What are the main types of bladder cancer. How is bladder cancer diagnosed. What are the treatment options for bladder cancer. What are the risk factors for developing bladder cancer. How can bladder cancer be prevented. What is the prognosis for patients with bladder cancer. How does bladder cancer affect quality of life.

Understanding Bladder Cancer: An Overview

Bladder cancer is a malignant tumor that develops in the urinary bladder, a hollow organ in the lower pelvis responsible for storing urine. This type of cancer occurs when cells in the bladder begin to grow uncontrollably, forming a tumor that can potentially spread to other parts of the body. Understanding the nature of bladder cancer is crucial for early detection and effective treatment.

What is the primary function of the bladder?

The bladder’s main function is to store urine produced by the kidneys. Urine is transported to the bladder through tubes called ureters. When you urinate, the muscles in the bladder walls contract, forcing urine out through the urethra.

Types of Bladder Cancer: A Comprehensive Guide

There are several types of bladder cancer, each with its own characteristics and treatment approaches. Understanding these types is essential for proper diagnosis and management of the disease.

What is the most common type of bladder cancer?

Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is by far the most prevalent type of bladder cancer. It accounts for approximately 90-95% of all bladder cancer cases. This type of cancer originates in the urothelial cells that line the inside of the bladder.

Are there other types of bladder cancer?

Yes, although less common, other types of bladder cancer include:

• Squamous cell carcinoma (1-2% of cases)
• Adenocarcinoma (about 1% of cases)
• Small cell carcinoma (less than 1% of cases)
• Sarcoma (very rare)

Each of these types has unique characteristics and may require different treatment approaches.

The Progression of Bladder Cancer: From Start to Spread

Understanding how bladder cancer develops and spreads is crucial for both patients and healthcare providers. This knowledge can inform treatment decisions and help predict outcomes.

How does bladder cancer begin and progress?

Bladder cancer typically starts in the innermost lining of the bladder, called the urothelium or transitional epithelium. As the cancer grows, it can penetrate deeper layers of the bladder wall. The more it progresses through these layers, the higher its stage and the more challenging it becomes to treat. Over time, the cancer may grow outside the bladder and into nearby structures, potentially spreading to lymph nodes or other parts of the body.

What are the common sites of bladder cancer metastasis?

When bladder cancer spreads beyond its origin, it tends to affect the following areas:

1. Lymph nodes
2. Bones
3. Lungs
4. Liver

Invasive vs. Non-Invasive Bladder Cancer: Key Differences

The classification of bladder cancer as invasive or non-invasive is crucial for determining the appropriate treatment approach and predicting the patient’s prognosis.

What distinguishes invasive from non-invasive bladder cancer?

Non-invasive bladder cancers are confined to the inner layer of cells (transitional epithelium) and have not grown into the deeper layers of the bladder wall. These cancers may also be referred to as carcinoma in situ (CIS) or stage 0 cancer. Invasive bladder cancers, on the other hand, have penetrated the deeper layers of the bladder wall. They are more likely to spread and generally more challenging to treat.

How are bladder cancers grouped for treatment purposes?

For treatment purposes, bladder cancers are often categorized based on whether they have invaded the main muscle layer of the bladder wall. Non-muscle invasive bladder cancer (NMIBC), also known as superficial bladder cancer, includes both non-invasive (stage 0) tumors and some early (stage I) invasive tumors that have not reached the muscle layer.

Papillary vs. Flat Bladder Cancer: Growth Patterns and Implications

The growth pattern of bladder cancer can provide valuable insights into its behavior and potential treatment approaches. Two main subtypes are recognized based on how the cancer grows: papillary and flat.

What are the characteristics of papillary bladder cancer?

Papillary carcinomas grow in slender, finger-like projections from the inner surface of the bladder toward the hollow center. These tumors often grow toward the center of the bladder without penetrating the deeper bladder layers. Non-invasive papillary cancers are a subset of this type. Very low-grade, non-invasive papillary cancer is sometimes referred to as papillary urothelial neoplasm of low-malignant potential (PUNLMP) and generally has a favorable prognosis.

How does flat bladder cancer differ from papillary?

Flat bladder cancers, in contrast to papillary tumors, do not grow toward the hollow center of the bladder. Instead, they remain flat against the bladder wall. These tumors can be more challenging to detect and may have a higher risk of becoming invasive.

Diagnosis and Staging of Bladder Cancer

Accurate diagnosis and staging of bladder cancer are crucial for determining the most appropriate treatment plan and predicting outcomes. Various diagnostic tools and techniques are employed to achieve this.

What are the common methods used to diagnose bladder cancer?

Diagnosis of bladder cancer typically involves a combination of the following:

• Urinalysis and urine cytology
• Cystoscopy (examination of the bladder with a thin, lighted tube)
• Biopsy
• Imaging tests (CT scan, MRI, ultrasound)
• Blue light cystoscopy (for enhanced tumor detection)

How is bladder cancer staged?

