Bladder Cancer

The bladder is the organ found within a person’s pelvis that stores urine before it passes through the urinary tract. It is hollow, expandable, and an essential part of the urinary tract which also contains the kidneys, ureters and urethra, and in men, also the prostate gland. The urinary tract works as a system of tunnels, with the urine coming from the kidney and down into the ureter, through the bladder and out of the body through the urethra. The urinary tract and all of its components are lined with urothelium – a layer of cells that is separated by a fibrous band known as the lamina propria, from the bladder wall muscles.   

Bladder cancer happens when the cells within this lining of cells rapidly grow and change uncontrollably, thus forming a tumour. As the urinary tract works as a team, cancer that is found within the renal pelvis or ureters is also considered as bladder cancer and is treated as such.

Bladder Cancer and its Types

There are three main types of bladder cancers commonly found in patients. These cancers are diagnosed based upon the visual conformation of the cells under a microscope.

• Urothelial carcinoma accounts for approximately 90% of all bladder cancers. It also makes up for 10-15% of kidney cancer found in adults. Typically, urothelial carcinoma starts in the urinary tract urothelial cells.
• Squamous cell carcinoma begins as an irritation in the bladder which develop squamous cells. These cells may become cancerous over time, developing squamous cell carcinoma, which accounts for approximately 4% of all bladder cancers.
• Adenocarcinoma develops from glandular cells. This is the least common bladder cancer, making up only 2% of all cases.
• There are also other, lesser bladder cancers, such as sarcoma of the bladder which begins in the layers of muscle in the bladder.
   

Describing Bladder Cancer

When described, bladder cancer is also identified as non-invasive, non-muscle-invasive or muscle-invasive.

• A non-invasive bladder typically comes in two forms: carcinoma in situ (CIS) and non-invasive papillary carcinoma. CIS is only found near or on the surface of the bladder. This is known as stage 0is. Non-invasive papillary carcinoma stage 0a is when a small growth is found on tissue that is simply removed.
• Bladder cancer that is non-muscle-invasive defined as stage 1 cancer. This means that the cancer as (typically) not grown into the muscle, only the lamina propria. Bladder cancer that is non-muscle-invasive has the potential to spread into the surrounding muscle.
• Muscle-invasive bladder cancer is a tumour that has developed into the bladder wall and occasionally into the fatty layers and surrounding tissue outside of the bladder.
  
  

Regardless of the description of your cancer, it has the potential to spread into the bladder muscles and beyond the bladder. When this spread occurs, this is known as a locally advanced disease. Bladder cancer can easily spread to the vagina and uterus in women, and the prostate in men, as well as into the lymph nodes of both sexes.

Symptoms of Bladder Cancer
There are several common symptoms associated with bladder cancer, although it is important to note that a person with bladder cancer may not experience any or all of these symptoms. Likewise, a person without diagnosed cancer may develop these symptoms for other medical reasons, and it does not necessarily mean that they have bladder cancer. 

• Blood in the urine
• Pain or burning when urinating
• The frequent need to urinate
• Feeling the need to urinate, but not being able to
• Urinating several times throughout the night
• Pain in one side of the lower back 
  
  

Diagnosing Bladder Cancer

Typically, bladder cancer is diagnosed when a patient tells their doctor that they have blood in their urine. Blood in the urine is known as hematuria. Hematuria is either known as “microscopic hematuria”, which can only be detected through testing, or “gross hematuria” which can be seen by the naked eye. While urine tests are not detailed enough to diagnose cancer, they are an important step used to rule out any other causes. One urine test that can detect cancer is known as cytology. In a cytology test, a urine sample is examined underneath a microscope to search for traces of cancer cells. Occasionally, when a patient notices the preliminary symptoms of bladder cancer, the cancer has spread throughout the body, making it difficult to detect early on. 

If you are diagnosed with bladder cancer, palliative care will become an important part of your treatment plan in order to relieve you of any symptoms being experienced. It is important to remain in open communication with your oncology team throughout your cancer journey and be on the look out for any new or changing symptoms.