BLADDER CANCER

Definition:

Bladder carcinoma starts when cells that make up the urinary bladder start to grow out of control. As more cells develop, they can form a tumor and, with time, spread to other parts of the body. The bladder is a hollow organ in the lower pelvis. It has flexible, muscular walls that can stretch to hold urine and squeeze to send it out of the body. The bladder’s main job is to store urine. Urine is liquid waste made by the 2 kidneys and then carried to the bladder through 2 tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra.

Types of Bladder Carcinoma : There are three types of bladder carcinoma:

Transitional cell carcinoma
Transitional cell carcinoma is the most common type of bladder carcinoma. 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.

Squamous cell carcinoma
Squamous cell carcinoma is rare 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.

Adenocarcinoma
Adenocarcinoma is also rare 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.

How Does Bladder Carcinoma Develop and Spread?
The bladder wall has many layers made up of different types of cells. Most bladder carcinoma start in the urothelium or transitional epithelium. This is the inside lining of the bladder. Transitional cell carcinoma is a tumor that forms in the cells of the urothelium.

Bladder carcinoma gets worse when it grows into or through other layers of the bladder wall. Over time, the tumor may grow outside the bladder into tissues close by. Bladder carcinoma may spread to lymph nodes nearby and others farther away. The carcinoma may reach the bones, the lungs, or the liver and other parts of the body. With NMIBC, the tumor will not have spread outside the bladder.

Invasive vs. non-invasive bladder carcinoma:
Bladder carcinomas are often described based on how far they have spread into the wall of the bladder:

Non-invasive carcinomas are only in the inner layer of cells (the transitional epithelium). They have not grown into the deeper layers.
Invasive carcinomas have grown into deeper layers of the bladder wall. These carcinomas are more likely to spread and are harder to treat. A bladder carcinoma can also be described as superficial or non-muscle invasive. These terms include both non-invasive tumors as well as any invasive tumors that have not grown into the main muscle layer of the bladder.

Papillary vs. flat carcinoma
Papillary carcinomas grow in slender, finger-like projections from the inner surface of the bladder toward the hollow center. Papillary tumors often grow toward the center of the bladder without growing into the deeper bladder layers. These tumors are called non-invasive papillary carcinomas. Very low-grade (slow growing), non-invasive papillary carcinoma is sometimes called papillary urothelial neoplasm of low-malignant potential (PUNLMP) and tends to have a very good outcome.
Flat carcinomas do not grow toward the hollow part of the bladder at all. If a flat tumor is only in the inner layer of bladder cells, it’s known as a non-invasive flat carcinoma or a flat carcinoma in situ (CIS).
If either a papillary or flat tumor grows into deeper layers of the bladder, it’s called an invasive urothelial (or transitional cell) carcinoma.

Symptoms:
How do you know that you may have bladder carcinoma? Some people may have symptoms that suggest they have bladder carcinoma. Others may feel nothing at all. Some symptoms should never be ignored. You may need to talk to a urologist about your symptoms. A urologist is a physician who focuses on problems of the urinary system and male reproductive system.

Talk to your physician if you have the following symptoms:

Hematuria (blood in the urine) – the most common symptom, often without pain
Frequent and urgent urination
Pain when you pass urine
Pain in your lower abdomen
Back pain

Symptoms You Should Not Ignore:
Blood in the urine is the most common symptom of bladder carcinoma. It is generally painless. Often, you cannot see blood in your urine without a microscope. If you can see blood with your naked eye you should tell your health care provider immediately. Even if the blood goes away, you should still talk to your physician about it.

Blood in the urine does not always mean that you have bladder carcinoma. There are a number of reasons why you may have blood in your urine. You may have an infection or kidney stones. But a very small amount of blood might be normal in some people.

Frequent urination and pain when you pass urine (dysuria) are less common symptoms of bladder carcinoma. If you have these symptoms, it’s important to see your health care provider. He/she will find out if you have a urinary tract infection or something more serious, like bladder carcinoma.

Causes and Risks:
The exact cause of bladder carcinoma is unknown. It occurs when abnormal cells grow and multiply quickly and uncontrollably, and invade other tissues.

Nicotine intake increases your risk of bladder carcinoma. Nicotine consumption causes half of all bladder carcinoma in men and women. The following factors also increase your risk of developing bladder carcinoma:

exposure to carcinoma-causing chemicals
chronic bladder infections
low fluid consumption
being male
being white
being older, since the majority of bladder carcinomas occur in people over the age of 55
eating a high-fat diet
having a family history of bladder carcinoma
having previous treatment with a chemotherapy treatment called Cytoxan
having previous radiation therapy to treat carcinoma in the pelvic area.

Diagnosis and treatments:
Your physician may diagnose bladder carcinoma using one or more of the following methods:

A urinalysis
an internal examination, which involves your physician inserting gloved fingers into your vagina or rectum to feel for lumps that may indicate a tumorous growth
a cystoscopy, which involves your physician inserting a narrow tube that has a small camera on it through your urethra to see inside your bladder
a biopsy in which your physician inserts a small tool through your urethra and takes a small sample of tissue from your bladder to test for carcinoma
a CT scan to view the bladder
an intravenous pyelogram (IVP)
X-rays
Your physician can rate bladder tumors with a staging system that goes from stages 0 to 4 to identify how far the tumor has spread.

Treatment overview
Basic descriptions of the most common types of treatments used for bladder tumors are listed below. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your oncologist and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your oncologist work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for bladder carcinoma because there are different treatment options. Learn more about making treatment decisions.