Bladder cancer staging is based on the TNM system:

1. T (Tumor): Describes the size and extent of the main tumor
2. N (Nodes): Indicates whether the cancer has spread to nearby lymph nodes
3. M (Metastasis): Shows if the cancer has spread to other parts of the body

The stage is then determined by combining these factors, ranging from stage 0 (very early cancer) to stage IV (advanced cancer that has spread to distant parts of the body).

Treatment Options for Bladder Cancer

The treatment of bladder cancer depends on various factors, including the type and stage of the cancer, as well as the patient’s overall health and preferences. A multidisciplinary approach is often used to provide the most effective care.

What are the primary treatment modalities for bladder cancer?

The main treatment options for bladder cancer include:

• Surgery (transurethral resection, partial or radical cystectomy)
• Intravesical therapy (medication instilled directly into the bladder)
• Chemotherapy
• Radiation therapy
• Immunotherapy
• Targeted therapy

How is the treatment plan determined?

The choice of treatment depends on several factors:

1. The stage and grade of the cancer
2. The patient’s age and overall health
3. The patient’s preferences and goals
4. Potential side effects and impact on quality of life

A multidisciplinary team of healthcare professionals typically collaborates to develop the most appropriate treatment plan for each patient.

Living with Bladder Cancer: Prognosis and Quality of Life

A bladder cancer diagnosis can significantly impact a person’s life. Understanding the prognosis and ways to maintain quality of life is crucial for patients and their caregivers.

What factors influence the prognosis of bladder cancer?

The prognosis for bladder cancer depends on several factors:

• The stage and grade of the cancer at diagnosis
• The patient’s age and overall health
• The response to treatment
• The presence of other medical conditions

Generally, early-stage bladder cancers have a more favorable prognosis than advanced-stage cancers.

How can patients maintain their quality of life during and after treatment?

Maintaining quality of life during and after bladder cancer treatment involves:

1. Managing side effects of treatment
2. Adhering to follow-up care and surveillance
3. Seeking emotional support and counseling
4. Maintaining a healthy lifestyle (diet, exercise, stress management)
5. Joining support groups or connecting with other survivors

It’s important for patients to communicate openly with their healthcare team about any concerns or challenges they face during their cancer journey.

Prevention and Risk Factors of Bladder Cancer

While not all cases of bladder cancer can be prevented, understanding the risk factors and taking preventive measures can help reduce the likelihood of developing the disease.

What are the main risk factors for bladder cancer?

Several factors can increase the risk of developing bladder cancer:

• Smoking (the most significant risk factor)
• Exposure to certain chemicals (e.g., in the textile, rubber, or paint industries)
• Chronic bladder inflammation
• Age (risk increases with age)
• Gender (more common in men)
• Race (more common in white individuals)
• Family history of bladder cancer
• Previous cancer treatment (certain chemotherapy drugs or radiation to the pelvis)

How can the risk of bladder cancer be reduced?

While some risk factors cannot be changed, there are steps that can be taken to reduce the risk of bladder cancer:

1. Quit smoking or never start
2. Limit exposure to chemicals in the workplace
3. Stay hydrated and maintain a healthy diet rich in fruits and vegetables
4. Exercise regularly
5. Seek prompt treatment for urinary tract infections or other bladder conditions

Regular check-ups and discussing any unusual symptoms with a healthcare provider can also aid in early detection and treatment of bladder cancer.

What Is Bladder Cancer? | Types of Bladder Cancer

• Types of bladder cancer
• Other cancers that start in the bladder
• Start and spread of bladder cancer

Bladder cancer starts when cells that make up the urinary bladder start to grow out of control. As more cancer cells develop, they can form a tumor and, with time, spread to other parts of the body. (To learn more about how cancers start and spread, see What Is Cancer?)

The bladder is a hollow organ in the lower pelvis. Its main job is to store urine. Urine is liquid waste made by the kidneys and then carried to the bladder through tubes called ureters. When you urinate, the muscles in the walls of the bladder contract, and urine is forced out of the bladder through a tube called the urethra.

Types of bladder cancer

Urothelial carcinoma (transitional cell carcinoma)

Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is by far the most common type of bladder cancer. In fact, if you have bladder cancer it’s almost always a urothelial carcinoma. These cancers start in the urothelial cells that line the inside of the bladder.

Urothelial cells also line other parts of the urinary tract, such as the part of the kidney that connects to the ureter (called the renal pelvis), the ureters, and the urethra. People with bladder cancer sometimes have tumors in these places, too, so all of the urinary tract needs to be checked for tumors.

Other cancers that start in the bladder

Other types of cancer can start in the bladder, but these are all much less common than urothelial (transitional cell) cancer.

Squamous cell carcinoma

In the US, only about 1% to 2% of bladder cancers are squamous cell carcinomas. Seen with a microscope, the cells look much like the flat cells that are found on the surface of the skin.

Adenocarcinoma

Only about 1% of bladder cancers are adenocarcinomas. These cancer cells start in gland-forming cells.

