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Bladder cancer is the most common type of cancer in older adults, especially men, compared to women. In this type of cancer, cancer cells develop in the organ that collects urine from the kidneys before expelling it from the body through urination. Cancerous cells of the bladder grow out of control and lead to the development of tumor, which may spread to lymph nodes, nearby tissues, and other areas. Most of the bladder cancers can be diagnosed at an early stage with an effective cure, but recurrence chances are high, which may need regular follow-ups.

The abnormal cells developed in the bladder can be benign or malignant. Malignant cancers can turn out to be life-threatening as they can spread quickly. If left untreated, these cancers can damage tissues and organs and spread to other parts of the body.

Types of Bladder Cancer

The most common type of Bladder cancer generally starts in the transitional epithelium cells; these cells line the bladder.

Bladder cancer can be of different types, but most cases are transitional cell carcinoma (TCC) or urothelial.

Transitional cell carcinoma

Most of the bladder cancers are transitional cell carcinoma (TCC), which starts in the urothelial cells that line the bladder.

These urothelial cells also line other parts of the urinary tract, so TCC (Transitional cell carcinoma) can also occur in the lining of the ureters and kidneys, too. So, during the diagnosis of TCC, the person usually undergoes an assessment of the complete urinary tract.

Transitional cell carcinoma can be invasive or non-invasive, depending on whether they are in the lining of the bladder (known as epithelium) or if they have spread more in-depth into the muscle layer or lamina propria.

TCCs can be divided into two types:

Papillary carcinomas: In this type of TCC, the abnormal cells grow in thin projections from the inner surface of the bladder towards the hollow center. They are non-invasive papillary cancers.

Flat carcinomas: These type of TCC do not grow towards the hollow centre. They generally remain in the inner layer of bladder cells, so they are known as flat carcinoma in situ (CIS) or a non-invasive flat carcinoma.

Other types of Bladder Cancer

Several other types of cancer can start in the bladder. However, these are much less common than TCC.

They include:

• Squamous cell carcinoma: Squamous cell carcinoma occurs in the squamous cells, the flat, thin cells similar to those that make up the surface of the skin. About 1 to 2 percent of bladder cancers are of this type. Most squamous cell cancers are invasive.
• Adenocarcinoma: Adenocarcinoma occurs in the cells of the mucus-secreting glands that is present in the bladder. It is somewhat similar to colon cancer. Most adenocarcinomas of the bladder are invasive. About 1 percent of bladder cancers are Adenocarcinoma.
• Small cell carcinoma: Small cell carcinoma starts in the cells called neuroendocrine cells. This cancer often grows quickly and requires chemotherapy treatment. Less than 1 percent of bladder cancers are Small cell carcinoma.
• Sarcoma: Sarcoma cancers are the rare form of bladder cancer that originates in the muscle cells of the bladder.

Symptoms of Bladder Cancer

In the early stages of bladder cancer, most symptoms are related to urination. These are:

• Urination habits: If a person has bladder cancer, then he/she may feel the urge to urinate more frequently than usual. There may be a pain or a burning sensation during urination, known as dysuria.
• Blood in the urine: One of the most common symptoms of bladder cancer is or blood in the urine. It is also called as hematuria. The blood may be highly visible, altering the color of the urine completely, or it may only be detectable by microscopy.
• In the later stages of bladder cancer, there may be back pain, bone pain, swelling in the feet, weight loss, and an inability to urinate.
• All the symptoms of bladder cancer can resemble some common less-severe problem such as a bladder infection. So, It is important to see a doctor if symptoms persist.

Bladder Cancer causes

Medical experts are not sure of the causes of bladder cancer, but genetic mutations may play an important role in its occurrence. These mutations may be inherited, or they can also be developed during a person's lifetime.

Exposure to chemicals and the use of tobacco may lead to bladder cancer, but these can affect people in different ways. Inherited genetic factors are not considered a major cause of bladder cancer, but they may decrease the immunity of a person that may increase the effects of certain industrial chemicals and tobacco.

Bladder Cancer Stages

The severity of bladder cancer depends on its spread outside the lining or to the other parts of the body. Staging of the cancer is determined by the additional tests after the diagnosis is confirmed.

Staging describes the spread of cancer, and it also helps the doctor to understand the suitable treatment for the patient.

Stage 0: At this stage of cancer, the abnormal cells occur on the outer surface of the inner lining of the bladder. This can also be termed as "carcinoma in situ."

Stage 1: At stage 1, cancer occurs within the inner lining, but has not invaded the muscular wall or lamina propria.

Stage 2: At this stage, cancer has invaded the muscular wall but has not spread outside the bladder.

Stage 3: At stage 3 of bladder cancer, the cancer has spread to the tissue surrounding the bladder, including potentially the uterus, prostate, or vagina.

Stage 4: This is the last stage of bladder cancer, and at this stage, cancer has already spread to other areas of the body, such as the bones, lymph nodes, and other organs such as liver or lungs.

Bladder Cancer Treatment

The bladder cancer can be treated by surgery, chemotherapy, radiation therapy and biological therapy. A combination of all the treatments can also be used.

The Treatment method for bladder cancer depends on the stage and location of cancer, the patient's age, overall health, preferences, and their support system.

