Bladder Cancer: Causes, Symptoms, Diagnosis, and Treatment

Bladder cancer, a prevalent form of cancer, tends to affect more individuals over the age of 60. It is also found more commonly in individuals who smoke or have a history of inflammation or recurrent urinary tract infections. This post aims to provide an in-depth understanding of bladder cancer, its symptoms, and how it manifests in the body.

What is Bladder Cancer?

Bladder cancer is a type of malignant tumor that forms in the tissues of the bladder. It is the most common form of tumor affecting the urinary system, accounting for 3-4 percent of all malignant neoplasms. It is more prevalent among males, ranking fourth among malignant tumors in this demographic, and eighth among females.

Bladder cancer can affect different types of cells, which influences both the progression of the disease and its treatment. The most common forms of bladder cancer include:

• Transitional cell carcinoma (or urothelial carcinoma): This is the most prevalent form of bladder cancer. It develops in the cells that form the internal lining of the bladder wall. The same cell type also covers the internal walls of the urethra and uterus, which are further sites potentially subject to the development of this form of cancer.
• Squamous cell carcinoma: This type of cancer involves flat, thin cells that may form in the bladder in response to a long-term infectious or irritative process.
• Adenocarcinoma: This form of cancer originates from cells belonging to the glandular component of the bladder. It is relatively rare.

Staging

Bladder cancer is classified into stages of increasing severity based on diagnostic results. The stage of the tumor is more advanced the greater the penetration of the tumor into the bladder muscles. Here's a general indication of the stages:

• Stage 0: The cancer is confined to the most superficial layer of the organ and has not invaded the underlying muscular layer.
• Stage I: The tumor cells have invaded the underlying layer, but without involving the muscular layer.
• Stage II: The carcinoma has invaded the bladder wall deeply, reaching the muscle layer.
• Stage III: Cancer cells have invaded surrounding tissues and may have reached the prostate in men and the vagina or uterus in women.
• Stage IV: Tumor cells have invaded local lymph nodes and may have involved other organs via the lymphatic circulation.

Identifying Risk Factors

Bladder cancer is more common in men, with a male to female ratio of 3:1. The incidence of this disease tends to increase with age, particularly in the 6th and 7th decades of life, while it is very low before the age of forty.

Smoking is a significant risk factor, with the risk of developing bladder cancer being twice as high in smokers than in non-smokers. The risk is particularly high for long-term smokers who consume 10 or more cigarettes a day.

Occupational exposure to certain chemicals, such as polycyclic aromatic hydrocarbons (e.g., 2-naphthylamine and 4-aminobiphenyl), can also increase the risk of bladder cancer. Workers in the textile, dye, rubber, and leather industries, miners, chimney sweeps, hairdressers, and those who apply preservatives and pesticides are at a higher risk.

Chronic or repeated urinary inflammation, common in paraplegics and catheterized patients or those with a history of kidney stones, can increase the risk of bladder cancer. Patients undergoing treatment with certain chemotherapy drugs or radiation therapy for cervical cancer are also at an increased risk.

Certain dietary factors, such as excessive consumption of fats, coffee, and artificial sweeteners, may increase the risk, while adequate intake of liquids, vitamin C, vitamin A, and carotenoids may have a protective effect.

Recognizing the Symptoms

The symptoms of bladder cancer can vary greatly from person to person. In many instances, the initial sign is the presence of blood in the urine. This symptom, known as hematuria, can manifest as red or rust-colored urine and may sometimes be accompanied by small blood clots. While hematuria can be caused by other conditions, its occurrence should prompt further investigation, especially if other symptoms of bladder cancer are present.

Common Symptoms

• Anuria: The absence of urine production.
• Bladder Dysfunction: Issues with bladder control, such as urinary incontinence or overactive bladder.
• Dysuria: Pain or discomfort during urination.
• Nocturia: The need to wake up and urinate during the night.
• Pollakiuria: Frequent urination during the day.
• Urinary Retention: Difficulty in fully emptying the bladder.
• Stranguria: Slow and painful urination, often in drops.
• Vesical Tenesmus: A constant urge to urinate, with little result.

Less Common Symptoms

• Abdominal Pain: Discomfort or pain in the abdomen.
• Backache: Pain in the lower back, not related to injury or exertion.
• Urethral Discharge: An unusual discharge from the urethra, which may only be visible after squeezing the glans.

When to Consult a Healthcare Professional

It's essential to remember that many of these symptoms can also be caused by conditions other than bladder cancer, such as benign prostatic hypertrophy, kidney stones, or prostate inflammation. However, if you're experiencing any of these symptoms, especially if they persist or are accompanied by other worrying signs, it's crucial to consult a healthcare professional. They can provide a more precise diagnosis and guide you towards appropriate treatment options.

Diagnosis

The diagnosis of bladder cancer involves a combination of clinical, instrumental, and laboratory tests. It is crucial to have a detailed personal and occupational history, along with an evaluation of the symptoms.

A rectal or vaginal examination can be conducted to identify the presence of any abnormal masses. The doctor delicately inserts a lubricated finger into the vagina and/or rectum, palpating the anterior region.

Urine analysis provides crucial diagnostic clues. During urinary cytology, a sample is examined under a microscope to look for abnormal cells. This test has good specificity but is not very sensitive, meaning a negative test does not necessarily rule out the presence of the tumor.

Instrumental tests such as urography, pelvic ultrasound, scintigraphy, and abdominopelvic CT can provide further information. However, cystoscopy remains the cornerstone examination in the diagnosis of bladder tumors. During this procedure, a thin tube equipped with a camera and a light source is inserted into the urethra and brought up to the bladder. This microcamera transmits detailed images of the organ, allowing the identification of any suspicious lesions. Biopsies can also be taken during this examination for further analysis.

Treatment

The treatment of bladder cancer depends on the type of tumor, its stage of development, and the patient's general health condition. If the carcinoma has not invaded the deep layers of the bladder wall, surgery is usually performed to remove the tumor mass. This can be performed transurethrally in less serious stages. The malignant formation is destroyed by inserting a flexible cytoscope into the urethra, which conveys a destructive electric current or high-energy laser to the abnormal formation.

Local chemotherapy interventions can support these treatments. These involve the instillation into the bladder of various substances capable of destroying the neoplastic formations.

Immunotherapy is another type of therapy commonly used in association with endoscopic treatments. With this technique, the body's immune response against tumor cells is improved. Attenuated bacterial strains are administered directly into the bladder for this purpose.

In serious cases, when the carcinoma has invaded the deep layers, the optimal therapeutic choice presents significant difficulties and often causes a significant worsening of the patient's quality of life. A multiple treatment approach is often necessary, combining different therapeutic techniques. Major surgery operations performed under general anesthesia play a prevalent role among these. It is possible to remove only the portion of the bladder containing the neoplasm or the entire sac along with the surrounding lymph nodes. In men, total removal of the bladder is accompanied by the removal of the prostate and seminal vesicles, while in women it is associated with the removal of the uterus, ovaries, and the anterior part of the vagina.

If necessary, the treatment of bladder cancer can be combined with general chemotherapy and radiotherapy. This is especially true in forms that have already metastasized.

In conclusion, understanding the diagnosis, staging, and treatment of bladder cancer is crucial for anyone affected by this disease. With early detection and appropriate treatment, the prognosis for bladder cancer can be significantly improved.