Small cell carcinoma

Less than 1% of bladder cancers are small cell carcinomas. They start in nerve-like cells called neuroendocrine cells. These cancers often grow quickly and usually need to be treated with chemotherapy like that used for small cell carcinoma of the lung.

Sarcoma

Sarcomas start in the muscle cells of the bladder. They are very rare. More information can be found in Soft Tissue Sarcoma and Rhabdomyosarcoma.

These less common types of bladder cancer (other than sarcoma) are treated a lot like TCCs, especially early-stage tumors, but if chemotherapy is needed, different drugs might be used.

Start and spread of bladder cancer

The wall of the bladder has several layers. Each layer is made up of different kinds of cells (see the image above).

Most bladder cancers start in the innermost lining of the bladder, which is called the urothelium or transitional epithelium. As the cancer grows into or through the deeper layers in the bladder wall, it has a higher stage, becomes more advanced, and can be harder to treat.

Over time, the cancer might grow outside the bladder and into nearby structures. It might spread to nearby lymph nodes, or to other parts of the body. (When bladder cancer spreads, it tends to go to the lymph nodes, the bones, the lungs, or the liver.)

Invasive vs. non-invasive bladder cancer

Bladder cancers are often described based on how far they have spread into the wall of the bladder:

• Non-invasive cancers are still only in the inner layer of cells (the transitional epithelium). They have not grown into the deeper layers. A cancer that is only in this inner layer might also be called carcinoma in situ (CIS) or stage 0 cancer.
• Invasive cancers have grown into deeper layers of the bladder wall. These cancers are more likely to spread and are harder to treat.

For treatment purposes, bladder cancers are often grouped based on if they have invaded into the main muscle layer of the bladder wall (see the image above). A bladder cancer that has not grown into the muscle layer can be described as superficial or non-muscle invasive bladder cancer (NMIBC). These terms include both non-invasive (stage 0) tumors as well as some early (stage I) invasive tumors.

Papillary vs. flat cancer

Bladder cancers are also divided into 2 subtypes, papillary and flat, based on how they grow (see the image above).

• 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 cancers. Very low-grade (slow growing), non-invasive papillary cancer is sometimes called papillary urothelial neoplasm of low-malignant potential (PUNLMP), and it 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.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Society of Clinical Oncology. Bladder Cancer: Introduction. 10/2017. Accessed at www.cancer.net/cancer-types/bladder-cancer/introduction on December 5, 2018.

National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Patient Version. October 19, 2018. Accessed at www.cancer.gov/types/bladder/patient/bladder-treatment-pdq on December 5, 2018.

See all references for Bladder Cancer

Last Revised: December 19, 2022

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

Bladder Tumors | University of Miami Health System

An abnormal growth that develops in the bladder is known as a bladder tumor. Some bladder tumors are benign (noncancerous), while others are malignant (cancerous). Malignant bladder tumors – also known as bladder cancer – can spread (metastasize) into other parts of the body.

Types of benign bladder tumors include:

• Fibromas: originate in the connective tissue of the bladder wall
• Hemangiomas: comprised of a mass or lump of blood vessels of the bladder wall
• Inverted papillomas: develop on the lining of the bladder and have a smooth surface
• Leiomyomas: originate in the muscle layer of the bladder wall
• Lipomas: originate in the cells in the fat layer that surrounds the bladder
• Neurofibromas: originate in the nerve tissue of the bladder
• Papillomas: originate in the urothelial cells, which make up the lining of the bladder and urinary tract

What are the symptoms of a bladder tumor?

• Back pain
• Blood in the urine (hematuria)
• Difficulty urinating
• Increased urinary frequency and urgency
• Pain in the pelvis
• Pain while urinating

The urologists at the Desai Sethi Urology Institute are experts in treating both benign and malignant tumors of the bladder.

Treatments

Surgery

In most cases, your urologist will recommend that you undergo surgery to remove the bladder tumor.

Tests

Cystoscopy

A tool called a cystoscope is inserted through the urethra (tube that transmits urine from the bladder) directly into the bladder to check for abnormalities like tumors or stones. This thin, tube-like instrument has a light and a lens for viewing. It can also have a tool to remove (biopsy) suspicious tissue samples. Pathologists review these samples with a microscope to look for signs of cancer.

Digital Rectal or Vaginal Exam

Your healthcare provider inserts a gloved finger into the rectum or vagina, which allows them to check for lumps or other abnormalities.

Laboratory Tests

A urine sample is checked for blood, chemicals, bacteria, and cells. The urine may be examined microscopically to look for cancer cells, or grown in a culture to check for infection.

Bladder Tumor Marker Studies

These tests look at cellular characteristics and substances released by bladder tumor cells into the urine.

Bladder Biopsy

Tissue samples can be taken from the bladder using a needle or during surgery if not removed with cystectomy. Pathologists review these samples with a microscope to look for signs of cancer or abnormal tissue.

Why Choose UHealth?

