Bladder urothelial carcinoma is a common type of cancer that begins in the lining of the bladder. It develops when cells within the bladder’s inner layer grow abnormally and form tumors.
What is Bladder Urothelial Carcinoma?
Urothelial carcinoma, previously known as transitional cell carcinoma, originates in the urothelial cells that line the inside of the bladder. These cells are also present in other parts of the urinary tract, including the kidneys, ureters, and urethra, though the bladder is the most frequent site for this cancer.
This cancer can be non-invasive or invasive. Non-invasive urothelial carcinoma remains confined to the inner lining of the bladder. Invasive urothelial carcinoma has spread beyond this inner layer into deeper muscle layers of the bladder wall or surrounding fatty tissues. The distinction between these forms influences treatment.
Causes and Symptoms
Several factors can increase the risk of developing bladder urothelial carcinoma. Smoking is a primary cause, as harmful chemicals from smoke are processed by the body and excreted in urine, damaging bladder lining cells. Occupational exposure to certain chemicals, particularly aromatic amines found in industries like dye, rubber, leather, textiles, and paint manufacturing, also elevates risk. Workers in these fields, along with painters, hairdressers, and truck drivers exposed to diesel fumes, may face increased risk.
Chronic irritation or inflammation of the bladder can also contribute to risk. This irritation may result from recurrent urinary infections, bladder stones, or long-term use of urinary catheters.
Bladder cancer risk tends to increase with age, with most diagnoses occurring in individuals over 55. Men are approximately three to four times more likely to develop bladder cancer than women. A family history of bladder cancer can also slightly increase susceptibility.
The most common symptom of bladder urothelial carcinoma is blood in the urine, known as hematuria, which may make urine appear orange, pink, or dark red. This bleeding is often painless and can be intermittent. Other symptoms include frequent urination, a painful or burning sensation during urination (dysuria), and a sudden, strong urge to urinate. While these symptoms can also indicate non-cancerous conditions, they warrant prompt medical evaluation.
Diagnosis and Treatment
Diagnosing bladder urothelial carcinoma typically begins with analyzing urine samples. A urinalysis can detect the presence of blood, and urine cytology involves examining urine under a microscope for abnormal cells. These initial tests can suggest further investigation.
A cystoscopy is a primary diagnostic procedure, where a thin tube with a camera is inserted through the urethra into the bladder to visually inspect its lining for abnormalities. If suspicious areas are found, a biopsy is performed to collect tissue samples. Imaging tests like CT scans, MRI, or intravenous pyelogram (IVP) may be used to assess the extent of the cancer and determine if it has spread beyond the bladder, a process known as staging.
Treatment approaches for bladder urothelial carcinoma depend on the cancer’s stage and grade, which describe how aggressive the cancer cells appear. For non-invasive cancers, transurethral resection of bladder tumor (TURBT) is a common surgical procedure to remove the tumor. Following TURBT, intravesical therapy may be administered, involving direct instillation of drugs or chemotherapy into the bladder to reduce recurrence risk.
For more advanced or invasive cancers, radical cystectomy, the surgical removal of the entire bladder, may be necessary. Surrounding lymph nodes and nearby organs may also be removed.
Systemic chemotherapy, which uses drugs to kill cancer cells throughout the body, may be given before or after surgery, or as a primary treatment for widespread disease. Radiation therapy, using high-energy rays to destroy cancer cells, can also be part of the treatment plan, sometimes combined with chemotherapy. Immunotherapy uses the body’s own immune system to fight cancer cells.
Outlook and Follow-Up Care
The outlook for individuals with bladder urothelial carcinoma varies based on the cancer’s stage at diagnosis, its grade (how abnormal the cells look), and how it responds to treatment. Bladder cancer, particularly non-invasive forms, has a relatively high rate of recurrence. Approximately 50% of cases are diagnosed while the cancer is still confined to the inner lining of the bladder wall.
Due to the potential for recurrence, consistent follow-up care is important after initial treatment. This typically involves regular cystoscopies to inspect the bladder for new growths. Surveillance schedules are personalized but often involve frequent examinations initially, gradually becoming less frequent over time if no recurrence is detected.
Adopting certain lifestyle changes can reduce the risk of recurrence and improve overall health. Quitting smoking, for instance, lowers the likelihood of developing new bladder tumors. Ongoing medical monitoring and adherence to follow-up schedules are key for detecting recurrence early, which generally leads to more effective treatment outcomes.