Bladder Cancer (Part One)

In most cases, bladder cancer begins in the cells lining the inside of the bladder. This cancer usually affects older adults, although it can occur at any age. Bladder cancer is often detected in the early stages when the cancer is highly treatable. However, even at this stage, it can recur. For this reason, survivors are monitored over a long period after treatment to detect any possible recurrence.

Symptoms

The symptoms of bladder cancer include:

• Blood in urine (hematuria). The urine may appear bright red or cola-colored. Also, the urine may look normal, but a microscopic analysis can reveal blood.
• Frequent urination.
• Painful urination.
• Back pain.
• Pelvic pain.

Causes

The causes of bladder cancer are not always clear. They have been linked to smoking, an infection from parasites, radiation exposure, or exposure to certain chemicals. Bladder cancer develops when cells in the bladder grow abnormally. Instead of developing normally, these cells become deformed, causing their growth to become uncontrolled and preventing them from dying. These abnormal cells form a tumor.

Types of bladder cancer

Different types of bladder cells can become cancerous. The type of cells where cancer begins determines the type of bladder cancer. Based on this, the best treatment method is determined. The types of bladder cancer are:

• Transitional cell carcinoma. This starts in the cells lining the inner part of the bladder. These cells stretch when the bladder is full and contract when it is empty. The same cells line the inside of the ureters and urethra, so the tumor can also form in these areas.
• Squamous cell carcinoma. Squamous cells appear in the bladder as a response to infection or irritation. Over time, they can transform into cancerous cells.
• Adenocarcinoma. This is rare and originates from glandular cells in the urinary bladder that secrete mucus.

Some types of bladder cancer consist of more than one type of cell.

Predisposing factors for the development of bladder cancer include:

• Smoking. Smoking can increase the risk of bladder cancer as a result of harmful chemicals that accumulate in the urine. During smoking, the body processes the chemical substances in tobacco and excretes some of them in the urine. These harmful substances can damage the lining, increasing the risk of cancer.
• Age. The risk of cancer increases with age. Bladder cancer can occur at any age, but it is rare to find it in young people under 40 years old.

Gender. Men are more predisposed than women.

Exposure to certain chemicals. The kidneys play a key role in filtering chemicals by transporting them through the urine to the urinary bladder. It is thought that their concentration in the bladder increases the risk of cancer. These substances include arsenic and chemicals used in the dyeing, rubber, leather, textiles, and paint manufacturing industries.

• Treatment of previous cancers. Using the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. Also, patients who have been treated with radiation in the pelvis for a previous cancer have a high risk of developing bladder cancer.
• Chronic bladder inflammation. Repeated bladder infections or inflammation, e.g., as a result of long-term urinary catheter use, can increase the risk of squamous cell bladder cancer.
• Personal or family history of cancer. If a patient has had bladder cancer before, they are predisposed to its recurrence. Similarly, if a person has one or more relatives with a history of bladder cancer, they are also at risk, although this is rare. If someone has a family history of a non-polyposis colorectal cancer known as Lynch syndrome, they may be predisposed to cancer in the urinary system as well as in the colon, uterus, ovaries, and other organs.

Complications

Bladder cancer often recurs. For this reason, those who survive this disease after successful treatment need to be monitored for many years. What tests and how often they need to be done depend on the type of cancer and the treatment method, among other factors.

Generally, cystoscopy is recommended to examine the urethra and urinary bladder from the inside every three months during the first years after treatment, then once a year. Patients with aggressive cancer may be monitored more frequently, while others are followed up less often.

Examinations and diagnosis

• Cystoscopy. This consists of inserting a cystoscope into the bladder. It is equipped with a lens system and optical fibers that allow for the examination of the bladder.
• Biopsy. Through the cystoscope, the doctor inserts a device into the bladder and takes material from the suspicious area for microscopic examination.
• Urine cytology. A urine sample is taken and examined under a microscope for cancer cells.
• Radiological examinations. Intravenous pyelography and scanner.