Surgery

A TUR (transurethral resection) surgery can treat bladder cancers of stage 0 and one. In this type of surgery, a cutting tool is inserted into the bladder, and the surgeon removes abnormal tissue and small tumors and burns away any remaining cancerous cells.

If the cancer is at a higher stage, that means it has reached deeper into the bladder, a form of surgery known as cystectomy can be carried out. Cystectomy can be of two types:

• Partial cystectomy: In this type of cystectomy, the surgeon removes the portion of the bladder that contains cancerous cells.
• Radical cystectomy: In a radical cystectomy, the surgeon removes the entire bladder and possibly the surrounding lymph nodes, seminal vesicles and the prostate, uterus, ovaries, and part of the vagina.

Reconstructive surgery is done to provide a new way for the body to store and expel urine.

A piece of the intestine can be used to create one of the following:

• A cutaneous continent urinary diversion: It is a small reservoir for urine that can be expelled through a hole in the abdomen with the help of a catheter.
• A urinary conduit: It is a tube to take the urine from the kidneys to urostomy bag (pouch) on the outside of the body.
• A neobladder: It is a reservoir that is attached to the urethra, allowing normal urination, generally with the help of a catheter.

Chemotherapy

• Chemotherapy uses drugs to kill cancerous cells or shrink tumors so that they can be removed with less invasive surgery.
• This method can be used to treat cancer before or after surgery, and the drugs can be administered intravenously, orally, or into the bladder with a catheter.
• Generally, chemotherapy is given in cycles, and after each treatment, the patient is given a period of rest to allow the body time to recover.

Biological therapy

Cancer at early stages can be treated by encouraging the immune system to fight the cancer cells. This is known as immunotherapy or biological therapy.

Bacillus Calmette-Guerin therapy (BCG)

• This is the most common form of Biological therapy.
• In this therapy, this bacterium is inserted into the bladder with the help of a catheter.
• The bacterium activates immune system cells, which are then able to fight cancerous bladder cells that are present. This treatment is usually given once a week for six weeks.

Interferon

Interferon is another option for biological therapy. This protein is made by the immune system to fight any kind of infection, and a synthetic version of Interferon can be used to fight bladder cancer. Sometimes, this method can also be clubbed with sometimes in combination with BCG.

Radiation therapy

Radiation therapy is the less frequently used treatment in comparison to the other ones. It is often used with chemotherapy. This therapy can kill cancerous cells that have invaded the muscular wall of the bladder. It may be helpful for patients who cannot undergo surgery because of any reason.

Tests and Diagnosis

When any person visits the doctor for the diagnosis of bladder cancer, then firstly, the doctor asks him/her about the symptoms and medical history. A physical examination is carried out and tests are done to confirm a diagnosis.

Cystoscopy

Female cystoscopy

The doctor examines the inside of the urethra and the bladder using a cystoscope. A cystoscope is a narrow tube that contains a lighting system and a camera. This tube is inserted into the bladder through the urethra.

Imaging tests

The following imaging tests are carried out to confirm a diagnosis and reveal the spread of cancer within the body:

• Pyelogram: In this Imagine test, a contrast dye is injected into the bladder, either by using a direct catheter or into a vein. The dye outlines the bladder and other associated organs; a tumor can be visible by X-ray if any.
• CT scan: This scan will help determine the size, shape, and position of any tumors in the bladder, ureters or kidney.
• Ultrasound and sonography: Sonography and ultrasound can be done to determine the size of the tumors present in the bladder. These tests also help to understand the spread if it has reached beyond the bladder to nearby organs or tissues.

Urine tests

Urine can undergo various tests:

• Urine cytology: The urine sample is examined to find the presence of cancerous cells. However, a negative result does not always guarantee the absence of cancer.
• Urine culture: The urine sample is placed in a growth medium where it is monitored for signs of any bacterial growth. Then the doctor identifies the available bacteria. In some cases, diagnosis may show an infection rather than cancer.
• Urine tumor marker test: In this test, the urine sample is examined for specific substances that can be released by cancerous cells present in the bladder. These tests are usually carried out alongside urine cytology.

Biopsy

• Bladder biopsy samples can be collected during a cystoscopy examination. In the presence of cancer, a biopsy can determine the grade and invasiveness of cancer.
• Biopsy samples can also be taken using a hollow, thin needle. This type of biopsy is called needle biopsy and is often guided by CT scan and ultrasound.

Bladder Cancer treatment Cost

Bladder Cancer Treatment Cost or the cost of surgery in India may be affected by the following factors:

• The hospital patient is opting for.
• Type of Room: Standard single, deluxe or super deluxe room for the number of nights specified (including meals, nursing fee, room rate, and room service).
• Operating room, ICU
• Fee for the team of doctors (Anesthetist, Surgeons, Physiotherapist, Dietician)
• Medicines
• The type of surgery performed
• Standard test and diagnostic procedures

No. of days required

• Total number of days:
• Days in Hospital:
• Days Outside Hospital:

Bladder cancer Prevention

Following a healthy lifestyle can decrease the chance of bladder cancer. Some of the lifestyle changes you need to follow are:

• Avoid smoking
• Be careful with chemicals
• Drinking plenty of water
• Eat a variety of fruit and vegetables