Leading experts in urology care. At the Desai Sethi Urology Institute, our team of recognized surgeons, researchers, technologists, and nurses has expertise in every subspecialty of urologic care, including urologic oncology and urologic reconstruction. You receive treatment from an experienced team that can give you the latest therapies.

Leaders in robotic surgery treatment. We have some of the world’s most experienced robotic surgeons for urologic procedures. In fact, doctors come from all over the world to learn at our Urology Robotic Program — the #1 ranked program in South Florida. The University of Miami Health System was the first academic medical center in the world to get the da Vinci Xi robotic surgery system and has completed more than 5,000 robotic surgeries — procedures that offer less pain and scarring and a faster recovery.

A top-ranked program for kidney and bladder cancer treatment. We offer advanced care for urologic cancers and are ranked among the top five kidney and bladder cancer programs in the country. Our urologists are dedicated to identifying cancer early so we can provide more effective treatment. We were the first — and only — medical center in South Florida to use enhanced Blue Light Cystoscopy with Cysview imaging technology to detect and identify bladder cancer. 

Bladder cancer – stages, symptoms, diagnosis

Bladder cancer is a malignant formation on the wall of the bladder or its mucous membrane. The disease occupies the third position after oncourological pathology of the prostate and kidneys. In men, this disease is diagnosed three times more often than in women. Approximately 79% of cases are people aged 50-80 years. Mortality from complications of this disease is low – from three to eight percent (statistics from developed countries). Every year in our country, bladder cancer is diagnosed in more than 16,000 people. The number of sick people is increasing every year.

Anatomy of the urinary system

The urinary bladder (UB) is a hollow organ of the urinary system located in the small pelvis. It is a reservoir for the accumulation of urine, which is emptied through the urethra. The capacity of a man’s organ is 0.35-0.55 l; women – 0.25-0.45 liters. When the organ is full of 0.15-0.25 l, there is an urge to urinate. The faster the organ is filled, the stronger the irritating effect on muscle receptors occurs and the work of the urinary system becomes more frequent.

Cancer of the urinary tract: classification and stages

The urinary bladder (UB) is a hollow organ of the urinary system located in the small pelvis. It is a reservoir for the accumulation of urine, which is emptied through the urethra. The capacity of a man’s organ is 0.35-0.55 l; women – 0.25-0.45 liters. When the organ is full of 0.15-0.25 l, there is an urge to urinate. The faster the organ is filled, the stronger the irritating effect on muscle receptors occurs and the work of the urinary system becomes more frequent.

Cancer of the bladder: classification and stages

A malignant tumor of this organ is detected by histological examination, according to the degree of cell differentiation, the formation of secondary foci (metastases), and the nature of growth. These parameters are extremely important for planning a therapy strategy.

The morphology of malignant tumors is as follows: over 90% falls on the share of transitional cell tumors; up to 5% – squamous; adenocarcinoma and sarcoma – up to 2%; 1% – papilloma. The rarest bladder cancer is small cell and spindle cell carcinoma.

The degree of anaplasia is divided into low-, moderate- and highly differentiated neoplasms. One of the main roles is played by the involvement of different layers of the bladder wall in the tumorogenic action. For this reason, the disease is invasive in a high or low stage, or proceeds superficially.

And also the tumor is subdivided into papillary, infiltrative, flat, nodular, intraepithelial growth patterns. Perhaps the combined development of neoplasms – cancer simultaneously has several signs.

Bladder cancer is classified according to the international TNM system.

Stages:

• T – primary neoplasia.
• TX – Primary neoplasia not assessable.
• TO – primary neoplasia without any data.
• Ta – superficial papillary carcinoma.
• Tis – flat carcinoma in situ – stage zero neoplasia.
• T1 – cancer cells penetrate into the vessels.
• T2 – neoplasia of the muscular layer (T2a – cancer that proceeds superficially; T2b – cancer that has penetrated deep into the tissues).
• T3 – the pathology is transmitted to the paravesical tissue. At the same time: T3a – at the microscopic level; T3b – at the macroscopic level.
• T4a – penetration of cancer at any stage into neighboring organs – the uterus, vagina, prostate are affected.
• T4b – penetration of cancer cells into the pelvic bones, abdominal wall.
• N1-3 – Metastases occur in one (N1) or several (N2) pelvic lymph nodes.
• M1 – penetration of metastases into neighboring organs – liver cancer, lung cancer, stomach cancer; in certain cases – damage to the bones.

Cancer of the bladder: signs

The onset of cancer at the initial stage may not manifest itself in any way, pass even without weak signs. That is, the tumor is at the primary stage of development, but the patient does not feel it at all.

The first manifestation of cancer of this unpaired hollow organ is hematuria – the presence of blood in the urine. This symptom is subdivided into microhematuria – when the urine is periodically stained pink; and gross hematuria – urine acquires a clear bloody hue and may contain clotted blood. Blood clots can cause urinary retention; difficulty and frequent urination.

