Choose the content to read

• What are the types of bladder cancer?
• What are the causes of bladder cancer?
• What are the symptoms of bladder cancer?
• What are the risk factors of bladder cancer?
• What are the diagnostic tests and procedures for bladder cancer?
• What are the treatment modalities for bladder cancer?
• Is bladder cancer preventable?
• A note from MedPark’s doctors

What is bladder cancer?

Bladder cancer arises from mutations in the transitional cells of the bladder lining. Early detection improves the chance of cure. However, patients require ongoing medical follow-up due to the high recurrence risk. Adhering to medical advice and undergoing continuous monitoring and treatment are essential for effective management of bladder cancer.

What are the types of bladder cancer?

• Transitional cell carcinoma or urothelial bladder cancer: This is the most common type, constituting 90% of bladder cancers. Cancer cells originate in the transitional cells of the bladder lining and spread to the fatty tissue surrounding the bladder.
• Squamous cell carcinoma: Comprising about 5% of bladder cancers. It frequently occurs in patients with chronic bladder inflammation.
• Adenocarcinoma: This is a rare cancer arising from glandular epithelial cells, accounting for only 1% to 2% of cases.
• Small cell carcinoma: Originates from small cells in the lining of the bladder and is a rare cancer.
• Sarcoma: Occurs when the connective tissue in the bladder wall becomes cancerous.

Classification of bladder cancer according to its depth of invasion

• Non-invasive: Small tumors or cancer cells confined only to the bladder.
• Non-muscle-invasive: Superficial bladder cancer that has not yet invaded the muscular layer.
• Muscle-invasive: Cancer that has invaded the muscular layer of the bladder wall and may have invaded the fatty layer and tissue around the bladder.

What are the causes of bladder cancer?

Currently, the exact cause of bladder cancer is unknown. However, risk factors that may contribute to bladder cancer include:

• Smoking
• Radiation therapy and chemotherapy
• Exposure to chemicals, such as fabric dyes
• Frequent bladder inflammation, bladder stones, or urinary tract infections
• Long-term indwelling urinary catheters

What are the symptoms of bladder cancer?

• Blood in urine
• Painful or burning sensation when urinating
• Frequent urination
• Urinary hesitancy
• Frequent bladder inflammation

When should I see a doctor?

If there is a change in urine color, blood in the urine, or any concerning symptoms, seek an appropriate medical diagnosis.  It is important to note that the symptoms of bladder inflammation and bladder cancer are similar. If symptoms of bladder inflammation do not improve after taking antibiotics, seek medical care.

What are the risk factors of bladder cancer?

• Smoking: Harmful chemicals may accumulate in urine, damaging the bladder lining and increasing cancer risk.
• Increasing age: People aged 55 and above have a higher risk of developing bladder cancer.
• Male gender: Men are at higher risk than women.
• Exposure to chemicals: The kidneys filter and excrete chemicals from the bloodstream, exposing them to substances that may cause bladder cancer. These include arsenic and chemicals used in fabric dye, rubber, leather, and paint manufacturing.
• History of cancer treatment: Cancer medications such as cyclophosphamide may increase the risk of bladder cancer. Those who have received radiation therapy to the pelvic area are at higher risk of developing bladder cancer.
• Chronic bladder inflammation: Long-term indwelling urinary catheters cause bladder inflammation and increase the risk of squamous cell carcinoma of the bladder. Chronic bladder inflammation can also result from schistosomiasis (a parasitic infection).
• Family or personal history of cancer: This includes Lynch syndrome, also known as hereditary non-polyposis colon cancer (HNPCC). It increases the risk of cancers of the urinary system, colon, uterus, and ovaries.

What are the diagnostic tests and procedures for bladder cancer?

• Urinalysis
• Cytology
• Cystoscopy

If the results confirm bladder cancer, additional tests may be necessary.

• Transurethral resection of t tumor (TURBT): An outpatient procedure to remove bladder tumors for pathologic examination
• Imaging tests: CT scan, MRI, or chest or bone X-rays to check if the cancer has spread to the lungs or bones.

What are the stages of bladder cancer?

