins, with urothelial carcinoma being the most common in the United States. Other types include squamous cell carcinoma and adenocarcinoma. Risk factors include smoking, chronic bladder inflammation, personal or family history of cancer, and a history of Lynch syndrome. While there is no guaranteed way to prevent bladder cancer, measures such as not smoking, following safety instructions when working with chemicals, and maintaining a diet rich in fruits and vegetables may help reduce the risk.

Understanding the disease

Symptoms

Symptoms of bladder cancer may include blood in urine (hematuria), frequent urination, painful urination, and back pain. If you notice discolored urine and are concerned it may contain blood, or if you have other signs or symptoms that worry you, it's recommended to make an appointment with your doctor to get it checked.

Risk Factors

Risk factors for developing bladder cancer include smoking, increasing age, being male, exposure to certain chemicals, previous cancer treatment, chronic bladder inflammation, and a personal or family history of cancer.

Development

Bladder cancer typically develops from the cells that line the inside of the bladder, known as urothelial cells. Urothelial cells are also found in the kidneys and the tubes connecting the kidneys to the bladder. The most common type of bladder cancer is urothelial carcinoma, which originates in these cells. Other types of bladder cancer include squamous cell carcinoma and adenocarcinoma, which begin in different types of cells in the bladder. Squamous cell carcinoma is associated with chronic bladder inflammation and is more common in areas where the parasitic infection schistosomiasis is prevalent. Adenocarcinoma begins in cells that produce mucus-secreting glands in the bladder and is very rare. It is important to note that some bladder cancers may involve more than one type of cell.

Assessment and Diagnosis

Triage

If you notice signs and symptoms of bladder cancer, such as blood in urine, frequent or painful urination, or back pain, you should make an appointment with your doctor to get it checked. Early detection and diagnosis are crucial for effective treatment and management of bladder cancer.

Diagnosis

To diagnose bladder cancer, your doctor may perform cystoscopy, where a small, narrow tube is inserted through the urethra to examine the inside of the bladder for signs of disease. They may also collect a sample of tissue for testing (biopsy) during cystoscopy. Additional tests such as CT scans, MRIs, PET scans, bone scans, and chest X-rays may be performed to determine the extent of the cancer. Urine tests, urine cytology, and potassium sensitivity tests are also used to diagnose bladder cancer or rule out other conditions.

Management and Treatment

Complications

Complications of bladder cancer and its treatments may include:

1. Cancer that spreads (metastasizes). Bladder cancer can spread to nearby organs, such as the uterus or rectum, or travel through the bloodstream or lymphatic system to other parts of the body. Once the cancer has metastasized, it can be more challenging to treat.
2. Recurrence. Even after successful treatment, bladder cancer can return. Patients typically need follow-up tests for years after treatment to monitor for recurrence.
3. Incontinence or urinary problems. Bladder cancer treatments, such as surgery to remove the bladder (radical cystectomy), can lead to urinary incontinence or other urinary problems.
4. Sexual dysfunction. Surgical treatments for bladder cancer, particularly those involving removal of the bladder or surrounding tissues, can cause erectile dysfunction or other sexual problems.
5. Infection. Bladder cancer treatments can increase the risk of developing urinary tract infections or other infections due to the weakening of the immune system or the impact on the bladder's function.
6. Emotional and psychological issues. Bladder cancer and its treatment can cause emotional distress, anxiety, and depression. Patients may benefit from counseling or support groups to help manage these challenges. It is important to discuss potential complications with your healthcare provider before starting any treatment plan.

Treatment

There are various treatments for bladder cancer, depending on the type, stage, and individual's overall health. Some common treatment options include:

1. Surgery: A surgical procedure called transurethral resection (TUR) may be performed to remove the cancerous cells. In more advanced cases, a cystectomy (removal of the bladder) might be necessary.
2. Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It may be used before or after surgery, or in combination with radiation therapy.
3. Radiation therapy: This treatment uses high-energy rays to kill cancer cells. It may be delivered internally or externally, depending on the stage and location of the cancer.
4. Immunotherapy: Immunotherapy treatments, such as immune checkpoint inhibitors, can help boost the body's immune system to fight cancer cells.
5. Targeted therapy: Targeted therapies are drugs that specifically target cancer cells without harming healthy cells. They may be used alone or in combination with other treatments. It's important to consult with a medical professional to determine the most appropriate treatment plan based on your specific situation.

Preparing for medical consultation

To prepare for an appointment for bladder cancer, you should:

1. Make an appointment with your primary care doctor or a specialist, such as a urologist or an oncologist, if you have signs or symptoms that worry you.
2. Gather a list of your symptoms, including any that may seem unrelated to bladder cancer.
3. Bring a family member or friend with you to the appointment, as they can help remember important information and provide emotional support.
4. Prepare a list of questions to ask your doctor, such as asking about the stage of your cancer, treatment options, potential risks, and whether a specialist consultation is necessary.
5. Find out if there are any preparations needed before the appointment, such as restricting your diet.
6. Write down your personal information, including any major stresses or recent life changes.
7. Bring a list of all your medications, vitamins, herbs, or supplements you are taking. Remember to be open and honest with your doctor about your concerns and any symptoms you are experiencing. This information will help your doctor determine the best course of action and provide you with the most appropriate care.