Urinary Bladder Cancer: Types, Symptoms, Stages, Treatment- TUR Surgery, Immunotherapy
Cancer which starts in the urinary bladder is known as urinary bladder cancer. Urinary bladder is located in the human pelvis and is shaped like a balloon. Its function is storing the urine. Cancer commonly begins in the internal lining of the cells of the bladder. Older adults are commonly affected by this disease; however, bladder cancer can occur in individuals from any age group.
In majority of the individuals, the diagnosis of urinary bladder cancer is made at an early stage, thus making the chances of treating the cancer high. However, there is always a chance of recurrence. So, patient should do follow-up tests for many years after they are declared cancer free to catch any recurrence of urinary bladder cancer.
Treatment for urinary bladder cancer depends on the stage of the cancer and patient's general health and it includes: Surgery, radiation therapy, chemotherapy and immunotherapy.
Types of Urinary Bladder Cancer
The type of the urinary bladder cancer depends on the bladder cell type where the cancer has originated. Different types of urinary bladder cancer are:
- Squamous Cell Carcinoma: In this type, the cells of the bladder, due to recurrent irritation and infection turn cancerous. This type of urinary bladder cancer is more common in those parts of the world where schistosomiasis, which is a parasitic infection, is widespread.
- Transitional Cell Carcinoma: This type develops in the cells which are lining the internal side of the bladder. Transitional cell carcinoma is one of the frequently occurring types of urinary bladder cancer in America.
- Adenocarcinoma: This type of urinary bladder cancer develops in the cells of the glands which secrete mucus in the bladder. Adenocarcinoma is quite sporadic in the United States of America.
There are some urinary bladder cancers in which more than one cell type is involved.
Causes of Urinary Bladder Cancer
The exact cause of urinary bladder cancer is not clear. Experts believe that DNA mutations in the cells cause uncontrollable and rapid dividing of the cells leading to build up of abnormal cells, which result in cancer or tumor. Some of the risk factors for urinary bladder cancers are: Parasitic infection, smoking, exposure to chemicals and radiation therapy for treatment of other/previous cancers.
Risk Factors for Urinary Bladder Cancer
- Smoking cigarettes, pipes, cigars etc. increases the risk for having urinary bladder cancer.
- The risk of urinary bladder cancer increases as you get older.
- White individuals are at a higher risk for developing bladder cancer when compared to other races.
- Men are at a higher risk for developing this cancer than women.
- Certain chemical exposure, such as to arsenic, and other chemicals which are used in manufacturing of rubber, dyes, textiles, paint products and leather increases the risk of having bladder cancer.
- Taking certain medications for diabetes, such as pioglitazone (Actos), for long duration increases the risk of bladder cancer.
- Treatment for previous cancer, such as with cyclophosphamide (Cytoxan), which is an anti-cancer drug; or radiation therapy to the pelvis for treatment of other cancers, increases the risk of having bladder cancer.
- Recurrent or chronic urinary infections or cystitis increases the risk of developing squamous cell bladder cancer.
- A certain parasitic infection (schistosomiasis) increases the risk of bladder cancer in certain parts of the world.
- Having a family history of Lynch syndrome, which is also known as hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of bladder cancer along with the cancer of colon, ovaries and uterus.
- Having a family history or a previous history of urinary bladder cancer increases the chances of you having one.
Signs and Symptoms of Urinary Bladder Cancer
- Hematuria, which is blood in urine, makes the urine appear bright red, dark yellow or cola colored.
- Pain upon voiding.
- Frequent urination.
- Pain in the back.
- Pain in the pelvis.
Investigations for Urinary Bladder Cancer
- Cystoscopy helps in viewing the inside of the bladder and urethra by inserting a cystoscope, which is a narrow tube through the urethra.
- Biopsy can be taken during cystoscopy and the collected tissue sample is sent for testing for cancer cells. Passing a special instrument via the cystoscope into the bladder to collect tissue sample or biopsy is known as transurethral resection (TUR). This test can also be done for treating urinary bladder cancer and is commonly done using general anesthesia.
