Bladder Cancer - Signs, Symptoms and Treatment

Bladder cancers arise from the outer lining of the bladder mostly. According to surveys, in the United States, 98% of bladder cancers are known as transitional cell carcinomas. Generally, bladder cancers grow in a pattern called a “papillary” growth pattern.

Bladder cancer is one of the most common forms of cancer, being the fourth most common cancer for men and the eighth most common dysplasia in women. Smokers have an increased 2-4 times the risk of having bladder cancer as compared to ordinary people, and smoking has been known to contribute to up to half of all bladder cancers that have been diagnosed.

Chronic bladder irritation arising from either bladder stones or long-term catheter use is believed to increase the risk of bladder cancer. Occupational exposures to substances such as polychromatic hydrocarbons (benzidine, benzene) can also increase the risk of bladder cancer. Recently, a link has been found between chlorinated drinking water and bladder cancer.

Smoking is the most common and strongest risk factor associated with the development of bladder cancer. Therefore, ceasing to smoke is the best way to prevent bladder cancer. Additionally, reducing exposure to cancer causing compounds (carcinogenic compounds) does also decrease the risk of developing bladder cancer. If abnormal cells are seen, then in over 95% of the time the presence of bladder cancer is signaled.

Either a gross hematuria or a microscopic hematuria is present in most of the cases of bladder cancer. In advanced stages of bladder cancer, the tumor begins to obstruct either the entrance of urine into the bladder or the exit of urine from the bladder. X-ray imaging of the upper urinary tract (which includes the ureters and the kidneys) should be performed to diagnose bladder cancer, or periodically after a diagnosis of bladder cancer to disavow any involvement of these structures with cancer.

Sometimes bladder cancer can advance to invasive disease prior to causing symptoms, which is very unfortunate. Bladder cancers often begin at the surface, involving only the outer lining of the bladder. Eventually, however, bladder cancers will invade into the bladder wall, involving dystrophy of the muscular layers of the wall. These forms of local extensions are the most common way that bladder cancer spreads.

Cancer can also spread by being able to access the lymphatic system. Bladder cancer usually spreads this way. Bladder cancer can also spread by going through the bloodstream.

Clinical Staging steps include:

T3b-Any tumor that extends beyond bladder on exam

Pathologic Staging steps include:
Ta-noninvasive papillary tumor
T1-tumor invading the mucosa (lining of bladder)
T2-tumor invades into muscle of bladder wall
T3-tumor is present outside of the bladder
T4-tumor invades other organs
N2-tumor spread to lymph nodes sized 2-5 cm
M0-no tumor spread to other organs

There is an important difference between bladder cancer which is a superficial disease (Ta, Tis, T1) or cancer which is muscular invasive in nature.

Superficial bladder cancer is that which has not invaded at all into the muscle and only involves the top layer. Although TUR is mostly used to treat superficial bladder cancers, bladder tumors have a tendency to recur (grow back) in about a third of the cases after TUR treatment.

Regimens that have shown the best results all start with maximum resection of the bladder tumor via TUR, similar to treatment with superficial bladder cancers. There are a variety of methods available for treatment of bladder cancer. These typically include surgery, radiation therapy and chemotherapy.