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Bladder Cancer

Unlike other cancers, about 50% of all bladder cancers are diagnosed while still localized in the bladder wall’s inner layer; cases like these are referred to as non-invasive, or in situ.

Unlike other cancers, about 50% of all bladder cancers are diagnosed while still localized in the bladder wall’s inner layer; cases like these are referred to as non-invasive, or in situ.

Overview

About 9 in 10 individuals diagnosed with bladder cancer are over 55, and the disease’s average age of diagnosis is 73. There is a major gender disparity in the disease: men have about a 1 in 27 chance of developing bladder cancer, while women have a chance of about 1 in 89 of developing it1https://www.cancer.org/cancer/bladder-cancer/about/key-statistics.html.

The most common type of bladder cancer is known as transitional cell carcinoma (TCC), and makes up about 95% of all cases of the disease. TCCs are divided into two subtypes:

  • Flat carcinomas, which stay on the bladder wall’s surface.
  • Papillary carcinomas, which grow out from the bladder wall’s inner surface and toward its hollow center, in projections that resemble fingers.

Other types of far more rare bladder cancers include: sarcomas, small-cell carcinomas, squamous cell carcinomas, and adenocarcinomas2https://www.cancercenter.com/cancer-types/bladder-cancer/types.

Traditionally, if your doctor suspects you have bladder cancer, they will first perform a physical exam to feel for anything abnormal. And if they find any cause for concern, they will likely follow up with a cystoscopy, an exam during which a specialist inserts a tiny light and lens or video camera to examine the bladder3https://www.cancer.org/cancer/bladder-cancer/detection-diagnosis-staging/how-diagnosed.html. Cystoscopies, however, have little demonstrated efficacy4https://onlinelibrary.wiley.com/doi/abs/10.1002/nau.23395, while diffusion weighted MRI has demonstrated promising results in studies5https://pubs.rsna.org/doi/10.1148/radiol.2511080873.

Symptoms

Signs and symptoms of bladder cancer could include symptoms that might be mistaken for other, benign conditions:

  • Pelvic pain
  • Back pain
  • Painful urination
  • Blood in the urine
  • Frequent urination

If you are having any of the above symptoms you need to talk to a doctor about the appropriate diagnostic work up. The Ezra scan is a screening test for asymptomatic individuals and it is not designed to diagnose existing or suspected cancers.

(Source)

Causes

Bladder cancer forms when cells start growing abnormally, developing mutations that prevent them from dying, thereby allowing them to form a tumor. Some causes of bladder cancer may include:

  • Tobacco use (not just limited to smoking)
  • Radiation exposure
  • Chemical exposure
  • Parasitic infections, particularly parasites from outside of the U.S. 
  • Chronic irritation of the bladder lining

And risk factors that may increase one’s chance of developing bladder cancer include:

  • Increasing age
  • Being a man
  • Being white
  • Smoking 
  • Chronic bladder inflammation
  • Previous cancer treatment
  • Exposure to some chemicals, such as arsenic and those used to make dyes, leather, rubber, paint, and textiles
  • A personal or family history of cancer

There are, however, cases in which people develop cancer with no clear risk factors or causes6https://www.mayoclinic.org/diseases-conditions/bladder-cancer/symptoms-causes/syc-20356104.

Detection

As previously mentioned, cystoscopies are traditionally performed to check for signs of bladder cancer. And if your physician finds cause for concern, it’s likely they’ll collect a biopsy for further analysis. Another test specialists sometimes use is called urine cytology; in this test, a sample of your urine is checked out under a microscope to look for cancer cells. And finally, your doctor may want to do a CT urogram or MRI, the former of which can expose you to potentially harmful radiation7https://www.mayoclinic.org/diseases-conditions/bladder-cancer/diagnosis-treatment/drc-20356109.

Studies, however, have shed light on the efficacy of some of these screening techniques:

On the other hand, diffusion weighted MRI has been shown to have high specificity and sensitivity in both detecting and staging bladder cancer10https://pubs.rsna.org/doi/full/10.1148/radiol.2511080873.

Diagnosis

After your doctor has confirmed the presence of bladder cancer, they will likely perform additional tests to determine whether the disease has spread to other areas of the body, such as your lymph nodes. These tests could include CT or bone scans, chest X rays, and MRIs. The information collected from these exams will be used to assign your bladder cancer a stage and grade, two systems which help inform the processes of diagnosis and treatment.

Bladder cancer stages range in Roman numerals from 0 to IV, with increasing levels of severity. The lower stages mean that the cancer is confined to the bladder’s inner layers, while stage IV means the cancer has spread to lymph nodes or other distant areas11https://www.mayoclinic.org/diseases-conditions/bladder-cancer/diagnosis-treatment/drc-20356109.

Finally, a bladder cancer grade indicates how the tumor cells look under a microscope12https://www.mayoclinic.org/diseases-conditions/bladder-cancer/diagnosis-treatment/drc-20356109.

  • Low-grade bladder tumors have cells that look and organize themselves like normal cells; these tumors generally grow more slowly and are less likely to spread to the bladder’s muscular wall.
  • High-grade bladder tumors appear very abnormal and do not look anything like normal tissue; these tumors grow aggressively and could be more likely to spread to the bladder’s muscular wall and other organs. 

Treatment

The best treatment for bladder cancer depends on the nature of the disease and how far it has spread. Treatment options may include: immunotherapy, surgery, radiation, chemotherapy, or bladder removal followed by reconstruction to create a new exit for urine13https://www.mayoclinic.org/diseases-conditions/bladder-cancer/diagnosis-treatment/drc-20356109.

Please consult with a physician on treatment options as necessary.

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