Bladder cancer: what is it?

By Cristiano Antonino Last updated Jun 20, 2023

Bladder cancer is a malignant transformation of the cells – mainly those called transitional cells – which cover the inner walls of the bladder, the organ responsible for collecting and expelling urine once it has been filtered by the kidneys

In some cases, transitional cells stop working properly and start growing and dividing uncontrollably, forming a tumor.

Depending on the cells involved in this uncontrolled proliferation, bladder tumors can be of three types

Transitional cell carcinoma

Transitional cell carcinoma is the most common tumor – it is estimated about 95% of cases – and originates from the cells that line the internal surface of the bladder.

The same type of cells also lines the urethra and ureter internally, which represent other sites subject to the development of this particular form of tumour, albeit less frequently.

Primary squamous cell carcinoma

Primary squamous cell carcinoma – an infrequent form of cancer – affects the squamous cells of the bladder and appears to be caused by a parasitic infestation.

Adenocarcinoma

Adenocarcinoma is a tumor formation, rather rare in this site, which develops from the cells that make up the glands present inside the bladder.

Bladder cancer represents about 3% of all tumor formations found in urology and, as a percentage, it affects male subjects more frequently than females in a ratio of 3:1.

It usually develops in middle-aged or older people: between 60 and 70 years of age.

What are the causes of bladder cancer and the risk factors

As already mentioned, bladder cancer is caused by the uncontrolled proliferation of bladder wall cells which – due to genetic mutations – lose their natural ability to control replication and differentiation.

The causes of the alterations of their physiological mechanisms are not yet fully understood, however some risk factors have been identified which significantly increase the possibility of developing this form of cancer.

Smoking is one of the main risk factors.

A heavy smoker sees double the chances of developing bladder cancer compared to a non-smoker.

Fortunately, this risk factor depends on the person’s habits, easily correctable thanks to an adequate therapeutic path.

The occupational factor associated with industrial processes is a rather important risk factor.

Exposure for long periods to polycyclic aromatic hydrocarbons – such as those used in the textile, dye, rubber and leather industries; hairdressers, miners and pesticide applicators – are more prone to developing bladder cancer.

Fortunately, this risk factor is slowly but steadily declining thanks to policies and regulations that limit the use of harmful substances.

Bladder infections – especially those caused by schistosoma haematobium – represent an important risk factor for the development of bladder cancer, especially in countries such as Tanzania, Egypt, Iraq, Kuwait where some parasitic infections are much more widespread.

In western latitudes, the risk of developing bladder cancer is connected to chronic urinary inflammation found in paraplegic or catheterized patients or with an important form of kidney stones.

Some drugs, both chemotherapy (cyclophosphamide and ifosfamide) and commonly used drugs (phenacetin), have been identified as possible risk factors for the development of bladder cancer.

An unbalanced diet contributes, together with other risk factors, to increasing the chances of developing bladder cancer and must therefore be avoided.

Bladder cancer: symptoms

The symptoms with which bladder cancer manifests itself are not dissimilar from the symptoms of other types of dysfunctions and pathologies affecting the urinary system:

Presence of blood in the urine and clot formation.
Sensation of intense burning in the bladder during maneuvers that increase the pressure inside the abdomen.
Difficulty and pain associated with urination.
Increased risk of contracting urinary tract infections.

Bladder cancer is unpredictable and, therefore, can produce metastases that first reach the lymph nodes through the lymphatic system, and then reach the rest of the body, reaching the lungs, liver and bones.

For this reason, it is important not to underestimate any symptoms, even if they are apparently negligible, and to ask your doctor for advice.

Diagnose bladder cancer

From the moment you go to a specialist doctor – generally the urologist, in collaboration with the oncologist – to undergo the investigations necessary to diagnose bladder cancer, the first tests required will be ultrasound and cystoscopy.

Cystoscopy – useful for visualizing the inside of the bladder and at the same time taking samples of suspicious tissue to then analyze them – consists in exploring the organ using a fiber optic instrument. The examination can be annoying but of undoubted importance for the purposes of an accurate diagnosis.

A cytological investigation will then be conducted on a urine sample in order to identify possible cancer cells within it.

Finally, tests such as CT, PET and bone scintigraphy will serve to exclude the possible presence of metastases.

If the hypothesis of the presence of bladder cancer is confirmed, the tumor formation should be classified according to the TNM system.

T parameter: describes the size and characteristics of the tumor.
Parameter N: describes the possible involvement of lymph nodes.
Parameter M: describes the possible presence of distant metastases.

Bladder cancer: the most appropriate therapy

The most appropriate treatment for bladder cancer depends on various factors, related to the characteristics and stage of progress of the tumor itself.

The oncologist specialist is the most appropriate doctor to identify the best therapeutic path based on the patient’s condition, which may include:

Surgical treatment

It is the primary therapy for bladder cancer, the patient’s condition permitting.

Depending on the characteristics and extent of the tumor, the removal of the tumor formation from the walls of the bladder will be performed endoscopically with an operation called TUR-V.

It may be necessary, in severe cases, to remove the entire bladder.

Patients who have undergone radical cystectomy will then undergo bladder reconstruction or an external diversion using the appropriate bag.

Medical treatment

In relation to the aggressiveness of the tumor, after surgery, it may also be necessary to instill – intravesically – a medical treatment based on chemotherapy and/or immunotherapy drugs.

On the other hand, systemic chemotherapy will be necessary if you decide not to intervene surgically or if the bladder tumor has generated widespread metastases in other organs of the body.

Radiotherapy treatment

Radiotherapy – often carried out in combination with chemotherapy – is a good alternative to surgery in case of bladder cancer in inoperable patients.

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