Too frequent urination can also be caused by tumor formation. When neoplasia is sufficiently developed and reaches several centimeters in size, it reduces the capacity of the bladder. Therefore, less urine accumulates in it, which is the reason for too frequent urination.

Against the background of the development of a neoplasm, pain in the pelvic area increases both during urination and at rest. The pains are often aching and rarely sharp. In the later stages, pain can be intense and prolonged. The condition is aggravated by progressive anemia and the general weakness caused by it.

Sometimes the tumor is located in such a way that it does not allow urine to pass from the upper urinary tract (the flow of urine from the kidneys to the organ is difficult), this leads to the development of chronic renal failure. In this case, a biochemical blood test will show an increased content of urea and creatine.

But not all signs are direct symptoms of bladder cancer. Many of them relate to other diseases of the pelvic organs: cystitis, urethritis, the presence of stones in the urinary system, a benign tumor of the prostate. The similarity of the symptoms of the initial periods leads to the fact that patients are engaged in prolonged self-medication, and this aggravates the overall clinical picture.

Causes

Doctors have not come to a generally accepted etiology of this disease, but have identified sources of risk that contribute to tumor formation:

Rare urination and prolonged stasis of urine. An increased content of metabolites in the urine has a tumorigenic effect, which can provoke a malignant change in the transitional epithelium.

Diseases of the pelvic organs. Prostate adenoma, prostatitis, urolithiasis, chronic cystitis – these pathologies can also cause prolonged stasis of urine, which will negatively affect the epithelium.

Infectious diseases. The influence of human papillomavirus infections as a cause of neoplasms remains questionable. Of the parasitic infections, urogenital bilharziasis provokes active carcinogenesis.

Professional factor. This risk affects people who regularly come into contact with substances such as xylene derivatives, phenols, phthalates, anti-cancer drugs, etc. Often these are painters, health workers, workers in the chemical, oil and gas production and processing sectors.

“Household” carcinogens. This risk group includes smokers who suffer from bladder cancer two to three times more than those who do not suffer from this addiction. And also chlorinated drinking water belongs to the category of carcinogens – it increases the likelihood of disease by more than one and a half times.

In some cases, tumor formation can be genetically determined and caused by hereditary factors.

Cancer of the urinary tract: diagnosis

Detection of tumor formation in the main organ of the urinary system is a complex clinical and laboratory study with instrumental examination included. Here, hematuria is detected by urinalysis; visual microscopic analysis reveals atypical cells; culture finds or excludes infection; a test for the detection of a tumor agent is carried out; a blood test ascertains anemia, confirming blood loss. And also held:

• Transabdominal (superficial) ultrasound. This diagnosis is able to detect neoplasia larger than 5 mm, located in most cases on the side of the cystic walls. Research efficiency: neoplasia up to 5 mm — 37%; tumor with a diameter of more than 5 mm – 83%.
• Transrectal or transvaginal scanning is done to diagnose tumors in the neck of an organ. In some cases, endoluminal echography is performed. This is a study using an ultrasound device inserted into the bladder through a natural opening. Accuracy of determining pathology – 94%.
• Urethrocystoscopy – biopsy of the urethral mucosa. This is a mandatory diagnostic procedure. Reveals the number, size, growth rate, location of tumor formation.
• CT high quality x-ray images. They make it possible to obtain more detailed data and find small neoplasms that cannot be determined by echographic examination. And also tomography can reveal the depth of the introduction of malignant tumors.
• MRI – high-precision images obtained by magnetic resonance imaging. The most informative type of diagnosis of bladder cancer.
• Endoscopy allows you to visually detect the appearance of neoplasia, its size and location. In addition, this examination makes it possible to take a biopsy and carry out morphological confirmation of bladder cancer.
• There is an x-ray diagnostics: in case of tumor formation, a cystographic examination is performed, which reveals the deformation of the borders of the bladder wall. This allows you to determine the growth of the neoplasm.
• With the help of pelvic phlebography and lymphadenography, the involvement of the veins of the pelvic region and lymph nodes is revealed.
• Distant metastases are detected by ultrasound examination of the abdominal and pelvic organs; chest x-ray, skeletal scintigraphy.

Therapy

Tumor formation in the bladder can be conditionally ungrouped.

• Non-muscle invasive (superficial) cancer.
• Invasive cancer – penetration of metastases deep into the muscle layers.

Therapy at the initial stage of the course of the disease can do without surgical methods. In this case, chemotherapy is used with the use of one or a group of cytostatics; treatment with immunological drugs. The purpose of these groups of drugs depends on the size, location and progression of malignancy.

Non-muscle invasive cancer: treatment

Transurethral resection of the bladder (TUR). A surgical operation in which special equipment is inserted through the urethra. The impact on the tumor is made by resection, laser, electrocoagulation.

Intravesical (local) chemotherapy. The method consists in introducing an antitumor drug into the organ cavity. The course of local chemical therapy is from 6 to 8 weekly intravesical installations. It is an effective method for preventing the recurrence of this cancer.

