Bladder cancer is one of the ten most frequent kinds of cancer worldwide, and males account for around 75 percent of new cases. Over ninety percent of urinary bladder malignancies are urothelial carcinoma (previously termed transitional cell carcinoma; UC). The majority of cancers do not invade muscle. Low-grade tumors are papillary and often simple to observe, but their cytology is frequently negative. High-grade tumors are often flat, in situ, and difficult to view, although their cytology is typically positive. When muscle invasion is present, transurethral resection is insufficient and radical cystoprostatectomy is typically recommended.
Risk factors
People who smoke cigarettes are more likely to develop bladder cancer. Cigarette smoking roughly raises the risk of acquiring bladder cancer by five.
- Exposure to specific chemicals in the dye business, such as aniline, increases the risk.
- Other organic chemicals used in the production of rubber and other products can potentially enhance the danger. Contact with the chemotherapeutic agent Cyclophosphamide (sometimes used to treat lymphoma or autoimmune illnesses in younger patients) is related to an increased risk of bladder cancer. Chronic inflammation of the bladder appears to promote bladder cancer development.
- Recurrent infections and bladder stones can cause irritation of the bladder. In certain regions of Africa and the Mediterranean, a parasite infection known as schistosomiasis irritates the bladder lining. It appears that the parasites that burrow into the bladder trigger the tumor.
Symptoms of TCC bladder
- Blood in the pee
- Pain during urinating
- Problems with urination
- Frequent urination
- Weight loss
- Anorexia
- Frequent urinary tract infection
- Fatigue
- Fever
- Night sweat
Diagnosis
This malignancy might be challenging to diagnose. Your doctor will do a physical examination to check for symptoms of the disease. They will order a urinalysis to detect blood, protein, and germs in your pee.
Your doctor may request additional tests to check the bladder, ureter, and renal pelvis based on the results of these tests.
Other possible tests include:
- Ureteroscopy to examine each ureter and renal pelvis for anomalies
- Intravenous pyelogram (IVP) to assess fluid transport from the kidneys to the bladder
- CT of the kidneys and urinary bladder
- Sonography of the abdomen
- MRI
- Cellular biopsies of each renal pelvis and ureter
Staging
Based on TNM classification:
- NX: Evaluation of regional lymph nodes is impossible.
- N0 (N zero): The malignancy has not spread to lymph nodes in the region.
- N1: The malignancy has spread to one regional pelvic lymph node.
- N2: The malignancy has progressed to two or more pelvic regional lymph nodes.
- N3: Cancer has spread to the common iliac lymph nodes, which are situated above the bladder and behind the major arteries in the pelvis.
Grading
Bladder cancer grades:
Bladder cancers are further categorized depending on the appearance of the cancer cells under a microscope. This is referred to as the grade, and your physician may classify bladder cancer as low grade or high grade:
- Low-grade bladder cancer: This form of cancer has cells that resemble and are organized similarly to normal cells (well-differentiated). A low-grade tumor grows more slowly and is less likely to breach the bladder’s muscular wall than a high-grade tumor.
- High-grade bladder cancer: This form of cancer has cells that lack any similarity to normal-looking tissues and have an aberrant appearance (poorly differentiated). A high-grade tumor is more likely to spread to the muscular wall of the bladder and other tissues and organs than a low-grade tumor.
Treatment
Localized/early transitional cell carcinomas of the bladder
- Transitional cell carcinomas are notoriously challenging to cure. Localized stage transitional cell carcinomas are treated with surgical resection, but recurrence is common. Some individuals are administered mitomycin into the bladder either as a single dosage in the immediate post-operative period (within 24 hours) or as a six-dose regimen a few weeks after surgery.
- Infusions of Bacille Calmette–Guérin into the bladder can also be used to treat localized/early transitional cell carcinomas. These are administered once per week for either six weeks (induction course) or three weeks (maintenance/booster dose). There is a slight probability that the patient will acquire systemic tuberculosis or become sensitized to BCG, resulting in severe intolerance and a probable loss in bladder volume due to scarring.
- Patients with evidence of early muscle invasion may also have drastic curative surgery in the form of a cysto-prostatectomy, typically accompanied by lymph node biopsy. In such individuals, a bowel loop is frequently employed to form a “neo-bladder” or a “ileal conduit” that acts as a storage area for urine before it is expelled by the urethra or a urostomy, respectively.
Advanced or metastatic transitional cell carcinomas
- First-line chemotherapy treatments for advanced or metastatic transitional cell carcinomas include gemcitabine and cisplatin or methotrexate, vinblastine, adriamycin, and cisplatin.
- Taxanes or vinflunine have been utilized as a second-line treatment (after progression on a platinum containing chemotherapy).
- Immunotherapy, such as pembrolizumab, is frequently utilized as a second-line treatment for metastatic urothelial carcinoma that has progressed despite GC or MVAC treatment.
- In May 2016, the FDA granted expedited approval to atezolizumab for the treatment of locally advanced or metastatic urothelial cancer following chemotherapy failure with cisplatin. The primary endpoint of the confirmatory trial (designed to convert the accelerated approval into a full approval) was not met.
- In April 2021, the FDA granted accelerated approval to sacituzumab govitecan for patients with locally advanced or metastatic urothelial cancer (mUC) who had previously been treated with platinum-containing chemotherapy and a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L) inhibitor.
Survival
- According to data from 2005-2011, the 5-year survival rate for bladder cancer patients is roughly 77.4%.
- Between 2004 and 2010, the relative 5-year survival rate for bladder cancer patients was 79.1 percent.
- When stratified by age, the 5-year relative survival of patients with bladder cancer was 83.8% for patients 65 years of age and 74.1% for patients 65 years of age.
- The prognosis of people with bladder cancer varies by disease stage. Below is a table illustrating the relative 5-year survival rate by bladder cancer stage:
Stage | 5-year relative survival (%), (2004-2010) |
All stages | 77.4% |
In situ | 96.2% |
Localized | 69.2% |
Regional | 33.7% |
Distant | 5.5% |
Unstaged | 48.7% |
