Bladder Cancer: Types, Causes, Symptoms, Stages, Diagnosis, Treatment & Prevention

Last Updated on May 5, 2023 by Shabnam Sengupta

Bladder cancer is one of the ten most common cancer types globally. Nearly 600,000 people get diagnosed with bladder cancer every year. Out of these, about 200,000 people die due to this disease. If diagnosed at an early stage, bladder cancer is highly treatable.

Introduction

Bladder cancer develops in the epithelial cell lining of the urinary bladder. The bladder is a hollow bag-like structure located in the lower part of the abdomen. The primary function of bladder is to store urine produced from the kidneys until it is passed. However, this prolonged storage also increases the risk of contact between the harmful substances in the urine and the inner bladder lining. This can lead to DNA changes and cancerous cell development if consistent over a very long period of time.

The most common toxic substance triggering bladder cancer is tobacco with a positive history of its consumption in more than 33% of all patients developing bladder cancer.

Types of Bladder Cancer

There are three types of bladder cancer on the basis of the type of cell composition of the tumour and the cells affected.

• Urothelial carcinoma: It develops from the epithelial lining of the urinary bladder called the urothelium. It is the most common type of bladder cancer.
• Adenocarcinoma: It is made up of mucous-producing cells and develops from the urothelium.
• Squamous cell carcinoma: This develops when there is chronic irritation in the cells of the bladder. For example, long-term catheter use or recurrent UTI. It is the rarest type of bladder cancer.
• Other rare types like small cell cancer, sarcoma, etc. can also be seen.

Causes and Risk factors

Consumption or exposure to substances that are carcinogenic can bring about malignant changes in the cells of the urinary bladder. This change can increase the risk of cancer development.

• Smoking: Prolonged exposure to tobacco causes cancerous cell mutations in the bladder.
• Gender: Males have a higher risk than females 
• Age: Risk of development increases after the age of 55
• Occupation: Occupational exposure to carcinogenic chemicals like dyes, paints, rubbers, etc. also predisposes to the development of bladder cancer 
• Family history: A positive family history increases the chances 
• Radiation exposure: Leads to harmful DNA mutations in the cell
• Recurrent UTI: Recurrent bladder infection may increase the risk
• Bladder stones: Repeated irritation in the bladder leads to irreversible changes in the bladder cell which may later progress to malignancy 

Signs and symptoms

In the early stages, bladder cancer can remain asymptomatic or present with occasional episodes of blood in urine. However, as the tumour starts to grow in size, other symptoms can be observed:

• Frequent hematuria (presence of blood in urine)

• Sudden urge to urinate 
• Pain while urinating 
• Burning sensation while urinating 
• Pelvic pain 
• Unintentional weight loss 
• Back pain 
• Symptoms due to metastasis to a distant organ

Stages of Bladder Cancer

The staging is done by the TNM method (T- Tumour, N- lymph nodes, M – Metastasis).

T Stage – There are five stages of tumour staging depending on the extent of tumour growth and metastasis:

• T 0: There is no tumour in the bladder
• T 1:  The tumour has spread to the connective tissue underlying the urothelium but not the muscle layer of the bladder 
• T 2: The tumour has infiltrated the muscle layer of the bladder 
• T3: The tumour has grown into the perivesical tissue (the fatty tissue that surrounds the bladder).
• T4: The tumour has spread beyond the perivesical tissue

N Stage – A total of four stages based on the number of lymph nodes involved:

• N0 – No lymph nodes are involved 
• N1- Only 1 lymph node is involved
• N2- Two or more lymph nodes are involved

M Stage – There are only two stages based on whether the tumour has metastasised or not:

• M0- No metastasis 
• M1- Distant metastasis 

Diagnosis

A bladder tumour can only be suspected based on the risk factors and the clinical signs and symptoms. Further tests are required for confirmation.

Bladder tumours are visualised with the help of various scans and tests to measure their dimensions, location and infiltration into surrounding tissue.

• Cystoscopy: A small camera fitted to a tube is passed from the urethra into the bladder to visualise the presence and extent of tumour growth.

• Urine cytology: This is the microscopic examination for the presence of malignant cells in urine.
• Biopsy: The confirmatory test where a small part of the tumour is removed and examined under a microscope to see the malignant changes in the tumour cells. It also helps us in the grading of bladder cancer.

Imaging may also be done to look for the extent of the tumour and for metastasis in distant organs: 

• PET-CT
• MRI 
• Bone scan
• Chest X-ray

Treatment

Treatment protocol varies with respect to the extent of tumour growth and the presence or absence of metastasis. 

Low-grade tumour: If the tumour is small, and hasn’t involved the bladder muscles then the following methods are opted for:

• TURBT ( transurethral resection of bladder tumour): Only the affected part of bladder tissue is removed via the urethra instead of removing the entire bladder.
• Chemotherapy in the bladder (intravesical chemotherapy): Drugs that kill the highly dividing cancerous cells are put directly inside the bladder

High-grade tumour: If the tumour is large in size and has infiltrated the muscle layer along with distant metastasis then systemic treatment protocols are opted for:

• Cystectomy: The entire bladder is removed and a bypass is created for the passage of urine by connecting it to the intestine or bag.
• Systemic chemotherapy: Anti-cancer drugs are intravenously given to kill all the cancer cells.
• Systemic radiotherapy: High-energy waves are used to eliminate the rapidly dividing cancer cells 
• Immunotherapy: Antibodies specifically against the cancer cells are administered. 
• Targeted therapy

Prevention

The risk of any cancer in the body can be reduced by maintaining a healthy lifestyle.

General methods of prevention: 

• Consumption of fruits and vegetables 

Specific methods of prevention:

• Avoiding smoking and tobacco consumption 
• Minimising exposure to carcinogenic chemicals 
• Frequent scans and checkups in case of cancer history or family history

Disclaimer: Medical Science is an ever evolving field. We strive to keep this page updated. In case you notice any discrepancy in the content, please inform us at [email protected]. You can futher read our Correction Policy here. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website or it's social media channels. Read our Full Disclaimer Here for further information.