Penetrating bladder cancer: methods of therapy

Cystectomy. This is a surgical operation to excise a fragment of the bladder or an entire organ. The degree of intervention is determined by the course of the cancer.

Radical cystectomy. The technique provides for a complex ectomy of organs, namely: the bladder; a fragment of the serous membrane of the abdominal cavity or tissue of the parietal space of the pelvis; prostate; paired organ of the male reproductive system. In women, a complex ectomy of the bladder is performed; uterus and its neck, appendages; anterior wall of the vagina. A mandatory procedure for cystectomy is the removal of pelvic lymph nodes.

The removed organ is replaced by ureterocutaneostomy – implantation of the ureters into the skin; urine diversion according to the Bricker method; orthopedic bubble from the tissue of the small intestine or stomach.

If necessary, the ectomy is enhanced by remote or contact laser treatment, chemotherapy, general or intravesical immunological therapy. If the patient refuses surgery, radical treatment with ionized radiation is prescribed.

Cancer of the bladder: preventive measures

Prevention of bladder cancer includes a wide range of measures. These are: complete exclusion of alcoholic beverages and cigarettes; increased physical activity – increased walking; a healthy diet with the inclusion of the required amount of vegetables and fruits; exclusion from the diet of chlorinated water and other carcinogens; maximum limitation of UV radiation.

At the slightest hint of signs of the disease, for example: increased urination, you should immediately contact a qualified specialist and undergo a diagnostic examination. A malignant neoplasm must be detected at an early stage – the effectiveness and success of treatment directly depends on this. Early diagnosis in some cases helps to avoid surgical intervention. Remember: cancer is a complex disease that needs to be detected in a timely manner.

symptoms and causes of development, types, stages, diagnosis and treatment of BC, prognosis

Bladder cancer (BC) is a malignant neoplasm that develops in the mucosa and submucosa or wall of the organ. The disease accounts for 4-5% of all malignant neoplasms. Among all tumors of the urinary system, pathology occupies 70% Source:
Dolgikh D.V. Bladder cancer (issues of etiology and pathogenesis) / D.V. Dolgikh [et al.] // Siberian Medical Journal (Irkutsk). – 2015. – № 7. – S. 26-30. In men, the tumor is diagnosed at a younger age, it is more aggressive. However, in women, when an invasive form of a neoplasm is detected in the later stages, the chances of surviving are less.

According to the Federal State Statistics Service in Russia in 2017, 16.5 thousand people were diagnosed with a malignant neoplasm of the bladder, established for the first time in their lives. Among them, 12.7 thousand are men, and 3.8 thousand are women. The primary incidence of malignant neoplasms of the bladder in Russia in 2017 was 11.2 per 100,000 of the population, while among men the primary incidence was 18.6 per 100,000 of the population, and among women 4.9per 100,000. Thus, the incidence of malignant neoplasms of the bladder among men is more than 3 times higher than among women. Source:
Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.0183 Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.. The disease is more often diagnosed in residents of industrialized countries, large cities.

RMP is one of the most difficult to treat, primarily due to late diagnosis. About 1 out of 10 detected cases of neoplasms is cancer with metastases.

Causes of bladder cancer

There is no single proven cause of a tumor. Many risk factors contribute to the development of bladder cancer. Among them:

• Smoking . It is considered the main factor provoking RMP. Approximately half of the detected cases of cancer are associated with smoking, in smokers it is diagnosed 3 times more often than in non-smokers.
• Poor water quality and unfavorable environmental conditions . The chance of getting sick is increased by an excess of chlorine and fluorine in drinking water, pollution by waste from industrial production of water and air.
• Abuse of alcohol, fried and fatty foods .
• Harmful working conditions – work with substances containing aromatic amines, phenols, phthalates. At risk are workers in the chemical, paint and varnish, rubber, oil, aluminum, leather and textile industries, artists, designers, hairdressers. RMP often occurs among drivers of long-distance flights, due to prolonged driving in a sitting position, frequent hypothermia, inability to urinate in a timely manner. Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..
• Non-infectious urogenital pathologies – chronic cystitis, urolithiasis, diverticulitis; genitourinary infections – chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis; parasitic diseases – schistosomiasis.
• Urinary stasis or infrequent urination for various reasons – prostate adenoma, narrowing of the urethra, insufficient fluid intake.
• Radiation therapy for tumors of the cervix and ovaries, prostate, chemotherapy with the use of “Cyclophosphamide” (increases the risk by 4.5 times), long-term use of phenacytin-containing analgesics (increases the risk of occurrence by 2-6.5 times) Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..
• In addition, the risk is significantly increased in people exposed to ionizing radiation Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..

Symptoms of bladder cancer

The main symptom of bladder cancer is hematuria (blood in the urine), which is often transient, its severity does not depend on the stage of the disease Source:
Kulesh P. A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.. Possible microhematuria, when the blood is not visible visually and is detected only during the analysis, and macrohematuria – the urine turns dark orange, pink, red, brown.

