Where Does Bladder Cancer Begin? Types & Stages

There are three main types of bladder cancer:

• Urothelial cell or transitional cell carcinoma: Urothelial cells are responsible for the tissue that lines the interior of the bladder. Urothelial carcinoma or transitional cell carcinoma is the most common type of bladder cancer.
• Squamous cell carcinoma: Squamous cell carcinoma is a rare type of bladder cancer that generally occurs as a result of chronic irritation or inflammation of the bladder lining due to infections or urinary catheter placement.
• Adenocarcinoma: Adenocarcinoma is also a rare type of bladder cancer that originates from the glands in the urinary bladder.

Bladder cancer is typically caused by acquired genetic mutations that accumulate over time as a result of exposure to substances that the kidneys process as waste.

Risk factors for bladder cancer include:

• Smoking (causes about half of all cases)
• Male sex (men are 4 times more likely to develop bladder cancer)
• Age (over 55)
• Family history of bladder cancer
• History of chemotherapy or pelvic radiation
• Chronic bladder infections
• Exposure to certain chemicals common in rubber, textile, printing, painting, and hairdressing industries
• Exposure to metals or petroleum products in the workplace
• Excessive herbal medications
• Drinking water from a well that has high levels of arsenic
• Drinking water that has been treated with chlorine
• Using urinary catheters for a long period time

Bladder cancer can manifest differently in each person. Common symptoms in both men and women include:

• Blood in your urine or hematuria
• Frequent or urgent urination
• Burning sensation when passing urine
• Pelvic pain
• Bone pain
• Unexplained weight loss
• Swelling of the legs
• Anemia
• Pain in the rectal, anal, or pelvic area

In women, early bladder cancer symptoms are often overlooked or misdiagnosed, perhaps because symptoms are confused for menstrual periods or urinary tract infections.

While many of these symptoms may not indicate bladder cancer, you should consult a doctor for assessment if you notice blood in your urine.

In order to confirm a diagnosis of bladder cancer, your doctor will perform a comprehensive physical examination, analyze your medical history, and order a few diagnostic tests:

• Urinalysis
• Imaging scans such as ultrasound and computed tomography scan
• Cystoscopy
• Biopsy

Depending on the results of the diagnostic tests, your doctor may stage and grade your bladder cancer:

• Stage 0 or carcinoma in situ: Tumor in the lining of the bladder that may appear flat or slightly raised
  • Stage 0A or noninvasive papillary carcinomas: Looks like a mushroom
• Stage I: Tumor has grown into the connective tissue but does not involve muscle layer.
• Stage II: Tumor has grown into the muscle layer of the bladder.
• Stage III:
  • Stage IIIA: One of the following:
    • Tumor has grown into nearby tissues outside of the bladder but has not grown into the pelvic wall or abdominal wall.
    • Cancer has spread to one lymph node in the pelvis.
  • Stage IIIB: Cancer has spread to two or more lymph nodes in the pelvis or to one or more common iliac lymph nodes (just above the pelvis).
• Stage IV:
  • Stage IVA: Tumor has grown into the pelvic wall or abdominal wall.
  • Stage IVB: Cancer has spread to other parts of the body (distant metastasis), such as the lungs, liver, or bone.

Grades of bladder cancer are as follows:

• Low grade:
  • Cells are abnormal but look a lot like normal cells
  • Usually grows slowly and is less likely to spread
• High grade:
  • Cells are abnormal and do not look very different from normal cells.
  • Usually grows more quickly and is more likely to spread

• Surgery:
  • Transurethral resection with fulguration:
    • A cystoscope (a thin illuminated tube) is placed into the bladder through the urethra during surgery.
    • Cancer is then removed or burned away with high-energy beams using an instrument with a wire loop on the end.
  • Partial cystectomy or segmental cystectomy:
    • A portion of the bladder is removed. 
    • Low-grade tumors that have infiltrated the bladder wall but are localized to one part of the bladder can be treated with this procedure.
    • You can pee regularly after recuperating from this surgery because only a portion of the bladder is removed.
  • Radical cystectomy:
    • Involves removing the bladder and any cancerous lymph nodes and surrounding tissues.
    • The prostate and seminal vesicles are removed in men. 
    • The uterus, ovaries, and a portion of the vagina are removed in women.
    • When cancer has progressed outside the bladder and cannot be entirely removed, surgery to remove just the bladder may be performed to alleviate cancer-related urine symptoms. When the bladder must be removed, the surgeon devises another method for urine to exit the body.
• Radiation therapy: Uses high-energy X-rays or other forms of radiation to either kill or prevent cancer cells from developing. 
• Chemotherapy: Uses medications to slow the growth of cancer cells, either by killing them or preventing them from growing.
• Immunotherapy: Immunotherapy is a cancer treatment that uses the immune system to combat the disease. 
• Targeted therapy: Targeted therapy uses medications or other substances to locate and destroy cancer cells. 
• Complementary therapies: These are often used in conjunction with conventional treatment to ease symptoms and side effects of cancer treatments. Some complementary therapies that may be beneficial include:
  • Acupuncture
  • Meditation
  • Massage and biofeedback 
  • Breathing exercises 
• Clinical trials: People who take part in clinical trials help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

At the time of diagnosis, over half of all new bladder cancers are in the early stages, which is encouraging for prognosis and survival. Overall, the 5-year relative bladder cancer survival rate is 7%. However, prognosis varies depending on the stage of cancer:

• Cancer in the bladder lining: 96%
• Cancer is invasive but localized: 69%
• Regional cancer: 37%
• Distant cancer: 6%

Survival rates are estimates, however, and cannot predict your life expectancy. Your doctor is the best source of information about your prognosis of bladder cancer.