Bladder Cancer Basics I: What You Need to Know

Bladder Cancer Awareness Month happens in May every year, and it is a time to raise awareness of symptoms and share crucial information about prevention and treatment. According to the World Cancer Research Fund, bladder cancer is the tenth most common cancer worldwide. In 2020, the number of deaths stemming from this cancer was over 90,000 in Asia. 

Bladder cancer can happen to anyone, including you or your loved ones. In this first part of the 2-parts series, you will get to know more about the different aspects of bladder cancer, including the causes, risk factors, symptoms and staging of the cancer.

What does the bladder do?

The bladder is a hollow organ with a thick-walled structure, consisting of a thin inner layer with a thick muscle covering. Its primary job is to store urine. It is located in the lower pelvis, and has muscular walls that can stretch to hold urine and squeeze to eject it out of the body. 

Urine is liquid waste made by your two kidneys and carried to the bladder via two tubes called ureters. When you urinate, muscles in the bladder contract. Urine is then moved out of the bladder through a tube called the urethra. 

What is bladder cancer? 

Bladder cancer begins when cells that make up the urinary bladder start to grow uncontrollably. As more cancer cells develop over time, they may form a tumour. This tumour may eventually spread to other areas of the body. 

Most tumours develop on the bladder’s inner layer lining, called the urothelial cells. As the tumour grows through the bladder layers into the muscle wall, it gets harder to treat. 

What are the signs and symptoms of bladder cancer?

The most common sign would be blood in the urine. Many patients may postpone seeking medical help as there is no pain associated with the bleeding. Moreover, the bleeding may only occurs occasionally. In addition, the blood may only be detected after a urine test as it is not always be visible to the eye.

Other signs and symptoms include:

• Increased frequency in urination 
• Increased urgency in urination
• Pain or burning during urination

What causes bladder cancer? Who is at risk? 

It is not known what really causes bladder cancer. However, there are many risk factors that contribute to its development: 

Smoking

• Smokers are at twice the risk as people who do not smoke. 

Chemical Exposure (including Arsenic)

• People who work with chemicals called aromatic amines are at a higher risk. These chemicals are used to make dye-based products.
• Drinking water polluted with a chemical called arsenic has been linked to a higher risk.

Age

• The risk increases with age. Although it can occur with any age, most people are diagnosed when they are older than 55 years old.

Race

• The incidence is lower in Asian countries. 

Gender

• Men are at a higher risk of getting bladder cancer. 

Family History

• You have a higher risk if one of your family members had it too. 

Long-term inflammation of the bladder

• Repeated inflammation and infections of the bladder has been linked with an increase the risk of developing bladder cancer.

What are the staging and grading of the cancer?

When you are diagnosed with bladder cancer, doctors have to figure out if cancer cells have spread within the bladder, or to other parts of the body. This process is called staging. 

The stage of a cancer refers to the extent of cancer in the body. At higher stages, the tumour has grown further away from its original site. Cancer can spread through tissue, the lymph system, and the blood. 

Stages for bladder cancer

• 0: Abnormal cells found in tissue lining the inside of the bladder. These come in 2 forms: non-invasive papillary carcinoma (long, thin growths growing from the bladder’s inner lining) and carcinoma in Situ (flat tumour on the bladder’s inner lining). 
• I: Tumour invades the connective tissue under the inner lining of the bladder
• II: Tumour invades the muscle layer
• III: Tumour penetrates the bladder wall and invades the surrounding fat layer
• IV:  Cancer spreads to other organs surrounding the bladder e.g. uterus, vagina, prostate, etc

Grades

Grade refers to how the cancer cells (or tumours) look under the microscope, and the number of cells which are actively multiplying. The grade is expressed as a number between 1 and 3. The higher the number, the more abnormal the tumour. Your doctor may refer to the tumour as low or high grade. 

Higher grade tumours have a higher number of uneven cancer cells and actively multiplying cells. Doctors use this information to predict how fast the cancer might grow. 

Summary of Part I

Bladder cancer may have very similar symptoms as some other conditions such as benign prostate hyperplasia (BPH). You may need to visit your urologist to assess and diagnose your condition, and start appropriate treatment. In the second part of this 2-parts series, find out how bladder cancer is being diagnosed, treated and prevented.