Early symptoms also include dysuric disorders: frequent or infrequent urination, accompanied by pain, cutting or burning, weak, intermittent urine stream.

All the first signs of bladder cancer are non-specific, characteristic of other diseases of the urogenital area. It is important to seek medical help as early as possible in order to conduct a differential diagnosis, identify a neoplasm in time and begin treatment.

Pain in bladder cancer may have different characteristics depending on the nature of the spread of the tumor. With a locally advanced tumor process, initially most often there is pain over the bosom, provoked by the act of urination, subsequently the pain becomes constant, pain appears in the perineum and in the sacrum. With obstruction by a tumor of the mouths of the ureter, hydronephrosis develops, pain in the lumbar region appears, a positive symptom of tapping of the lumbar region, an enlarged kidney is palpated. Bone pain is usually indicative of skeletal metastases Source:
Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..

In the later stages of cancer, general weakness, pain in the lumbar and inguinal regions, lower abdomen, lack of appetite and weight loss, fever, swelling in the legs, swollen lymph nodes join. Fistulas may appear between the bladder and rectum.

Types of bladder cancer

By prevalence in the muscle layer:

• non-muscle invasive – located only on the mucosa and submucosa;
• muscle invasive – Invades the thickness of the bladder wall.

Localization:

• on the dome – the upper wall of the bladder;
• on side, front or rear walls ;
• in Lieto’s triangle – a space in the form of a triangle with vertices at the mouths of the ureters and the outlet of the urethra;
• on the bladder neck ;
• in the region of the orifices of the ureters ;
• in the area of ​​the urachus – normally closed rudimentary primary duct located above the bladder;
• Tumor involves several areas .

By type of growth:

• exophytic (papillary) – the formation grows upward from the mucous membrane, initially looks like a polyp;
• endophytic (infiltrative) – grows inside the wall of the organ with the transition to the muscle layer, has no clear boundaries;
• mixed form – neoplasm grows inward and outward simultaneously;
• flat ;
• nodular ;
• intraepithelial .

According to histological structure:

• Epithelial cancer . In 98% of cases, bladder tumors develop from epithelial cells Source:
  Kulesh P.A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019.. In 90-95% of cases, bladder tumors are morphologically transitional cell carcinoma Source:
  Dolgikh D.V. Diagnosis of bladder cancer / D. V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – No. 6. – S. 141-147 .. It can be low- and highly differentiated, on which the degree of malignancy of the formation depends. Verrucous carcinoma, adenocarcinoma and clear cell adenocarcinoma, urachus cancer, small cell carcinoma are diagnosed much less frequently.
• Non-epithelial cancer . Tumors from muscle, fibrous vascular and other tissues: rhabdomyosarcoma, fibrous histiocytoma, leiomyoma, hemangioma, melanoma, germ cell tumors.

Histological picture of a low-grade superficial bladder urothelial tumor. Source: cureus.com

Stages of bladder cancer

In the first stage bladder cancer, tumor cells are located only in the epithelial layer. The process does not affect the wall of the bladder, nearby and distant organs.

second stage is characterized by invasion of the neoplasm into the muscle layer. Adjacent organs are not affected, there are no distant metastases.

At the third stage , in addition to the germination of cancer in the muscular layer of the bladder, there is an increase in regional lymph nodes.

The fourth stage is characterized by any size of the tumor, while regional lymph nodes are affected, metastases are observed in distant organs.

9 is used for international classification0071 TNM system :

• T – indicates the extent of the tumor, indicated by numbers from 1 to 4.
• N – the presence of metastases in the lymph nodes. The number 0 indicates the absence of metastases in the lymph nodes, 1 – a single affected node, 2 – metastases in 2-5 lymph nodes.
• M – (x, 0 or 1) – the inability to detect, the absence or presence of distant metastases.

Bladder cancer staging

Diagnosis of bladder cancer

The first stage in the diagnosis of bladder cancer is examination of the patient, taking an anamnesis of life and illness, laboratory and instrumental studies. The doctor will ask the patient in detail about the symptoms, the time of their occurrence, the frequency of occurrence, the presence of bad habits, and other factors that provoke the disease.

During a urological examination, the doctor will determine Pasternatsky’s symptom – the presence or absence of pain when tapping on the lower back, and also check the condition of the prostate gland using a digital examination through the rectum.

In addition to general and biochemical blood and urine tests, which are not informative in the diagnosis of oncological diseases, the patient may be assigned to study the urine sediment for the presence of pathological cells and to determine tumor markers of bladder cancer .

Ultrasound for bladder cancer allows to visualize the tumor if its size exceeds 4 mm, determine the form of tumor growth (exophytic, endophytic or mixed) and the depth of its invasion into the wall Source:
Long D. V. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – No. 6. – P. 141-147. During a cold cystoscopy, the bladder is examined and a section of the affected tissue is excised for analysis. Another treatment and diagnostic method is TUR-biopsy , when the neoplasm is completely excised, with the capture of healthy tissue. During transurectal resection with photodynamic diagnosis, a doctor can see even the smallest areas of a tumor lesion in blue illumination.

