Understanding Bladder Cancer: Types, Symptoms & Treatment

Bladder cancer comes in several forms, but the most common is called a transitional cell (urothelial) carcinoma.

Symptoms of bladder cancer

Blood in the urine (may be visible or only microscopic)
Frequent urination
Urgent urination
Burning when urinating
Possibly urinary obstruction causing pain
Pus in the urine
Pelvic pain in advanced cases
Possible pelvic mass

Who gets bladder cancer?

Bladder cancer is more common in men than women, and the older you are, the higher the risk. Bladder cancer in smokers is common. Anyone on long-term chemotherapy drug cyclophosphamide is at risk. Anyone with chronic irritation of the bladder is at further risk, for example long-term use of catheters. Certain chemical exposures can also increase risk. ^1,2

Types of bladder cancer

Transitional cell carcinoma (urothelial carcinoma) account for over 90 per cent of bladder cancers. The most common of these is the papillary carcinoma, which is usually close to the surface and grows outwards. Sessile tumours are more invasive and dangerous.

Squamous cell carcinomas are less commonly found, and most often occur in people with a bladder parasite or long-running irritation.³
Adenocarcinomas may occur as tumours that have not become cancerous.⁴

Recurrence of bladder tumours happens frequently, either in the same site or another area of the bladder. Bladder cancer often spreads to lymph nodes, lungs, liver, and bones.

Diagnosing bladder cancer

Diagnosis is done via cystoscopy – a thin tube with a camera on it inserted into the bladder via the urethra – and a biopsy taken. The cells (or urine) are then observed under a microscope to check for malignancy, though urine tests are not done in isolation because malignancy may not show in the urine. Further biopsies may be taken, including of muscle tissue. Other testing may be done to see if the cancer has spread to other parts of the body. A rectovaginal examination may be done. ⁵

Staging of bladder cancer (AJCC/TNM)

Staging of bladder cancer is done based on the stage of the tumour growth, whether it is invasive, whether the local lymph nodes have been affected, and next if the cancer has spread to other parts of the body.

Treating bladder cancer

Chemotherapy directly into the bladder is the treatment of choice, as well as removal of the cancer or tumours.^6,7 A cystectomy (complete removal of the bladder) may be recommended for invasive cancers. ^8,9 Other treatments may be recommended, like immune system treatments directly into the bladder. Treatment may continue for one or two years, but this will depend largely on the type of cancer and the stage it’s at. New advances in diverting urine and creating a ‘new’ (neo) bladder are becoming more common and can be appropriate in many cases. There are some version of the neobladder that act like a normal bladder, and urinating can be done more naturally using the pelvic floor muscles and abdominal pressure, using the urethra. Some incontinence may occur at night though.^10,11 An external stoma may also be connected (an outside-the-body bag). Radiation therapy may be appropriate.

Outcomes (prognosis) of bladder cancer

Superficial forms of bladder cancer (stage Ta or T1) typically do not cause death. Stage Tis (carcinoma in situ) is often a more aggressive form of bladder cancer, and anyone with invasive cancers that have crept into the muscle wall, the survival rate is about half. Chemotherapy can improve results. Anyone with progressive or recurrent invasive bladder cancer or squamous cell carcinoma/adenocarcinoma does not have positive outcomes. This is because they are typically discovered at a late stage when treatment is less effective. ^12,13

References

1.
Saginala K, Barsouk A, Aluru JS, Rawla P, Padala SA, Barsouk A. Epidemiology of Bladder Cancer. Medical Sciences. Published online March 13, 2020:15. doi:10.3390/medsci8010015
2.
Zhang Y, Rumgay H, Li M, Yu H, Pan H, Ni J. The global landscape of bladder cancer incidence and mortality in 2020 and projections to 2040. J Glob Health. Published online September 15, 2023. doi:10.7189/jogh.13.04109
3.
Larkins MC, Pasli M, Bhatt A, Burke A. Squamous cell carcinoma of the bladder: Demographics and outcomes associated with surgery and radiotherapy. Journal of Surgical Oncology. Published online November 20, 2023:649-658. doi:10.1002/jso.27525
4.
Dadhania V, Czerniak B, Guo C. Adenocarcinoma of the urinary bladder. Am J Clin Exp Urol. 2015;3(2):51-63. https://www.ncbi.nlm.nih.gov/pubmed/26309895
5.
Zhu CZ, Ting HN, Ng KH, Ong TA. A review on the accuracy of bladder cancer detection methods. J Cancer. Published online 2019:4038-4044. doi:10.7150/jca.28989
6.
Liu S, Chen X, Lin T. Emerging strategies for the improvement of chemotherapy in bladder cancer: Current knowledge and future perspectives. Journal of Advanced Research. Published online July 2022:187-202. doi:10.1016/j.jare.2021.11.010
7.
Teply B, Kim J. Systemic therapy for bladder cancer – a medical oncologist’s perspective. J Solid Tumors. 2014;4(2):25-35. doi:10.5430/jst.v4n2p25
8.
D’Andrea VD, Melnick K, Yim K, et al. Evidence-Based Analysis of the Critical Steps of Radical Cystectomy for Bladder Cancer. JCM. Published online October 30, 2023:6845. doi:10.3390/jcm12216845
9.
Parekh DJ, Reis IM, Castle EP, et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. The Lancet. Published online June 2018:2525-2536. doi:10.1016/s0140-6736(18)30996-6
10.
Fasanella D, Marchioni M, Domanico L, et al. Neobladder “Function”: Tips and Tricks for Surgery and Postoperative Management. Life. Published online August 4, 2022:1193. doi:10.3390/life12081193
11.
KAKIZOE T. Orthotopic neobladder after cystectomy for bladder cancer. Proceedings of the Japan Academy Ser B: Physical and Biological Sciences. Published online July 31, 2020:255-265. doi:10.2183/pjab.96.019
12.
Ripoll J, Ramos M, Montaño J, Pons J, Ameijide A, Franch P. Cancer-specific survival by stage of bladder cancer and factors collected by Mallorca Cancer Registry associated to survival. BMC Cancer. Published online June 7, 2021. doi:10.1186/s12885-021-08418-y
13.
Mohammadbeigi A, Rezaianzadeh A, Mobaleghi J, Mohammadsalehi N. Survival analysis of patients with bladder cancer, life table approach. J Mid-life Health. Published online 2012:88. doi:10.4103/0976-7800.104468