Understanding Bladder Cancer: Types and Diagnosis

The human bladder is a hollow organ located in the lower pelvis, and it forms an essential component of the urinary system as it stores urine. Bladder cancer refers to the uncontrolled growth of cells inside the bladder. From uncontrolled growth of cancer cells, a tumour can grow, and over time, the tumour may migrate to other parts of the body. These can manifest as blood in urine, frequent urination and discomfort. Most bladder cancer cases are determined early when there is a lot of hope for treatment.

However, bladder tumours can also recur after successful treatment, even in the early stages. As such, patients with bladder cancer often need periodic follow-up testing for decades after their treatment to check the reoccurrence of this disease.

Types of Bladder Cancer

There are several forms of bladder cancer that start in the bladder lining. The sort of cells that develop into cancer determines the name of each cancer type:

1. Transitional Cell Carcinoma (TCC)

The most prevalent kind of bladder cancer is called transitional cell carcinoma, often known as urothelial carcinoma. The inner layer of the bladder’s transitional cells is where it starts. Transitional cells are those that, when the tissue is stretched, change form without breaking. Its detection entails numerous exams like cystoscopy, with tailor-made treatments based on its level and grade.

2. Squamous Cell Carcinoma

A less common form of bladder cancer arising from irritation and inflammation of the bladder is often associated with long-term infection or chronic bladder stones. Your bladder’s interior is lined with thin, flat cells called squamous cells.

3. Adenocarcinoma

Cancers in the glands lining your organs, such as the bladder, are known as adenocarcinomas. With about 1% to 2% of bladder cancer cases being this kind, it is an extremely uncommon cancer.

Bladder cancer can also be categorised as noninvasive, non-muscle invasive, or muscle invasive.

• Noninvasive: Most cancer cells are limited to the inner layer of the bladder without penetrating deeper tissues. This form is termed Non-Muscle Invasive Bladder Cancer (NMIBC).
• Invasive: Cancer cells invade the deeper layers of the bladder wall, potentially spreading to adjoining tissues and organs. This shape is referred to as Muscle-Invasive Bladder Cancer (MIBC).
• Muscle-invasive: It’s viable that this bladder cancer has migrated to the fatty tissues or layers of the organs outside of your bladder, having grown into the muscle of your bladder wall.

What symptoms of bladder cancer are common?

Bladder cancer typically manifests through identifiable symptoms:

• Haematuria: Blood in urine, visible as pink, orange, or red discolouration.
• Urinary Changes: Frequent urination, urgency, pain or burning sensations during urination.
• Pelvic Discomfort: Aching in the pelvic region.
• Advanced Signs: Urinary infections, inability to urinate, or back pain in later stages.
• Persistent bladder infections: There are similarities between the symptoms of bladder cancer and infections. If your bladder infection doesn’t go away after taking antibiotics, contact your doctor.

Diagnosis of Bladder Cancer

Several diagnostic tests are performed by doctors to identify bladder cancer, such as:

Physical Examination: A comprehensive physical examination is performed, together with a review of the patient’s medical history, to detect any anomalies or indicators of bladder cancer.

Diagnostic Tests: To identify bladder cancer, doctors do a number of tests, such as:

• Urine Analysis: Your urine is examined by physicians using a range of tests. To rule out infection in this situation, a urinalysis may be performed.
• Cystoscopy: Identifying and diagnosing bladder cancer is mostly done using this test. The purpose of this test is to see within your bladder and urethra using a lighted tube the size of a pencil, known as a cystoscope. Your bladder cancer may be more visible with the use of a fluorescent dye and a unique blue light. When conducting cystoscopies, healthcare professionals may also collect tissue samples.
• Cytology: Under a microscope, providers check cells for indications of cancer.

Doctors may do tests to find out more information about bladder cancer if findings from cytology, cystoscopy, and urinalysis indicate that you have it. These procedures include:

• Transurethral Resection of Bladder Tumour (TURBT): This process is used by providers to remove bladder tumours in preparation for more testing. Remove bladder tumours using TURBT treatments before they have a chance to infiltrate the muscular wall of your bladder.
• Magnetic resonance imaging (MRI) test: This imaging test creates comprehensive pictures of your bladder using radio waves, a computer, and a magnet.
• Chest X-ray: Doctors can use this test to look for indications that bladder cancer has progressed to the lungs.
• Bone Scan: Bone scans, similar to chest X-rays, look for evidence that bladder cancer has spread to the bones.
• Computed Tomography (CT) scan: This test may be performed by providers to check for cancerous growths outside of the bladder.

Staging of Bladder Cancer

Next, doctors stage the illness based on their knowledge of the cancer. Cancer staging helps in the planning of care and the development of a possible prognosis or predicted result for the patient. There are two types of bladder cancer: Invasive (which penetrates the bladder wall and may spread to surrounding organs or lymph nodes) and Early Stage (which is limited to the bladder’s lining). The phases go from TA, which is limited to the bladder’s internal lining, to IV, which is the most intrusive. The cancer is limited to the lining of your bladder or the connective tissue directly underneath the lining during its early stages (TA, T1, or CIS), and it hasn’t yet spread to the bladder’s main muscular wall.

Invasive cancer is shown by stages II to IV:

• Cancer has progressed to the bladder’s muscular wall in Stage II.
• The cancer has progressed to the fatty tissue outside of your bladder muscle at Stage III.
• When a cancer is at Stage IV, it has moved from its original location in the bladder to other organs, bones, or lymph nodes.

Tumour, Node Involvement, & Metastases, or TNM, is a more advanced and favoured staging classification. Within this framework:

• Tumours that invade the bladder can be classified as T2 (which spreads to the primary muscle wall underneath the lining of the bladder) or T4 (which extends outside of the bladder to surrounding organs or the wall of your pelvis).
• The involvement of lymph nodes can vary from N0 (no cancer in nodes) to N3 (several lymph nodes with cancer or one or more big lymph nodes greater than 5 centimetres).
• M0 denotes the absence of metastases, or dissemination, outside of the pelvis. M1 indicates that it has spread to areas other than your pelvis.

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