Bladdera hollow, muscular sac in the pelvis that stores urine cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a relatively common malignancy that develops in the bladder, a hollow, muscular sac in the pelvis that stores urine. The bladder is one of the main organs of the urinary system.
The bladder is composed of four main tissuea group of cells that work together to perform a function layers: the urothelium, lamina propria, muscularis propria, and perivesical tissue. The urothelium is the innermost layer of the bladder, and is made up of urothelial cellsthe basic structural and functional unit of all living things that prevent urine from being absorbed into the body. The next innermost layer of the bladder is the lamina propria, which contains the bloodthe red bodily fluid that transports oxygen and other nutrients around the body vessels surrounding the urothelium. The third layer of the bladder is the muscularis propria, which is the thickest, muscular layer. This layer is responsible for the contraction and dilation of the bladder, which is how we either hold or empty the bladder. The outermost layer is the perivesical tissue layer, which is made up of fat to separate and cushion the bladder from surrounding organs.
Bladder cancer is more common in males, and is generally diagnosed over the age of 60. However, anyone can develop this disease.
Types of Bladder Cancer
There are several different types of bladder cancer, which are categorised by the types of cells they develop from, and whether or not the cancer has spread to the muscle in the bladder.
Non-Muscle-Invasive Bladder Cancer
Non-muscle-invasive bladder cancer (NMIBC) is bladder cancer that has not spread to the muscle layer of the bladder. This type of cancer is only found in the lining of the bladder, and is generally early-stage cancer. Any type of bladder cancer can be a NMIBC, and if left untreated it could become invasive.
Muscle Invasive Bladder Cancer
Muscle invasive bladder cancer (MIBC) is bladder cancer that has spread to the muscle layer of the bladder. This type of cancer is often found in both the lining of the bladder, the muscle layer, and possibly further in advancedat a late stage, far along cases. This type of cancer can be seen as a late-stage cancer, and can be any type of bladder cancer.
Urothelial Carcinoma
Urothelial carcinomas, also known as transitional cell carcinomas, are the most common type of bladder cancer. They often develop from urothelial cells in the innermost layer of the bladder, or urothelium. While urothelial carcinomas can be aggressive, they can have a good prognosisto predict how a disease/condition may progress and what the outcome might be.
Squamous Cell Carcinoma
Squamous cell carcinomas (SCCs) are a rarer form of bladder cancer that begin in the squamous cells that line the bladder. They are more likely to develop as a result of chronica long-lasting disease that changes slowly over time irritation of the bladder, such as an infectiona condition where harmful pathogens, such as bacteria, viruses or parasites, have entered the body from long-term use of a urinary cathetera hollow tube put into the body to help drain fluids such as urine from the bladder or inject fluids such as long term antibiotics, or chronic urinary tract infections. SCCs of the bladder are often aggressive, and may not have as good of a prognosis as other types of bladder cancer.
Adenocarcinoma
Adenocarcinomas of the bladder are a very rare subtype of bladder cancer that develop from mucus-producing cells, or glandular cells, in the lining of the bladder. Adenocarcinomas of the bladder are often aggressive, and may not have as good of a prognosis as other types of bladder cancer.
Rare types of Bladder Cancer
These types of bladder cancer are very rare:
- Sarcomas.
- Small Cell Carcinomas.
- Plasmacytoid carcinomas.
- Micropapillary carcinomas.
Treatment
If bladder cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, age, stage of disease, if the muscle is affected, and overall health.
Treatment of NMIBC
Treatment for NMIBC may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, most often a transurethral resection (TUR)removal of abnormal tissue through a tool inserted into the urethra of the bladder.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Immunotherapya treatment that uses a person's immune system to fight cancer.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Treatment of MIBC
Treatment of MIBC may include:
- Surgery, potentially including:
- Complete or partial cystectomycomplete or partial removal of the bladder.
- Urinary diversioncreating a new pathway for urine to exit the body when urine flow is blocked, such as a urostomya surgical procedure that creates a new opening (stoma) in the abdomen to allow urine to drain from the body when the bladder is removed or not functioning properly or a neobladdera surgical procedure to create a new bladder out of a portion of the small intestine.
- Chemotherapy.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Immunotherapy.
- Trimodal therapya treatment involving a combination of a TURBT surgery, radiation therapy and chemotherapy.
- Clinical trials.
- Palliative care.
Risk factors
While the cause of bladder cancer remains unknown, the following factors may increase the likelihood of developing the disease:
- Having a history of smoking.
- Being male.
- Being over 60 years old.
- Being exposed to certain chemicals, potentially including:
- Aromatic amines.
- Benzene products.
- Aniline dyes.
- Arylamines.
- Arsenic.
- Chronic irritation of the bladder, such as an infection from long-term use of a urinary catheter, or chronic urinary tract infections (generally only a riskthe possibility that something bad will happen for SCCs).
- Previous cancer treatment with either chemotherapy or radiation therapy.
- Certain treatments for diabetes.
- Having a history of cancer.
- Having a family history of bladder cancer.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
The symptoms of a bladder cancer are generally the same across all subtypes, and may include:
- Haematuriathe presence of blood in urine.
- Burning feeling when you urinate.
- Polyuriafrequent urination.
- Increased urgency of urination.
- Constipationa condition where a person has difficulty passing faeces/stools.
- Dysuriaburning, tingling and/or stinging of the urethra when urinating.
- Persistent urinary tract infections (UTIs).
- Unexplainable weight loss.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Urinary incontinenceloss of control over release of urine or faeces.
- Abdominal pain (rare).
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have a bladder cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Pelvic examinationa physical exam of the external and internal female pelvic organs (women).
- Digital rectal examinationan examination conducted by a urologist where a finger (or digit) is inserted into the rectum to feel the anus (DRE).
- Blood teststesting done to measure the levels of certain substances in the blood.
- Urine teststesting done to measure the levels of certain substances in the urine.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Cystoscopyan examination of the bladder and urethra with a small, flexible instrument known as a cystoscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