- Urine cytology where a urine sample is taken and microscopically analyzed for the presence of cancer cells.
- Intravenous pyelogram uses dye for highlighting the urinary system (ureters, bladder, and kidneys).
- CT (Computerized Tomography) scan helps in better assessment of the urinary system and its adjacent tissues.
Staging Tests for Urinary Bladder Cancer
Tests done to determine the stage or the extent of the urinary bladder cancer include:
- Chest x-ray.
- CT scan.
- Bone scan.
- Magnetic resonance imaging (MRI).
Stages of Urinary Bladder Cancer
- Stage I: In this stage, the cancer is confined to the inner lining of the bladder and has not spread to the wall of the bladder.
- Stage II: In this stage, the cancer is still restricted to the bladder, but has infiltrated the bladder wall.
- Stage III: In this stage, the cancer has metastasized through the wall to the adjacent tissues. In men, cancer could also have metastasized to the prostate. Whereas, in women, cancer may have metastasized to the vagina or uterus.
- Stage IV: In this stage, the cancer has metastasized to the lymph nodes and organs like liver, lungs or bones.
Treatment of Urinary Bladder Cancer
Treatment for urinary bladder cancer depends on the stage and the type of the cancer, patient's general health and patient's treatment choices. Treatment options include:
Surgery for Urinary Bladder Cancer
There are many surgical procedures available and the choice of the procedure depends on the cancer stage, patient's general health and treatment preferences.
Surgical procedures for urinary bladder cancer which is in its early stage, i.e. where the cancer is small and hasn't infiltrated the bladder wall include:
- Transurethral Resection (TUR) is a surgical procedure which is commonly done to remove cancer which is restricted to the inner layers of the urinary bladder. In this procedure, the surgeon passes a small sized wire via the cystoscope into the bladder. Electric current or high-energy laser is used to kill or burn the cancer cells. Side effects of TUR include bloody or painful urination for some days after the surgery.
- Segmental Cystectomy or Partial Cystectomy comprises of removing the tumor along with a small part of the bladder containing cancerous cells. Segmental cystectomy is done when the cancer is confined to a part of the urinary bladder and can be easily removed without damaging the bladder function.
The risks of surgery include infection and bleeding. Side effects include frequent urination, which may get better over time.
Surgical procedures for urinary bladder cancer which is invasive, i.e. where the cancer has infiltrated the deep layers of the wall of the bladder include:
- Radical cystectomy is where the entire urinary bladder along with the surrounding lymph nodes is removed. This also includes removing the seminal vesicles and prostate in men; and ovaries, uterus and a portion of the vagina in females.
- There is a risk of infection and bleeding with cystectomy. Men may experience erectile dysfunction. Women will suffer from premature menopause and infertility due to removal of uterus and ovaries.
Immunotherapy or Biological Therapy for Urinary Bladder Cancer
Immunotherapy, also known as Biological Therapy, is a treatment where the body's immune system is enhanced or used to fight against cancer cells. Drugs used in immunotherapy for urinary bladder cancer are intravesical therapy, i.e. administered via urethra directly into the bladder; and these drugs include : Bacillus Calmette-Guerin (BCG) and interferon alfa-2b (Intron A).
Chemotherapy for Urinary Bladder Cancer
Chemotherapy involves the use of medicines or drugs to destroy cancer cells. Drugs used in chemotherapy for treating urinary bladder cancer may be two or more drugs used in combination. Chemotherapy drugs can be administered intravenously or directly into the bladder, which is known as intravesical therapy. Chemotherapy is also done before surgery to shrink the tumor or after the surgery to kill any remaining cancer cells. Chemotherapy can also be used in conjunction with radiation therapy.
Radiation Therapy for Urinary Bladder Cancer
Radiation therapy involves the use of high-energy beams, such as x-rays, which are directed at the area of the body where the cancer is present, to kill cancer cells. Like chemotherapy, radiation therapy can also be done after the surgery to destroy or kill any remaining cancer cells. Radiation therapy can also be used in conjunction with chemotherapy.