Bladder cancer is one of the most common types of cancer in the world. Bladder cancer affecting hundreds of thousands of people is more common in men than women. This cancer can develop at any age but often affects elderly-adult people.
Bladder cancer is caused by malignant tumors in the wall tissue of the bladder, one of the organs of the urinary system. 90% of cancers are caused by ‘transitional cell carcinomas’ on the inner lining of the bladder wall.
The bladder is a hollow muscular organ located in the lower abdomen that stores urine. Tumor formation starts with the proliferation of cancer cells in the cells lining the inner side of the bladder wall. Although bladder tumors are mostly detected in the bladder, they can also develop in other parts of the excretory system.
What are the Symptoms of Bladder Cancer?
Blood in the urine is the most common symptom of bladder cancer. Blood in the urine, i.e. hematuria, is observed in 80% of bladder cancer patients.
Other most common symptoms observed when cancer develops in the bladder include:
- Blood in the urine (hematuria)
- the feeling of urgent need to urinate
- frequent feeling of need to urinate
- the feeling of incomplete emptying of the bladder
- the need to strain while urinating
- painful urination (dysuria)
These symptoms alone are not adequate for the diagnosis of cancer. Some of these symptoms can also be observed due to some other problems.
What are the Risk Factors for Bladder Cancer?
Risk factors that may cause the proliferation of cancer cells in the bladder include:
Smoking: Smoking causes an accumulation of chemicals in the urine. This can raise the risk of cancer. When you smoke, your body processes the chemicals in the smoke and releases some of them into your urine. These harmful chemicals can damage the lining of the bladder wall.
Increasing Age: The risk of developing cancer increases with increasing age. Cancer can develop at any age, but is rare in people under 40 years of age.
Being Male: Men are more likely than women to develop tumors in their bladder.
Exposure to Chemicals: The kidneys filter out the harmful chemicals from the blood and carry them to the bladder. The accumulation of such chemicals in the bladder is thought to raise the risk of cancer in the bladder. Arsenic and chemicals used in the manufacture of paint, rubber, leather and textiles carry this risk.
Having had Cancer Treatment in the Past: Having taken an anti-cancer drug (cyclophosphamide) in the past. Having had cancer treatment in the past may increase the risk of cancer.
Chronic Bladder Inflammation: Long-term use of a urinary catheter is a risk factor for tumor formation in the bladder. Repeated urinary infections or inflammations (cystitis) can increase the risk of bladder cancer.
Individual or Family History of Cancer: People who have had cancer in their bladder in the past are at a higher risk of developing cancer. Those with a first-degree relative with cancer are at risk, as well.
Diagnosis of Bladder Cancer
There are certain tests and procedures performed to diagnose bladder cancer.
Cystoscopy: To perform the cystoscopy procedure, your physician inserts a small, narrow tube (cystoscope) into the urethra. The urologist can observe the inside of the urethra and bladder and examine the disease through the cystoscope.
Biopsy: During cystoscopy, the urologist uses a special instrument for biopsy examination. This procedure is sometimes called ‘transurethral resection of bladder tumor’ (TURBT). TURBT can also be performed in the treatment of cancer.
Urine Cytology: A urine sample is taken through the procedure known as urine cytology. The sample taken is then analyzed under a microscope.
Imaging Tests: Computed tomography (CT), urogram, and retrograde pyelogram tests are performed. Thanks to these imaging technologies, the structure of the patient’s urinary tract is examined.
Retrograde Pyelogram: It is an X-ray exam intended to view the upper urinary tract in detail. Dye is injected into the ureters through a thin tube (catheter) inserted into the urethra and bladder. The dye then meets X-rays, and X-ray images are captured.
Stages of Bladder Cancer
Stages of bladder cancer are identified based on a series of findings and test results. The stage of cancer is identified based on the results of all tests, physical examinations, biopsies and imaging tests.
According to the cancer classification (TNM classification) specified in the American NCCN guidelines, there are 4 main stages in this type of cancer.
Unlike other types of cancer, bladder cancers have also a Stage 0. In this stage, the cancer has not spread the nearby lymph nodes or distant parts of the body. It is analyzed in two groups.
