Bladder Cancer: Stages, Risk Factors, Diagnosis, Treatment And Preventions

Bladder cancer is a common type of cancer that begins in the cells of the bladder. The bladder is a hollow muscular organ in your lower abdomen that stores urine.

Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder. Urothelial cells are also found in your kidneys and the tubes (ureters) that connect the kidneys to the bladder. Urothelial cancer can happen in the kidneys and ureters, too, but it's much more common in the bladder.

Most bladder cancers are diagnosed at an early stage, when the cancer is highly treatable. But even early-stage bladder cancers can come back after successful treatment. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs.

What are the types of Bladder cancer?

There are three types of bladder cancer:

1. Transitional cell carcinoma

Transitional cell carcinoma is the most common type of bladder cancer. It begins in the transitional cells in the inner layer of the bladder. Transitional cells are cells that change shape without becoming damaged when the tissue is stretched.

2. Squamous cell carcinoma

Squamous cell carcinoma is a rare cancer in the United States. It begins when thin, flat squamous cells form in the bladder after a long-term infection or irritation in the bladder.

3. Adenocarcinoma

Adenocarcinoma is also a rare cancer in the United States. It begins when glandular cells form in the bladder after long-term bladder irritation and inflammation. Glandular cells are what make up the mucus-secreting glands in the body.

What are the symptoms of Bladder cancer?

Bladder cancer signs and symptoms may include:

Blood in urine (hematuria), which may cause urine to appear bright red or cola colored, though sometimes the urine appears normal and blood is detected on a lab test

Frequent urination

Painful urination

Lower back pain.

Does bladder cancer has stages?

After someone is diagnosed with bladder cancer , doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent (amount) of cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.

To find the cancer’s stage, doctors try to answer these questions:

How far has the cancer grown into the wall of the bladder?

Has the cancer reached nearby tissues or organs?

Has the cancer spread to the nearby lymph nodes or to distant organs?

The stage of bladder cancer is based on the results of physical exams, biopsies, and imaging tests (CT or MRI scan, x-rays, etc.), which are described in Tests for Bladder Cancer, as well as the results of surgery. 

Understanding your bladder cancer stage

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The staging system most often used for bladder cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

T (Tumor) -- This measures how far the main tumor has grown through the bladder and whether it has spread into nearby tissues.

N (Lymph Nodes): These are groups of cells that fight disease. “N” is used to describe whether cancer has spread into lymph nodes near the bladder.

M (Metastasized): Doctors use this to describe whether the disease has spread into organs or lymph nodes that aren’t near the bladder.

Your doctor will assign a number or letter after T, N, and M. The higher the number, the more the cancer has spread.

Once they've determined your T, N, and M stages, your doctor will use this information to give you an overall cancer stage. These range from 0 to the Roman numeral IV. Here’s what each stage means:

Stage 0: The cancer has only grown into the center of your bladder. It hasn’t spread into the tissues or muscle of your bladder wall itself. It hasn’t spread to your lymph nodes or other organs, either.

Stage I: The cancer has grown through the inner lining of your bladder, but not the muscle of your bladder wall. Nor has it spread to your lymph nodes or distant organs.

Stage II: The cancer has grown through the connective tissue in your bladder and into the muscle layer of the bladder.

Stage III: Cancer is now in the layer of fatty tissue that surrounds your bladder. It may also be in your prostate, uterus, or vagina. But it hasn’t spread to nearby lymph nodes or to distant organs.

Stage IV: This may include any of the following:

The cancer has spread from your bladder into your pelvic or abdominal wall. But it hasn’t spread to lymph nodes or distant organs.

The cancer has spread to nearby lymph nodes. But it hasn’t reached distant organs.

Cancer is now in your lymph nodes or distant sites like your bones, liver, or lungs.

The more information you have about the stage of your bladder cancer, the better able you’ll be to choose the right treatment option for you.

What Causes Bladder Cancer?

Researchers do not know exactly what causes most bladder cancers. But they have found some risk factors and are starting to understand how they cause cells in the bladder to become cancer.

Certain changes in the DNA inside normal bladder cells can make them grow abnormally and form cancers. DNA is the chemical in our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA, but DNA affects more than just how we look.

Some genes control when cells grow, divide into new cells, and die:

. Genes that help cells grow, divide, and stay alive are called oncogenes.

Genes that normally help control cell division, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.

Cancers can be caused by DNA changes (gene mutations) that turn on oncogenes or turn off tumor suppressor genes. Several different gene changes are usually needed for a cell to become cancer.

. Acquired gene mutations

Most gene mutations related to bladder cancer develop during a person’s life rather than having been inherited before birth. Some of these acquired gene mutations result from exposure to cancer-causing chemicals or radiation. For example, chemicals in tobacco smoke can be absorbed into the blood, filtered by the kidneys, and end up in urine, where they can affect bladder cells. Other chemicals may reach the bladder the same way. But sometimes, gene changes may just be random events that sometimes happen inside a cell, without having an outside cause.

