Bladder Cancer: All You Need to Know to Raise Your Guards

Bladder Cancer, although not the most prevalent cancer of them all, often does not get the attention it deserves. As a result, symptoms often go unnoticed causing a delayed diagnosis.

Timely diagnosis significantly increases the chances of a successful treatment, making it all the more important to educate people about this lesser known type of cancer. The blog is aimed at raising awareness about bladder cancer by highlighting the basics including the signs and symptoms associated with the disease and the importance of early detection.

What is Bladder Cancer?

Bladder cancer is a type of cancer that begins in the cells of the bladder, the organ responsible for storing urine. Most bladder cancers start in the urothelial cells lining the bladder's interior. Key symptoms include blood in the urine, frequent urination, and pain during urination. Major risk factors include smoking and exposure to certain chemicals. Early detection through tests such as cystoscopy and urine analysis is crucial for successful bladder cancer treatment.

Types of Bladder Cancer

There are several types of bladder cancer, each defined by the type of cell in which the cancer originates. Here's a breakdown of the main types:

• Transitional Cell Carcinoma: The most common type is Transitional Cell Carcinoma (TCC), also known as urothelial carcinoma. TCC begins in the urothelial cells that line the inside of the bladder. This type can occur in two forms: non-invasive, where the cancer is confined to the inner layer of the bladder, and invasive, where the cancer spreads into deeper layers of the bladder wall.
• Squamous Cell Carcinoma: Squamous Cell Carcinoma is a type of bladder cancer that develops in the thin, flat cells that can form in the bladder following chronic irritation or infection. This type accounts for a small percentage of bladder cancers overall. It typically arises in cases where there has been long-term inflammation or repeated irritation of the bladder lining, often due to factors such as persistent infections or the presence of bladder stones. 
• Adenocarcinoma: Adenocarcinoma is a rare type of bladder cancer that begins in the glandular cells responsible for mucus production in the bladder. This type represents a small percentage of bladder cancers and is usually associated with long-term irritation and inflammation of the bladder.

What are the Signs and Symptoms of Bladder Cancer?

Bladder cancer often presents several signs and symptoms, though it's essential to note that these can also be indicative of other conditions. Here are some common signs and symptoms associated with bladder cancer:

• Blood in Urine (Hematuria): One of the most common symptoms of bladder cancer is blood in the urine, known as hematuria. The urine might appear pink, red, or cola-coloured. It's crucial to note that hematuria can occur due to various reasons, including infections or kidney stones, but it should always be investigated promptly, especially if it recurs.
• Urinary Changes: Bladder cancer can cause changes in urinary habits. This may include increased frequency of urination, urgency to urinate, or feeling the need to urinate without being able to pass much urine. These symptoms may mimic those of a urinary tract infection (UTI) but persist despite treatment.
• Painful Urination: Some individuals with bladder cancer may experience pain or burning during urination. This symptom can also be associated with urinary tract infections or other bladder conditions, so it's essential to seek medical evaluation if it persists.
• Pelvic Pain: Progression of bladder cancer causes discomfort or pain in the pelvic region. This pain may be persistent or intermittent and can vary in intensity.
• Back Pain: In some cases, bladder cancer may cause pain in the lower back, particularly if the cancer has spread to nearby tissues or organs, such as the kidneys or lymph nodes.
• Weight Loss and Fatigue: Advanced bladder cancer can lead to unintentional weight loss and fatigue. These symptoms often indicate a more advanced stage of the disease, where cancer may have spread to other parts of the body.
• Bone Pain: If bladder tumour metastasis (spreads) to the bones, it can cause bone pain, particularly in the pelvis, spine, or long bones like the femur or ribs.

Importance of Early Detection

Early detection is critical for successful bladder cancer treatment for a few key reasons:

• Increased Treatment Options: When bladder cancer is caught early, it's typically confined to the inner lining of the bladder. This allows for less invasive treatments like cystoscopy with tumour removal or transurethral resection of bladder tumour (TURBT). These procedures have high success rates and good long-term outcomes.
• Improved Bladder Cancer Prognosis: Early detection significantly improves the chances of a complete cure. When bladder cancer is diagnosed and treated in its early stages, the chances of successful treatment and long-term survival are higher. Conversely, delaying diagnosis can allow the cancer to progress, potentially making it more challenging to treat and reducing the likelihood of a favourable outcome.
• Preservation of Bladder Function: Early intervention can often preserve bladder function. If the cancer is more advanced, removing the entire bladder (cystectomy) may be necessary, which can significantly impact quality of life.
• Enhanced Quality of Life: Early detection not only improves the chances of successful bladder carcinoma treatment but also allows individuals to maintain a better quality of life throughout their treatment journey. By addressing the bladder cancer tumour in its early stages, individuals may experience fewer symptoms and have a shorter recovery time following treatment, allowing them to resume their normal activities more quickly.
  

