Prostate cancer and testicular cancer get most of the attention, however, most people aren't aware that bladder cancer is the fourth malignancy in men. The good news is when caught early, bladder cancer has a high success rate. The bad news is recurrence is common and bladder cancer can often be mistaken for other diseases.
As many as 53,000 American men are diagnosed with bladder cancer each year, while over 10,000 are expected to die as a result of the malignancy, according to Verywell Health. This includes Black men, who are often diagnosed with bladder cancer at later stages.
Here's what you need to know about bladder cancer.
Types
The most common form of bladder cancer is transitional cell carcinoma (TCC), also known as urothelial carcinoma. It is limited to the innermost lining of the bladder (transitional epithelium). The transitional epithelium is only a few cell thick, so if the cancer is caught early, you will have a high likelihood of treatment being a success.
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Approximately 70 percent of bladder cancers are confined to the transitional epithelium, however, others will penetrate deeper into the bladder wall. Non-muscle invasive carcinoma involves an underlying layer of cells called the lamina propria. Invasive carcinomas involves cells that penetrate even deeper into the muscles of the bladder.
Adenocarcinomas, small cell carcinomas and sarcomas are all less common types of bladder cancer. Each account for less than one percent or less of the U.S. population.
Symptoms
Most people living with bladder cancer find that it is painless. The most common sign of bladder cancer is urinary bleeding, either overt (known as gross hematuria) or detected with blood or imaging tests (microscopic hematuria). Bladder cancer patients may experience bleeding that is consistent or intermittent. Although blood in urine is one of the most common signs of bladder cancer and can be understandably distressing, it isn't a sure sign that you have cancer. It also doesn't determine the severity of your cancer, if you do have it.
Signs and symptoms of bladder cancer vary based on the size and location of the tumor and the stage of the disease. However, these are some of the common symptoms you may experience:
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- A persistent urge to urinate (urinary urgency)
- Frequent urination (urinary frequency)
- Back or abdominal pain
- Loss of appetite
- Unexplained weight loss
Causes
Bladder cancer forms due to mutated cells that proliferate and form a tumor—in this case, in the bladder. It affects men three to four times more often than women, and is more common in white than Black men.
Cigarette smoking is the most significant risk factor for bladder cancer because many of the carcinogens found in cigarettes are expelled from the body in urine. This makes doubles your risk of developing bladder in comparison to a non-smoker, so if you smoke, this is your sign to quit.
Other bladder cancer risk factors include:
- Prolonged exposure to industrial toxins (although the incidence has decreased with improved workplace safety regulations
- Prolonged use of Cytoxan (cyclophosphamide) chemotherapy
- Radiation therapy for prostate cancer
- Chronic urinary tract infections (UTIs)
- Schistosomiasis, a parasitic infection common in the tropics
Certain genetic mutations (particularly the FGFR3, RB1, HRAS, TP53, and TSC1 mutations) may further predispose you to bladder cancer.
It is also important to know your family history. Rare inheritable genetic disorders like Lynch syndrome (associated with colorectal cancer), Cowden disease (linked to thyroid and breast cancer), and retinoblastoma (an eye cancer) are also linked to an increased risk of bladder cancer.
Diagnosis
Because bladder cancer shares many of the same symptoms as kidney stones and UTIs, your doctor will first rule out any other causes before considering more invasive investigations. Your doctor may order a digital rectal exam and a prostate-specific antigen (PSA) test to rule out prostate problems as well as imaging tests, such as X-rays and computed tomography to exclude kidney stones, bladder stones and urinary tract disorders.
The diagnosis of bladder cancer is often complicated by the fact that it shares many of the same symptoms of other, more common genitourinary conditions, including kidney stones and UTIs.
To this end, the diagnosis relies heavily on the exclusion of all other causes before more invasive investigations begin. This may include a digital rectal exam and prostate-specific antigen (PSA) test to rule out prostate problems. Imaging tests such as X-rays and computed tomography (CT) may be used to exclude kidney stones, bladder stones, and urinary tract disorders.
Urinary cytology (the microscopic evaluation of urine to check for cancer cells) can also provide evidence of cancer, however, the test is often inaccurate if the tumor is small and non-invasive.
Newer options called the bladder tumor antigen (BTA) and nuclear matrix protein 22 (NMP) tests are more likely to detect larger, more advanced tumors making them more useful in monitoring a diagnosed malignancy than establishing the initial diagnosis.
The gold standard for diagnosis of bladder cancer is cystoscopy, which is performed under local anesthesia to numb the urethra (the tube through which urine exits the body), Verywell Health notes.
Cystoscopy can offer definitive evidence of bladder cancer. Your doctor may also order additional tests such as a bone scan, liver function tests, and CT scans of the chest, pelvis, and abdomen may to establish if and how far the cancer has spread.
Bladder Cancer Staging
After your diagnosis, a urologic oncologist will stage the cancer. This will help doctors determine the appropriate course of treatment and predict the prognosis of the disease. Your prognosis doesn't necessarily determine the amount of years you will live. Doctors use it to gauge the effectiveness of treatment. Many people with bladder cancer live long, healthy lives.
The staging is classified based on the type and location of the tumor as follows:
- T0: No evidence of cancer
- Ta: A non-invasive papillary (finger-like) tumor
- Tis: A non-invasive flat carcinoma (carcinoma in situ)
- T1: Infiltration of the lamina propria
- T2a: Infiltration of the inner muscle
- T2b: Infiltration of the deep muscle
- T3a or T3b: Extending beyond the bladder wall
- T4a: Involving the prostate gland or seminal vesicles
- T4b: Involving the pelvic wall or abdominal wall
If the lymph nodes are involved, "N+" is tagged onto the end of the tumor stage (for example, T3N+). If cancer has metastasized to the lymph nodes and distant organs, "N+M1" is tagged to the end of the tumor stage, according to Verywell Health.
Life As A Cancer Survivor
Bladder cancer can successfully be treated, but it still helps to take some extra steps to help you readjust to life as a cancer survivor and reduce your risk of the cancer returning. This requires some lifestyle changes.
Not sure where to start? Here are some tips from Verywell Health:
- Quitting cigarettes is considered a must. Even if you have smoked heavily in the past, studies suggest that your risk of recurrence may be entirely mitigated if you remain smoke-free for 10 years.20
- Low-fat diets are believed to be beneficial, both in preventing bladder cancer and avoiding recurrence. Eating large amounts of processed red meats should also be avoided, since they have been associated with an increased risk.21
- Antioxidant-rich foods may also help reduce cancer risk, including those that contain quercetin (cranberries, broccoli), lycopene (tomatoes, carrots, red cabbage), vitamin E (almonds, sunflower seeds), or epigallocatechin gallate (green tea, apples, dark chocolate).22
- Increased fluid intake may also decrease your risk. A 10-year retrospective study concluded that men who drank two quarts of water per day were 49% less likely to get bladder cancer compared to those who drank less a quart per day.