The gene changes that lead to bladder cancer are not the same in all people. Acquired changes in certain genes, such as the TP53 or RB1 tumor suppressor genes and the FGFR and RAS oncogenes, are thought to be important in the development of some bladder cancers. Changes in these and similar genes may also make some bladder cancers more likely to grow and spread into the bladder wall than others. Research in this field is aimed at developing tests that can find bladder cancers at an early stage by finding their DNA changes.

. Inherited gene mutations

Some people inherit gene changes from their parents that increase their risk of bladder cancer. But bladder cancer does not often run in families, and inherited gene mutations are not thought to be a major cause of this disease.

. Some people seem to inherit a reduced ability to detoxify (break down) and get rid of certain types of cancer-causing chemicals. These people are more sensitive to the cancer-causing effects of tobacco smoke and certain industrial chemicals. Researchers have developed tests to identify such people, but these tests are not routinely done. It’s not certain how helpful the results of such tests might be, since doctors already recommend that all people avoid tobacco smoke and hazardous industrial chemicals.

How do I know if I am at risk of bladder cancer?

Smoking is the first trigger that increases your risk of bladder cancer. Smoking causes half of all bladder cancers in men and women. 

The following factors also increase your risk of developing bladder cancer:

Exposure to cancer-causing chemicals

Chronic bladder infections

Low fluid consumption

Being male

Being white

Being older, since the majority of bladder cancers occur in people over the age of 55

Eating a high-fat diet

Having a family history of bladder cancer

Having previous treatment with a chemotherapy drug called Cytoxan

Having previous radiation therapy to treat cancer in the pelvic area.

How is bladder cancer diagnosed?

Your doctor may diagnose bladder cancer using one or more of the following methods:

. A urinalysis

An internal examination, which involves your doctor inserting gloved fingers into your vagina or rectum to feel for lumps that may indicate a cancerous growth

a cystoscopy, which involves your doctor inserting a narrow tube that has a small camera on it through your urethra to see inside your bladder.

. A biopsy in which your doctor inserts a small tool through your urethra and takes a small sample of tissue from your bladder to test for cancer.

. A CT scan to view the bladder

an intravenous pyelogram (IVP).

. X-rays

Your doctor can rate bladder cancer with a staging system that goes from stages 0 to 4 to identify how far the cancer has spread. The stages of bladder cancer mean the following:

Stage 0 bladder cancer hasn’t spread past the lining of the bladder.

Stage 1 bladder cancer has spread past the lining of the bladder, but it hasn’t reached the layer of muscle in the bladder.

Stage 2 bladder cancer has spread to the layer of muscle in the bladder.

Stage 3 bladder cancer has spread into the tissues that surround the bladder.

Stage 4 bladder cancer has spread past the bladder to the neighboring areas of the body.

How is bladder cancer treated?

Your doctor will work with you to decide what treatment to provide based on the type and stage of your bladder cancer, your symptoms, and your overall health.

1. Treatment for stage 0 and stage 1

Treatment for stage 0 and stage 1 bladder cancer may include surgery to remove the tumor from the bladder, chemotherapy, or immunotherapy, which involves taking a medication that causes your immune system to attack the cancer cells.

2. Treatment for stage 2 and stage 3

Treatment for stage 2 and stage 3 bladder cancer may include:

Removal of part of the bladder in addition to chemotherapy

removal of the whole bladder, which is a radical cystectomy, followed by surgery to create a new way for urine to exit the body

chemotherapy, radiation therapy, or immunotherapy that can be done to shrink the tumor before surgery, to treat the cancer when surgery isn’t an option, to kill remaining cancer cells after surgery, or to prevent the cancer from recurring.

3. Treatment for stage 4 bladder cancer

Treatment for stage 4 bladder cancer may include:

chemotherapy without surgery to relieve symptoms and extend life

radical cystectomy and removal of the surrounding lymph nodes, followed by a surgery to create a new way for urine to exit the body

chemotherapy, radiation therapy, and immunotherapy after surgery to kill remaining cancer cells or to relieve symptoms and extend life.

What is the outlook for people with bladder cancer?

Your outlook depends on a lot of variables, including the type and stage of cancer.

 

According to the American Cancer Society, the five-year survival rates by stage are the following:

The five-year survival rate for people with stage 0 bladder cancer is around 98%.

The five-year survival rate for people with stage 1 bladder cancer is around 88%.

The five-year survival rate for people with stage 2 bladder cancer is around 63%.

The five-year survival rate for people with stage 3 bladder cancer is around 46%.

The five-year survival rate for people with stage 4 bladder cancer is around 15%.

There are treatments available for all stages. Also, survival rates don’t always tell the whole story and can’t predict your future. Speak with your doctor about any questions or concerns you may have regarding your diagnosis and treatment.

How to prevent Bladder cancer?

Although there's no guaranteed way to prevent bladder cancer, you can take steps to help reduce your risk. For instance:

. Don't smoke. 

If you don't smoke, don't start. If you smoke, talk to your doctor about a plan to help you stop. Support groups, medications and other methods may help you quit.

. Take caution around chemicals. 

If you work with chemicals, follow all safety instructions to avoid exposure.

. Choose a variety of fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.

Sources:

www.cancer.org

www.mayoclinic.org

www.healthlines.com

www.webMD.com