Bladder cancer: causes, symptoms and treatment

Every year, there are more than 3.500 new cases of bladder cancer in Portugal, the equivalent of 5% of all cancers detected in our country. This disease is three times more prevalent in men than in women and is most frequent between the ages of 60 and 70. Learn about the symptoms and discover essential steps to increase the effectiveness of treatment. Find out what bladder cancer is, the warning signs and how it is treated. 

What is bladder cancer? 

Bladder cancer occurs when the cells in the bladder lining multiply in an uncontrolled and irregular manner, exceeding the normal rate of cell renewal and leading to a buildup of cancer cells. These have the capacity to migrate and lodge in other organs (metastasis), invading and destroying tissue. 

Bladder cancer is usually malignant; only 5% of bladder tumours are benign. When the tumour is confined to the bladder lining, it is called a non-muscle invasive bladder cancer (NMIBC). But when the tumour grows into the wall or other parts of the bladder, it is a malignant muscle invasive bladder cancer (MIBC). In advanced stages, the cancer invades nearby organs or the lymph nodes, progressing until it has spread to distant parts of the body.

What are the types of bladder cancer? 

Bladder cancer is not a unique disease. There are different types, classified according to the type of cells where the tumour develops. This distinction is important because it influences how the disease progresses and the respective treatment options.

Urothelial carcinoma (formerly transitional cell carcinoma) 

This is the most common type of bladder cancer. It develops in the urothelial cells, which line the bladder and allow this organ to expand as it stores urine. This cancer can be non-muscle invasive (NMIBC), confined to the bladder lining, or invasive (MIBC), invading deeper layers of the bladder wall.

Squamous cell carcinoma  (SCC)

This type of bladder cancer is less common and is usually associated with chronic irritation or inflammation of the bladder, such as recurring urinary tract infections. SCC tends to be diagnosed in advanced stages.

Adenocarcinoma 

This is a rare type of bladder cancer that develops in glandular cells. It can be associated with chronic changes in the bladder’s mucosa and, like squamous cell carcinoma, it is usually more aggressive.

What are the causes of bladder cancer?

The scientific community has identified some causes and risk factors for developing bladder cancer.

Smoking

This is the leading risk factor for developing bladder cancer, and is the cause of over 50% of cases in the male population and more than 20% in the female population. The duration of the habit and the number of cigarettes smoked per day are directly related to the incidence.

Exposure to chemicals

Several studies indicate a greater risk of bladder cancer in people exposed to carcinogenic aromatic amines, which are present in dyes, rubber, textiles, leather and paint industries. Exposure to certain chemicals accounts for a significant share of cases of bladder cancer, representing around 20% of diagnoses.

Age and gender

The older the person, the greater the risk of developing bladder cancer. This disease has the highest incidence in people between the ages of 60 and 70. Furthermore, males are affected more than females, at a ratio of 3 to 1. However, women present the greatest delays in diagnosis and lowest survival rates, often due to being misdiagnosed as urinary tract infections.

Recurring urinary tract infections

Bladder cancer has been directly associated with chronic urinary tract infections, which are especially common, for example, in cases of long-term catheter use.

Genetics

Scientific evidence confirms a genetic susceptibility to bladder cancer. A personal or family history of this disease are an important risk factor, especially in parents or siblings.

How is bladder cancer diagnosed?

Bladder cancer is diagnosed by a urologist. The process begins by ruling our other disorders with similar symptoms, such as urinary tract infections, kidney stones, benign prostatic hyperplasia, etc.

The urologist will begin by analysing the medical history and symptoms. In suspected cases, urine tests and other diagnostic exams are prescribed, such as urinalysis, ultrasound, CT and cystoscopy. This is the most sensitive exam, which involves inserting a cystoscope through the urethra to the bladder, to observe the mucosa and identify the cancerous lesion.

In addition to enabling the bladder cancer diagnosis to be confirmed, these exams also stage the disease, to help determine if the tumour has spread to other organs and, based on this, prepare the best treatment plan.

Overall, bladder cancer is staged using the TNM classification:
•    T (Tumour): describes the size of the tumour, on a scale from T1 to T4.
•    N (Nodes): describes spread of the tumour to lymph nodes, on a scale from N0 to N3.
•    M (Metastasis): describes spread of the tumour to other parts of the body, on a scale from M0 to M1.

When bladder cancer is diagnosed early, intervention can have a curative purpose. However, when detected late, the survival rate is dramatically lower and, in this case, intervention involves giving the patient the best quality of life possible.

What precautions help prevent bladder cancer? 

Although not all cases of bladder cancer can be prevented, adopting certain healthy habits can help reduce the risk of developing this disease. We list some key precautions below:

Don’t smoke

Smoking is the leading risk factor for bladder cancer. The toxic substances in tobacco are filtered by the kidneys and eliminated through urine, exposing the bladder to carcinogens and potentially damaging bladder cells.

Drink plenty of water

Good hydration helps dilute urine and eliminate potentially harmful substances more frequently, reducing the contact time with the bladder wall.

Take precautions when handling chemicals

Prolonged exposure to industrial chemicals can increase the risk of bladder cancer. Whenever applicable, workplace safety regulations should be observed, including the use of personal protective equipment.

Maintain a balanced diet

A diet rich in fruit, vegetables and foods with antioxidant properties can help protect the body’s cells and maintain urinary tract health.

Don’t ignore urinary symptoms

Alterations such as blood in urine, pain when urinating or a frequent need to urinate should be assessed by a physician. Early diagnosis is crucial for a more effective treatment.

Bladder cancer: frequently asked questions

We answer below some frequently asked questions about bladder cancer. 

What are the early symptoms of bladder cancer? 

The most common symptom is blood in urine, usually without pain. Other signs may include pain or a burning sensation when urinating, frequent urination and difficulty emptying the bladder. These symptoms can be associated with other conditions and should therefore be assessed by a physician.

Is bladder cancer curable? 

When diagnosed early, treatments for bladder cancer have high success rates. The progression and prognosis depend on the type of tumour, stage of the disease and response to treatment.

Can smoking really cause bladder cancer? 

Yes. Smoking is the primary known risk factor for bladder cancer. The inhaled carcinogens are eliminated through urine, which is stored in the bladder and substantially increases the risk of developing this disease.

How is bladder cancer diagnosed? 

Diagnosing bladder cancer can include urine tests, imaging exams and a cystoscopy, which allows direct examination of the inside of the bladder. In some cases, a biopsy may be required to confirm the diagnosis.

Can bladder cancer return after treatment? 

Yes, bladder cancer is a disease with a risk of relapse, even after successful treatment. This is why regular medical check-ups are essential to detect any recurrence early.

Joaquim Chaves Saúde, for the sake of your health

The sooner you act, the better your chances of detection and cure. Therefore, look out for signs and clarify your medical condition as soon as possible. There’s only one way to know if you have a serious problem: seek medical help. 

At Joaquim Chaves Saúde, you can count on close support from an experienced and specialised team, aided by the most innovative and effective technological means. Don’t hesitate, schedule your consultation and get answers.