Treatment Options for Bladder Cancer

Treatment options for bladder cancer vary depending on several factors, including the stage and grade of the cancer, the overall health of the patient, and their preferences. Following is a list of bladder cancer treatment options:

Surgery 

• Transurethral Resection of Bladder Tumour (TURBT): This is the most common procedure for bladder cancer, especially in the early stages. During a TURBT, a thin, lighted instrument is inserted through the urethra (the tube that carries urine out of the body) to reach the bladder. The surgeon then uses electrical current to remove the tumour. TURBT can also be used for diagnostic purposes to determine the extent and nature of the cancer.
• Radical Cystectomy: This surgery involves removing the entire bladder, along with some surrounding lymph nodes and nearby organs like the prostate in men or the uterus and ovaries in women. This is typically recommended for invasive bladder cancer that has spread beyond the inner lining of the bladder. After the cystectomy procedure, a bladder cancer doctor needs to create a new way for urine to leave the body (urinary diversion). There are different types of diversions, such as creating an ileal conduit (using a part of the small intestine) or forming a neobladder (a pouch from nearby intestine).

Chemotherapy

Chemotherapy may be used as an adjuvant treatment before or after surgery (neoadjuvant or adjuvant chemotherapy) for MIBC (Muscle-Invasive Bladder Cancer) to help shrink tumours, reduce the risk of recurrence, or treat cancer that has spread beyond the bladder. In some cases, chemotherapy for bladder cancer may be used as the primary treatment for individuals who are not candidates for surgery.

Immunotherapy

Immunotherapy drugs are increasingly being used to treat advanced or metastatic bladder cancer that has progressed despite other treatments. These medications work by boosting the body's immune response to target and destroy cancer cells

While generally well-tolerated, immunotherapy can cause side effects such as fatigue, rash, and flu-like symptoms. More serious side effects are possible but less common.

Radiation Therapy

Radiation therapy is another weapon in the fight against bladder cancer. It uses high-energy X-rays or other forms of radiation to kill cancer cells or shrink tumours.

• External Beam Radiation Therapy: This is the most common type of radiation therapy used for bladder cancer. A large machine outside the body directs beams of radiation precisely at the tumour and surrounding tissues.

• Internal Beam Radiation Therapy: In some cases, a radioactive implant may be placed directly into the bladder for a short period. This approach delivers a concentrated dose of radiation to the tumour while minimising exposure to healthy tissues. This approach is also termed as Brachytherapy.

Frequently Asked Questions

What is a bladder cancer awareness campaign?

Bladder cancer awareness campaigns are initiatives designed to educate the public and healthcare providers about bladder cancer. Organisations around the world hold events, share educational resources.

What are the gender differences in bladder cancer?

Men are 3-5 times more likely to get bladder cancer than women. However, women are more often diagnosed at a later stage and have a worse prognosis despite the lower incidence. This difference is likely due to factors like smoking, occupational exposures, hormones, and genetics

There aren't significant symptom differences between male bladder cancer and female bladder cancer. Both genders experience the same core symptoms. However, some studies suggest women might be more likely to mistake blood in the urine for menstruation, potentially delaying diagnosis. This is why it's important for everyone to be aware of these symptoms and seek medical evaluation regardless of gender.

How is bladder cancer diagnosed?

Diagnosing bladder cancer often involves a combination of tests:

• Urinalysis: Checks for blood or abnormal cells in your urine.
• Cystoscopy: A thin camera is inserted through the urethra to view the inside of the bladder.
• Biopsy: A tissue sample is removed from the bladder for analysis under a microscope to confirm cancer.

Imaging tests like CT scans or ultrasounds may also be used in some cases.

What are the new treatments for bladder cancer? 

The field of bladder cancer treatment is constantly evolving, with new and promising therapies emerging. Here's a glimpse into some of the recent advancements

• Targeted Therapy: These drugs target specific molecular abnormalities within cancer cells, aiming to disrupt their growth and spread. While still under investigation, targeted therapy holds promise for bladder cancer, particularly for patients whose tumours have specific mutations.
• Gene Therapy: This approach involves introducing genetic material into cells to alter their function. New gene therapies are being approved by the FDA for a specific type of high-risk, non-muscle invasive bladder cancer that hasn't responded to BCG treatment.

Can bladder cancer be fully cured?

Yes, bladder cancer can be fully cured, especially in early stages (non-muscle invasive) with treatments like surgery or BCG therapy. Early detection is key for maximising cure for bladder cancer.

What is the survival rate of bladder cancer? 

Yes, bladder cancer can be fully cured, especially when caught early. Treatments like surgery or chemotherapy are effective, but success depends on factors like cancer stage and overall health. Regular follow-ups are crucial for monitoring and managing any recurrence.

How painful is bladder cancer?

Bladder cancer itself isn't usually painful in the early stages. Blood in the urine (hematuria) is often the first noticeable symptom. In advanced stages, however, pain may occur in the lower back, pelvis, or during urination.

Conclusion

Bladder cancer may not be at the forefront of health concerns, but with awareness and early detection, you can significantly improve your chances of a successful outcome. Share this information with your loved ones and don't hesitate to seek medical advice at Max Hospitals if you experience any concerning symptoms.