Bladder Cancer

Bladder Cancer always originates in the deepest layer of the bladder. It is an unrestrained, atypical growth that multiplies the cells in the urinary bladder. This cancer can also mutate and spread to other parts of the human body like the lungs, bones and liver.

Bladder cancer arises in males more often than in females. It generally affects older adults but can be diagnosed at any age.

Bladder cancer can appear in various forms. Some of the most common forms are:

  • Shrub-Like
  • Nodule
  • Irregular, solid growth
  • Flat, barely perceptible thickening of the inside of the bladder wall

Most common types of bladder cancer:

  • Urothelial carcinoma (cancer in the cells that line the inside of the bladder). 
  • Adenocarcinoma (found in cells that form part of the mucus-secreting gland in the bladder)
  • Squamous cell carcinoma (chronic irritation of the bladder, e.g. infection or long-term use of urinary catheter)
  • Pheochromocytoma (rare)
  • Sarcoma (in muscle tissue)

Signs and Symptoms

Most common:

  • Blood in urine
  • Distended bladder
  • Unable to urinate
  • Pain in flanks
  • Painful bones
  • Swollen feet and ankles
  • Blood in the phlegm (Coughing blood)
  • Pelvic pain
  • Back pain
  • Frequent urination

Diagnosis

The following test are conducted in order to diagnose bladder cancer:

  • Urinalysis
  • Urine cytology
  • Ultrasound
  • CT Scan
  • MRI Scan
  • Cystoscopy and biopsy

Stages of bladder cancer

Bladder cancer can be categorized based on the aspects of its cells under the microscope.

T stages:

 T stages alludes to the depth of the tumour from the deepest lining to the deeper layers of the bladder.

  • Tx – Primary tumour
  • T0 – No primary tumour
  • Ta – Tumour is limited to the deepest lining of the surface layer
  • Tis – Flat Tumour
  • T1 – Tumor occupies connective tissue under the surface layer
  • T2 – Tumour occupies the muscle of the bladder
    • T2a – Inner half
    • T2b – Outer half
  • T3 – Tumour occupies fatty tissue
    • T3a – Microscopically
    • T3b – Macroscopically
  • T4 – Tumour spreads beyond the fatty tissue and occupies prostate, uterus, vagina, pelvic wall or abdominal wall.

N stages:

Connection of the lymph nodes in the pelvic region

  • Nx – Regional lymph nodes cannot be evaluated.
  • N0 – No regional lymph node metastasis.
  • N1 – Metastasis in a single lymph node < 2 cm in size
  • N2 – Metastasis in a single lymph node > 2 cm, but < 5 cm in size, or two or more lymph nodes < 5 cm in size.
  • N3 – Metastasis in a lymph node > 5 cm in size and/or to lymph nodes along the common iliac artery.

M stages:

The absence of the spread of bladder cancer to the rest of the human body.

  • Mx – Distant metastasis cannot be evaluated
  • M0 – No distant metastasis
  • M1 – Distant metastasis

Risk Factors

  • Smoking (due to harmful chemicals that gather in the urine)
  • Age (rarely found in people younger than 40)
  • Being a male
  • Exposure to certain chemicals
  • Previous cancer treatment
  • Chronic bladder inflammation
  • Personal or family history of cancer

Treatment

It is important to know exactly what type of bladder cancer you have in order to select the correct treatment, as this may have huge implications on therapy.

Some types of bladder cancer may not respond to radiation and other bladder cancers may not respond to chemotherapy.

The microanatomy of the cancer can also have an implication on the surgery that may be needed to ensure complete cure.