Papillary bladder tumor (cystoscopy). Source: cureus.com

To determine the involvement of the lymph nodes, metastasis to other organs, use:

• CT and MRI,
• scintigraphy,
• lymph node biopsy,
• chest x-ray,
• abdominal ultrasound;
• tests for tumor markers.

Three markers, UBC, TPS and VEGF, have the highest sensitivity and specificity in staging bladder cancer. An increase in the level of UBC in the urine characterizes the initial stages of bladder cancer and the possible non-invasive recurrence of the tumor with organ-preserving treatment. In patients with non-muscle-invasive bladder cancer, an elevated level of VEGF can serve as an additional criterion not only for disease recurrence, but also for its progression. The simultaneous rise in the content of UBC in the urine and TPS, VEGF in the blood serum is associated with the progression of tumor growth and characterizes the initial stage of bladder cancer invasion into the muscle layer. A high level of VEGF is characteristic of a tumor growing outside the organ, as well as with a high activity of tumor growth and a low degree of its differentiation, which is a poor prognostic factor Source:
Long D.V. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – № 6. – S. 141-147. The study allows to assess the patency of the ureters, to identify neoplasms both in the upper urinary tract and in the bladder Source:
Kulesh P. A. The study of clinical and morphological features of bladder cancer / P.A. Kulesh, A.A. Bagaeva // Eurasian Union of Scientists. – 2019..

Multislice computed tomography Source:
DV Dolgikh. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – № 6. – P. 141-147. Source radiopaedia.org

Bladder cancer treatment methods

0181 transurethral resection followed by intravesical chemotherapy or immunotherapy – injection of drugs into the bladder cavity. The advantage of intravesical administration is the absence of side effects of systemic chemotherapy, such as nausea, vomiting, hair loss.

BCG vaccine is used for intravesical immunotherapy. Weakened Koch’s sticks activate cells of the immune system, which begin to attack the tumor.

A more modern method of immunotherapy is the use of checkpoint inhibitor drugs. Checkpoints are molecules that suppress the immune response, including to prevent the occurrence of autoimmune diseases. Inhibitors block these points and stimulate the immune system to fight cancer cells.

Another low-traumatic method of treatment is laser en-bloc resection , which allows you to remove the neoplasm in the mucous and submucosal membranes, the muscle layer as a single block. This method is not suitable for large formations without clear boundaries.

In the advanced stages of bladder cancer, if the above methods have not helped, resort to complete removal of the organ – cystectomy , followed by radiation or chemotherapy.

Isolated cystectomy (bladder removal only) is rarely performed for invasive cancer. More often it is combined with the removal of neighboring organs: the prostate and seminal vesicles in men, the appendages and uterus in women. At the same time, the entire urethra or part of it, pelvic lymph nodes are excised.

After cystectomy, it is possible to perform a reconstructive operation – neocystoplasty, when the removed bladder is replaced with an isolated section of the intestine, to which the ureters and urethra are connected.

Prognosis for the disease

The prognosis of survival depends on the stage at which the tumor is diagnosed, how timely and complete the treatment is. If a single epithelial lesion is detected and TUR is performed in conjunction with chemotherapy or immunotherapy, the chances of recovery are about 91 %. In the second stage, without the spread of cancer to other organs, timely transurethral resection and chemotherapy (rarely radiation therapy) allow us to hope for recovery without recurrence in 73-75% of patients. In the third stage and the transition of the process to nearby organs, even after removal of the bladder and chemotherapy, there is a possibility of relapse, a five-year survival rate is observed in 50% of patients. At the fourth stage, the process is considered inoperable, palliative methods are used, the five-year survival rate is less than 7%.

Prevention of bladder cancer

Stopping smoking and alcohol, eating a lot of fresh fruits and vegetables, which contain antioxidants that prevent cell regeneration, will help reduce the likelihood of developing a tumor. Bladder cancer is less likely to occur in those who drink enough water per day. It is believed that the risk of neoplasm is reduced by 7% for every 240 ml of added liquid.

It is necessary to be attentive to your health and consult a doctor when the first, even minor, signs of illness appear. It is important to monitor the regularity of urination, to protect yourself from genitourinary infections, to diagnose and treat inflammatory processes of the urinary tract in time. Workers in hazardous industries should not neglect professional examinations. People over the age of 40 are recommended to undergo an annual medical examination.

Sources

1. Dolgikh D.V. Diagnosis of bladder cancer / D.V. Dolgikh [et al.] // Siberian Medical Journal. – 2015. – No. 6. – S. 141-147.
2. Dolgikh D.V. Bladder cancer (issues of etiology and pathogenesis) / D.V. Dolgikh [et al.] // Siberian Medical Journal (Irkutsk). – 2015. – No. 7. – S. 26-30.
3. Dunaev M.