Bladder cancer is caused by the uncontrolled growth of cells lining the bladder’s walls. It is usually treated with surgery, chemotherapy, immunotherapy, or radiation therapy.
The bladder is a hollow, muscular balloon-shaped organ where urine is deposited and stored. The kidneys’ urine produces urine, which ‘clean’ the blood by filtering water and waste products to form urine.
Urine passes from the kidneys to the bladder through tubes called ureters and the urethra.
What is bladder cancer?
Bladder cancer develops in the lining of the bladder walls. It is caused by uncontrolled cell growth.
Bladder cancer mainly affects people over 50 and is more common in men than women.
types of bladder cancer
There are different types of bladder cancer, named for the type of cell where cancer first occurs and how far it has spread. These are described below:
Transitional cell carcinoma (TCC). This type of cancer is the most common type of bladder cancer and develops in the top layer of cells that line the bladder’s walls. These cells are in contact with waste products in the urine that can cause cancer.
Squamous Cell Carcinoma (SCC). This type of cancer develops in the cells of the stratum spinosum that cover the walls of the bladder.
Adenocarcinoma. This is a scarce type of bladder cancer that develops in the cells that make the mucus that covers the bladder’s walls.
Superficial bladder cancer (non-invasive). This cancer is found only in the lining of the bladder and has not spread to the inner layers. Superficial bladder cancer is usually an early stage of transitional bladder cancer. It usually appears as a mushroom-shaped growth on the bladder’s lining (called papillary carcinoma).
Invasive bladder cancer. Cancer has spread to the muscular wall of the bladder. Transitional cell cancer can become invasive. Depending on how far it has spread, invasive bladder cancer is divided into T2, T3, or T4. For more information, see Cancer Stages and Staging.
Bladder cancer symptoms
- Symptoms of bladder cancer include:
- burning when urinating
- need to urinate frequently
- the feeling of wanting to urinate but not being able to
- pelvic pain
- blood in the urine
Causes of bladder cancer
Doctors have not been able to determine why bladder cancer develops fully. However, certain factors increase the chances of developing it.
Smoking triples the risk of bladder cancer. Passive smokers are also at risk.
Exposure to certain industrial chemicals (for example, those used in printing and textiles, gas and tar manufacturing, and the iron and aluminium processing industries).
Long-term infection of the tropical disease schistosomiasis (bilharziasis).
Repeated bladder infections or long-term infections.
Diagnosis of bladder cancer
You may need to have the following tests to confirm the diagnosis:
Cystoscopy. This is a procedure used to see inside the bladder and urinary system. The surgeon may take a biopsy (a small tissue sample) during the process. This will be sent to a lab to determine the type of cells and whether they are benign (not cancerous) or cancerous.
Intravenous urography (IVU). This x-ray procedure is used to see inside the bladder and urinary system, during which a dye is injected into the blood through a vein in the arm. The kidneys then remove the paint from the blood, and x-ray images show how the dye travels through the urinary system. This helps the surgeon determine if there is anything unusual.
Ultrasound, Magnetic Resonance Imaging (MRI), or Computerized Axial Tomography (CAT). These scans help doctors check the urinary system to determine if cancer has spread.
Bladder cancer treatment
- Treatment depends on the position and size of cancer in the bladder and how fast it has spread. The doctor will discuss treatment options with you.
- Transurethral resection of the bladder (TURB)
- This is a procedure used to remove unusual growths or tumours on the bladder wall. Using a flexible cystoscope, a loop-shaped wire is inserted through which an electrical current passes to cut or burn the tumour and healthy tissue around it. For more information, see transurethral resection of the bladder, TURB.
- Bladder treatment with Mitomycin C or Bacillus Calmette and Guérin (BCG)
- Mitomycin C is a chemotherapy drug used to kill cancer cells. BCG is an immunotherapy that contains a weakened form of the bacterium Mycobacterium Bovis, which is also used to vaccinate against tuberculosis (TB). BCG stimulates the immune system to attack cancer cells. Mitomycin C and BCG are usually given after bladder surgery and are sometimes used alone to treat bladder cancer. For more information, see Bladder Treatment with Mitomycin C or Bacillus Calmette and Guérin (BCG).
- Surgery (total or partial cystectomy)
- The primary treatment for muscle-invasive bladder cancer is to remove the bladder and surrounding tissue. This operation is called a total or partial cystectomy. It is usually followed by radiotherapy treatment.
Radiation therapy or chemotherapy may also be given to shrink the tumour before surgery.
Urostomy. The ureters are connected to a small opening (stoma) in the abdomen using a small part of the small intestine. A flat, airtight bag is placed over the stoma to collect the urine.
Continent cutaneous urinary diversion. A part of the intestine is used to form a bag to collect urine. The load is connected to the outside of the body through a stoma that is kept closed with a valve. You should empty the bag four to five times a day by inserting a catheter into the stoma.
Bladder reconstruction. A new bladder is built using part of the intestine. Urine drains from the ureters into the new bladder. You will need to learn to urinate through the urethra using your muscles. It may be that you have lost the nerves used to feel when your bladder is complete, so you will need to remember to empty your bladder regularly.
Bladder cancer prevention
Consuming enough vitamin D reduces the risk of developing several types of cancer, including bladder cancer.
Vitamin D is naturally produced by the body when the skin is exposed to sunlight.
You can reduce your risk of developing bladder cancer by quitting smoking and taking 35 to 50 micrograms of vitamin D a day (about three to four high-potency 12.5-microgram tablets). Always read the patient information leaflet that comes with your supplements, and if you are pregnant or nursing, check with your doctor or pharmacist first. Also, consult your doctor if you take diuretics to treat high blood pressure or if you have a history of kidney stones or kidney failure.
living with bladder cancer
After bladder cancer treatment, you should have regular checkups with your doctor. Many hospitals have nurses who can help and advise you on how to care for your urostomy.
questions and answers
Can bladder cancer be diagnosed through a urine test?
A urine test is usually done to determine if a urinary tract infection causes the symptoms and to detect the presence of blood in the urine. Bladder cancer is generally diagnosed by taking a biopsy of the bladder wall.
Currently, bladder cancer is diagnosed through cystoscopy and biopsy of the bladder wall. However, other tests are developing that could diagnose bladder cancer from a urine sample.
NMP22 (nuclear matrix protein 22) test. This marker checks the levels of the protein NMP22 in the urine. Some MPNs have been found in cells
of certain types of bladder cancer, including the most common type, transitional cell carcinoma (TCC). NMP22 levels are often higher in the urine of TCC patients than in people with a healthy bladder.
Mcm5 test (mini-chromosome five maintenance). This marker checks the levels of Mcm5 protein in the urine. This protein is produced by certain types of cancer, including TCC. Mcm5 levels are generally higher in CBT patients than in people with a healthy bladder.
BTA test (bladder tumour-associated antigen). This marker uses two monoclonal antibodies (proteins made in a laboratory) to look for specific cancer proteins in the urine. BTA protein levels are generally higher in patients with bladder cancer than in people with a healthy bladder.