Staging bladder cancer helps doctors plan treatment strategies and predict treatment outcomes. Bladder cancer may be staged according to the TNM staging system as follows:

• T refers to the size of the tumor (T1-T4).
  
  • T1: A tumor is 2 cm or less in size.
  • T4: A large tumor extending to the outer layer or nearby organs.
• N refers to the extent of cancer spread to adjacent lymph nodes (N0-N3).
  
  • N0: No cancer found in lymph nodes.
  • N3: Cancer found in multiple lymph nodes or a metastatic lymph node larger than 5 cm.
• M refers to the spread of cancer to distant organs, such as the lungs or liver.
  
  • M0: Cancer has not spread.
  • M1: Cancer has spread beyond the pelvic region.

What are the treatment modalities for bladder cancer?

1. Surgery
   • Transurethral resection of bladder tumor (TURBT): This procedure can diagnose and remove a tumor in the same sitting. It is suitable for non-invasive bladder cancer. Doctors may surgically remove the tumor or destroy the cancerous tissue using an electric current (Fulguration).
   • Radical cystectomy: This involves complete removal of the bladder. It is appropriate for patients whose cancer has spread to other organs, those who have multiple primary cancers, or those whose cancer has grown into the deep muscle layer. In male patients, the doctor will also remove the prostate gland and seminal vesicles. In female patients, doctors will resect the ovaries, uterus, and part of the vagina. The surgeon may also perform urinary diversion.
2. Chemotherapy
   • Intravenous chemotherapy: This may be given before and after surgery to kill cancer cells. Doctors may use it in combination with radiation therapy.
   • Intravesical chemotherapy: The drug is instilled directly into the bladder and then flushed out after a period. Doctors may use this method as the primary treatment for cancer in the lining of the bladder that has not spread to the muscular layer.
3. Immunotherapy treatment
   • Intravenous immunotherapy: Suitable for patients with advanced-stage cancer or recurrent cancer.
   • Intravesical immunotherapy: This treatment uses Bacillus Calmette-Guerin (BCG), a component of tuberculosis vaccines, to activate the immune system to target and destroy cancer cells.
4. Radiation therapy
   • This method employs high-energy X-rays and photons to precisely and accurately destroy cancer cells. Doctors often recommend radiation therapy and chemotherapy for patients who do not want or cannot undergo surgery.
5. Targeted therapy
   • Targeted therapy stops or interferes with the functioning of cancer cells, preventing proliferation. It is suitable for advanced-stage cancers that do not respond to other treatment methods.
6. Bladder-preserving cancer treatment
   • For patients with muscle-invasive bladder cancer who do not want to undergo bladder removal surgery, doctors may recommend tri-modality therapy. These combine TURBT, chemotherapy, and radiation therapy. If cancer persists or recurs, patients may need to undergo radical cystectomy.

After treatment

Patients should attend follow-up appointments with their doctor to monitor for any recurrence of bladder cancer. Following initial treatment, follow-up appointments are typically scheduled every 3-6 months for the first few years. If the cancer does not return within 2-3 years, the doctor may decrease follow-ups to once a year.

Is bladder cancer preventable?

While we do not have foolproof bladder cancer preventive measures, we can avoid risk factors. For example:

• Quit smoking.
• Avoid exposure to chemicals.
• Seek medical attention promptly if there are any unusual symptoms, such as painful urination or blood in the urine.

Preparing for doctor appointments

• Take notes of symptoms and any medications or supplements currently being taken.
• Write down questions to ask the doctor, such as:
  
  • Do I need any additional tests?
  • What are the treatment options and their risks?
• Prepare answers for questions doctors might ask, such as:
  
  • What symptoms are you experiencing? Are they constant or intermittent?
  • How severe are the symptoms?
  • What alleviates or worsens the symptoms?

FAQ

• What are the warning signs of bladder cancer one should not ignore?
  If you notice blood in the urine, see a doctor promptly for proper diagnosis and evaluation.

A note from MedPark’s doctors

About half of bladder cancers are diagnosed and treated at the localized stage, significantly improving the chances of a cure. Patients concerned about the recurrence of bladder cancer should discuss ways to avoid risk factors and lifestyle modifications with their doctor to manage the disease and enhance their quality of life effectively.