What is Bladder Cancer?

Bladder cancer is an abnormal tissue (tumor) growth in the bladder. There are several stages of bladder cancer. Your treatment and experience,  will depend on the specific characteristics of the tumor (pahse of the tumor) and the expertise of your medical team.

The sections of this series provide general information about bladder cancer, diagnosis and various treatment options. Discuss with your doctor, what is best in your personal situation.

What causes bladder cancer?

Several biological factors and harmful substances can increase the risk of developing bladder cancer. A higher risk does not surely mean that there will be cancer. Sometimes, bladder cancer can occur without any known cause.

Phases of the Disease

The growing tumor into the bladder without growing into the bladder’s muscle tissue is called non-muscle invasive. These tumors are superficial and represent the early stage. This is the most common type of bladder cancer. In most cases, these tumors are not aggressive and rarely spread to other organs, so they are usually not fatal, but may reappear (= recurrence) or develop aggressive characteristics (= progression).

As the cancer grows into the bladder muscle and spreads around the surrounding muscles, it becomes muscle invasive bladder cancer. This type of cancer is more likely to spread to other parts of the body (metastatic disease) and is more difficult to treat. In some cases it can be fatal.

If bladder cancer spreads to other parts of the body, such as lymph nodes or other organs, it is called locally advanced or metastatic bladder cancer. At this stage it is unlikely to be cured and treatment is limited to controlling the spread of the disease and reducing the symptoms.

Risk Factors for Bladder Cancer

Bladder cancer develops slowly and is more common in older people (60 years and older). According to the European Urology Association’s bladder cancer guidelines, tobacco contains many harmful substances and is responsible for almost half of bladder cancer cases.

Another known source of risk is occupational exposure to chemicals used in paint, metal and oil production; however, the safety instructions applied at the workplace have helped to reduce this risk.

Infections caused by some parasites and chronic urinary tract infections increase the risk of bladder cancer development.

Bladder Cancer Prevention

A higher risk does not necessarily mean that a person will have cancer. Sometimes bladder cancer develops without a known cause.

Maintaining a healthy lifestyle is important. If you smoke, try to quit. Comply with workplace safety regulations and avoid exposure to harmful chemicals. Some evidence suggests that drinking too much fluid, especially water, can reduce the risk of bladder cancer. A balanced diet with large amounts of fruits and vegetables has health benefits and can protect against cancer. If you have questions or need help to maintain a healthy lifestyle, ask your healthcare team for help or guidance.

Findings and Symptoms

The presence of blood in the urine is the most common symptom in the presence of bladder cancer. Tumors on the inner surface of the bladder (non-muscle-invasive) do not cause bladder pain and are usually not seen with lower urinary tract symptoms (sudden need to urinate, irritation).

If you have urinary tract symptoms such as painful urination or more frequent urination, a malignant tumor may be suspected, especially if the presence of infection can be ruled out or there is no reduction in symptoms despite treatment. Muscle-invasive bladder cancer may cause symptoms as it grows into the bladder muscle and spreads towards the surrounding muscles.

In some cases, when the tumor is more advanced, some symptoms may be seen, such as pelvic pain, side pain, weight loss, or mass sensation in the lower abdomen.

Urine test
Because urine blood is the most common symptom in the presence of a bladder tumor, your doctor will test your urine to seek out cancer cells in your urine and exclude other possibilities, such as urinary tract infections. Your doctor may call this test “urinary cytology”.
Physical examination cannot demonstrate non muscle invasive bladder cancer and can rarely show a mass if the cancer progresses to the muscle invasive phase. If there is a suspicion of muscle-invasive bladder cancer, your doctor should perform a rectal examination by hand and perform a vaginal examination by hand for women (bimanual palpation).

In addition, your doctor will perform a series of tests to put the diagnosis. Advanced diagnostic tools are described in the next section.

Diagnosis and Treatment

Your doctor will take a detailed medical history and ask questions about your symptoms. Prepare for the interview and help your doctor.
• Make a list of your previous surgical procedures.
• Make a list of the medicines you are using.
• Talk about other diseases and allergies.
• Identify your lifestyle in which exercise, smoking, alcohol and diet are involved.
• Explain your current symptoms.
• Indicate how long you have been present.
• Talk about family history, especially urinary tract tumors.

 

Transabdominal Ultrasound

Ultrasound is a diagnostic tool that can visualize masses larger than 5-10 mm in non-invasive, full bladder. It cannot detect very small or superficial tumors (CIS). This study does not require intravenous contrast; however, ultrasound cannot replace CT urography or cystoscopy.

CT Urography

A computed tomography (CT scan) urography provides your doctor with information about possible tumors in the kidneys or ureters and, moreover, lymph nodes and abdomen. Scanning takes about 10 minutes and uses x-rays. This imaging technique is the most accurate way to diagnose cancer in the urinary tract.

Cystoscopy

Cystoscopy is the basic test used to diagnose bladder cancer. It allows your doctor to look inside your bladder and urethra using a thin, light tube called a cystoscope.

Transurethral Resection of Bladder Tumor

TURBT is the surgical removal of bladder tumors (resection). This procedure is both diagnostic and therapeutic. It is a diagnostic procedure because the surgeon removes the tumor and all necessary additional tissues for microscopic examination (histological evaluation). TURBT is also therapeutic because complete removal of all visible tumors is the treatment of this cancer. Complete and correct TURBT is necessary for good prognosis. In some cases, a second TURBT is needed after a few weeks.

Radical Cystectomy

The main treatment of muscle invasive bladder cancer is the surgical removal of the bladder.

There are several reasons your doctor may recommend removing the entire bladder:

  • Presence of muscle invasive tumor
  • The presence of multiple cancerous areas (multifocal), aggressively growing (high-grade) or superficial but recurrent after chemotherapy or immunotherapy
  • Failure or relapse after a bladder-sparing approach (chemoradiation) or serious side effects
  • Symptoms such as bleeding or pain in patients who cannot be treated definitively

How to Perform Bladder Removal?

The removal of the bladder is done by an abdominal incision (open) to the patient under general anesthesia (performed by a combination of intravenous drugs and inhaled gases; so that you will be asleep). The bladder, the proximal end of the ureters, the pelvic lymph nodes and some of the sex-specific adjacent organs (part) are removed. Then another way to store and empty urine (urinary diversion) should be established.