Bladder cancer is a type of cancer that begins in the cells of the bladder, the organ responsible for storing urine before it is expelled from the body. It is one of the most common cancers, particularly in older adults. Bladder cancer often starts in the urothelium, the inner lining of the bladder, but it can spread to other layers of the bladder wall and beyond if not detected and treated early.

Types of Bladder Cancer

1. Urothelial Carcinoma (Transitional Cell Carcinoma):

   • The most common type, accounting for about 90% of cases.

   • Begins in the urothelial cells, which line the inside of the bladder.

2. Squamous Cell Carcinoma:

   • Accounts for about 1-2% of bladder cancers.

   • Often develops after long-term irritation or infection of the bladder.

3. Adenocarcinoma:

   • A rare form of bladder cancer (about 1% of cases).

   • Begins in the glandular cells of the bladder.

4. Small Cell Carcinoma:

   • A very rare and aggressive form of bladder cancer.

   • Comprises neuroendocrine cells, which are hormone-releasing cells in the nervous system.

Symptoms of Bladder Cancer

• Blood in the Urine (Hematuria):

  • The most common symptom, often causing the urine to appear pink, red, or dark brown.

  • Sometimes blood is not visible and is only detected through a urine test.

• Frequent Urination:

  • The need to urinate more often than usual.

• Painful Urination:

  • Discomfort or a burning sensation during urination.

• Urgent Need to Urinate:

  • A sudden, strong urge to urinate.

• Pelvic Pain:

  • Pain or discomfort in the lower abdomen or pelvic area.

• Back Pain:

  • Pain in the lower back or side, which may indicate advanced disease.

Risk Factors

• Smoking:

  • The most significant risk factor for bladder cancer. Smokers are several times more likely to develop the disease than non-smokers.

• Exposure to Chemicals:

  • Certain industrial chemicals, such as those used in the manufacture of rubber, leather, textiles, and dyes, can increase the risk.

• Age:

  • Most bladder cancers occur in people over 55.

• Gender:

  • Men are more likely to develop bladder cancer than women.

• Chronic Bladder Inflammation:

  • Long-term bladder infections or conditions like urinary stones can increase risk.

• Previous Cancer Treatments:

  • Previous radiation therapy or chemotherapy with certain drugs (like cyclophosphamide) can increase the risk.

• Family History:

  • A family history of bladder cancer can increase the risk.

Diagnosis

Diagnosis usually involves a combination of the following:

• Urinalysis:

  • Testing the urine for blood or abnormal cells.

• Cystoscopy:

  • A procedure where a thin tube with a camera (cystoscope) is inserted into the bladder through the urethra to examine the bladder lining.

• Biopsy:

  • During a cystoscopy, a small tissue sample may be taken for laboratory analysis to confirm the presence of cancer cells.

• Imaging Tests:

  • CT scans, MRIs, or ultrasounds may be used to visualize the bladder and surrounding organs.

• Urine Cytology:

  • Examining a urine sample under a microscope to look for cancer cells.

Staging

Bladder cancer is staged based on how far it has spread:

• Stage 0: Cancer is confined to the inner lining of the bladder.

• Stage I: Cancer has grown into the bladder wall but not into the muscle layer.

• Stage II: Cancer has spread into the muscle layer of the bladder wall.

• Stage III: Cancer has spread beyond the bladder to surrounding tissues or organs.

• Stage IV: Cancer has spread to distant parts of the body (metastasis).

Treatment Options

Treatment depends on the stage and grade of the cancer, as well as the patient's overall health:

1. Surgery:

   • Transurethral Resection of Bladder Tumor (TURBT): A common procedure for early-stage cancers where tumors are removed through the urethra.

   • Cystectomy: Removal of part (partial cystectomy) or all (radical cystectomy) of the bladder. In a radical cystectomy, nearby lymph nodes and sometimes surrounding organs (prostate in men, uterus, and part of the vagina in women) may also be removed.

   • Reconstructive Surgery: If the bladder is removed, reconstructive surgery can create a new way for urine to leave the body (urinary diversion).

2. Intravesical Therapy:

   • Immunotherapy: Treatment involves placing Bacillus Calmette-Guerin (BCG) directly into the bladder to stimulate the immune system to attack cancer cells.

   • Chemotherapy: Delivered directly into the bladder through a catheter to target cancer cells.

3. Systemic Chemotherapy:

   • Used before surgery (neoadjuvant) to shrink tumors or after surgery (adjuvant) to kill remaining cancer cells.

4. Radiation Therapy:

   • High-energy beams are used to kill cancer cells, often used when surgery is not an option or as a supplemental treatment.

5. Immunotherapy:

   • Drugs that help the immune system recognize and attack cancer cells. Examples include checkpoint inhibitors like pembrolizumab and atezolizumab.

6. Targeted Therapy:

   • Drugs that target specific molecules involved in cancer growth. These therapies are often used for advanced or metastatic bladder cancer.

Prognosis

The prognosis for bladder cancer depends on the stage at diagnosis, with earlier detection leading to better outcomes. Superficial (non-muscle-invasive) bladder cancers have a high recurrence rate but are usually treatable. Muscle-invasive bladder cancers are more serious and may require more aggressive treatment.