- Stage 0a: In this stage, there may be one or more papillary carcinoma inside the bladder. The cancer is located in the superficial epithelial layer. (It has not invaded deep layers)
- Stage 0is: In this stage, there are cancer cells that do not grow papillary into the bladder, but laterally in the superficial cells of the urinary bladder. Such cancers are called “carcinoma in situ”. They are very aggressive cancers.
In this stage, the cancer has spread to a lower layer of the superficial epithelial layer, i.e. to the subepithelial tissue. The cancer has not spread to the muscle layer.
In this stage, the cancer has not spread the nearby lymph nodes or distant parts of the body.
In this stage, the cancer has progressed up to the muscle layer. The cancer has not spread the nearby lymph nodes or distant parts of the body.
This stage is evaluated in two groups.
- Stage 3A: The cancer has spread to the fatty layer in the deep layers of the muscles or to the surrounding organs (prostate/vagina). It has metastasized to at most 1 of the regional lymph nodes. There is no metastasis to distant organs or (>1) lymph nodes.
- Stage 3B: The cancer has metastasized to a great number of pelvic or upper pelvic lymph nodes. There is no metastasis to distant organs or lymph nodes above common iliac arteries.
- Stage 4A: Cancer has also spread to distant lymph nodes above the iliac vessels. There is no metastasis to organs.
- Stage 4B: The cancer has metastasized to organs such as bone, lung, liver.
Treatment of Bladder Cancer
There are more than one option for the treatment of bladder cancer, which is a quite common disease. The treatment procedures should be evaluated based on the condition of the patient, and the procedure should be selected in the presence of an urologist.
Bladder Cancer Surgery: It is the procedure intended for the treatment of bladder cancer, which involves surgical removal or elimination of cancerous cells.
Intravesical Chemotherapy: It is the method of performing chemotherapy limited to the patient's bladder. It is generally preferred in cancers likely to recur or progress to advanced stages.
Artificial Bladder: It is the removal of the diseased bladder and the production of an artificial bladder for the discharge of urine from the body.
Systemic Chemotherapy It is the procedure that involves chemotherapy for the whole body.
Immunotherapy: It is a treatment procedure intended to trigger the immune system.
Radiation Therapy: It is preferred when surgery is not an option.
Bladder Cancer Surgery
Surgery is a quite important treatment method in cancer treatment. Bladder cancer surgery is performed with the TUR or Cystectomy method.
The surgical procedure is intended to purify the bladder from cancer cells. Before surgery, the procedure and treatment option are determined based on the spread of the cancer.
> TUR Bladder Cancer Surgery
The most known bladder surgery is Transurethral Resection (TUR). When a tumor is detected by cystoscopy, TUR-Bladder surgery is performed by accessing the targeted tissue through the urinary tract.
TUR is usually the first preferred procedure for the treatment of early-stage bladder cancers. TUR operations are preferred for the treatment of bladder tumors that have not metastasized to the muscles.
The entire cancerous mass is removed after accessed through the urinary tract with an instrument equipped with a camera and scraping knife on its tip.
TUR-Bladder surgery has many advantages. It can be performed many times with minimal risk and perfect results.
> Bladder Tumor Surgery with Radical Cystectomy
Radical Cystectomy is surgical procedure intended to remove the whole or just the cancerous part of the bladder. It can be an option when it is possible to remove the cancerous mass without damaging the bladder.
Radical cystectomy also involves the surgical removal of prostate and seminal vesicles in male patients. In men, removal of the prostate and seminal vesicles is likely to cause erectile dysfunction. However, your surgeon can preserve the nerves needed for erection.
In women, radical cystectomy also involves the surgical removal of the uterus, ovaries, and a part of the vagina. In women, removal of the ovaries leads to infertility and premature menopause.
Cystectomy carries the risk of infection and bleeding.
Radical cystectomy, which is a successful surgical procedure in the treatment of urinary bladder cancer, is called ‘robotic radical cystectomy’ when performed using a da Vinci robotic surgical robot.