Bladder cancer: first and subsequent signs, causes, treatment options

Medically reviewed: 1, February 2024

Signs of Bladder Cancer

Bladder cancer is a fairly common disease among men. It refers to malignant tumors that can lead to death, especially if you do not diagnose and treat it in a timely manner. The tumor begins to develop in the mucous membrane of the bladder, gradually affecting the surrounding tissues and organs – the urethra, the rectum, the prostate gland.

The bladder is a muscular bag situated in the mid-line of the pelvis at the lowest point in the abdomen, immediately behind the pubic bone. There are three principal layers in the bladder wall. The inside mucous membrane (mucosa), the muscle layer of circular and longitudinal fibers, and the outer layer, the peritoneum.

Primary bladder cancer constitutes about seven per cent of cancers in men and about three per cent of new cancers in women. It is three times as common in men as in women.It is more common in white people than in black people and the average age at diagnosis is 65.

At the time of diagnosis about 85 per cent of bladder cancers are still limited to the bladder only. The remainder have spread to the lymph nodes (glands).

There are several types of tumors, the most frequent of which is carcinoma (transitional cell form). The prognosis of the disease depends on the stage of the process – the smaller the stage, the more favorable the prognosis.

The difficulty of early detection of the disease lies in the fact that in the early stages of the tumor very rarely manifests itself with clinical signs, developing completely asymptomatic.

With the localization of cancer in the bladder, the symptoms in many ways resemble the manifestations of cystitis. Inflammation of the bladder in some cases provokes the development of a tumor, known as squamous cell cancer.

The first signs of bladder cancer

Bladder cancer shows itself by the painless passage of blood in the urine (haematuria), by the frequent need to urinate or by pus in the urine and a burning pain on urination. These signs are commonly an indication of other less serious conditions, but they should always be taken seriously, especially when occurring for the first time in older people.

They always require proper investigation. Sometimes pain is caused by the retention of blood clots in the bladder from bleeding from the tumor.

Pain may also result from spread of the cancer to local nerves.

The first signs of bladder cancer include hematuria, dysuria, and several other symptoms that often suggest other illnesses. More on symptoms below.

Hematuria (blood in the urine)

So called the presence of blood in the urine. This symptom can be called specific, especially in the absence of pain.

The blood is fresh, not coagulated, most often of scarlet color. May manifest as droplets, streaks or clots. Bleeding can be massive (can be seen with the naked eyes) or microscopic (blood can be detected only with the help of special equipment).

Bleeding is often caused by injuries to the villi of a non-infiltrating neoplasm during bladder contraction. Hematuria is divided into terminal (episodic) – appears in moments of contraction of the bladder and total – incessant. The latter is most often a sign of a neglected, decaying stage 3-4 tumor.

The intensity of the process varies in the color of urine – from a barely visible pink color to bright red or saturated scarlet with the presence of bloody clots.

With the greatest intensity of tumor bleeding, the bladder is completely filled with clots, as a result of which urination is difficult or delayed.

Hematuria can be very rare and short-term, appearing every few months or even years.

Dysuria – absense of urine

So called any urinary disorders. This can be very frequent or, on the contrary, extremely rare urination.

If dysuria appears, then an infiltrative growth of education occurs, a tumor is formed in the bladder neck, the process of disintegration or ulceration, the addition of other diseases (for example, cystitis or prostate adenoma) takes place.

The most frequent manifestations of dysuria in bladder cancer are pain with frequent urination or difficulty.

With the development of prostate adenoma, acute urinary retention occurs. If the cancer is localized in the bladder neck, a feeling of an incompletely empty bladder is formed.

Dysuria begins to be more pronounced in the event that an infection joins (pyelonephritis, cystitis). The following factors contribute to its development:

• obstruction of urine flow (stagnation in the bladder) from the upper urinary tract and bladder;
• ulceration of the bladder wall;
• disintegration or infiltration of a neoplasm;
• decaying tissues and pus appear in the urine, the odor becomes fetid;
• if a tumor disintegrates, an alkaline reaction and the smell of ammonia appear in the urine;
• with tumor infiltration, urination becomes frequent and painful, especially at the end.

Symptoms of advanced bladder cancer

Bladder cancer on advanced stages have specific symptoms. With the progression of the tumor process, other signs of bladder cancer join. People with advanced bladder cancer may have symptoms caused by the local and the more distant spread of tumor. There may be pain in the lower back, obstruction of the ureters (the tubes that carry urine down to the bladder from the kidneys), or bone pain from secondary cancer. Rarely, there may be a mass that can be felt in the area of the bladder.

Pain in the suprapubic area

With the progression of the process of development of infiltration develop pain, which are continuous. During urination, they usually increase, increasing by the end of the act due to the reduction of the detrusor.

When a tumor grows deeper – on neighboring organs and paravesicular fiber, pains radiate to the buttocks, perineum, sacrum, hips, and genitals.

Over time, the pain becomes unbearable and can not be removed even by strong narcotic drugs.

In the lumbar region, pain occurs due to the pressure of the tumor on the mouth of the ureter, the presence of pyelonephritis and hydronephrosis.

The development of secondary diseases and complications

• Chronic renal failure. Always evolving. It is characterized by itchy skin, general lethargy, dry mucous membranes and skin.
• Hydronephrotic transformation of the kidneys. Manifested by urine outflow.
• Rectus or suprapubic fistula. Formed during the germination of the tumor in the surrounding tissue with their subsequent decease.
• Violation of lymph drainage. In the presence of metastases in the lymph nodes (most often the inguinal and retroperitoneal) lymph flow from the legs is inhibited, swelling of the scrotum and lower extremities is formed.

General symptoms of bladder cancer

In addition to the signs characteristic of bladder cancer, there are a number of symptoms common to many types of diseases that manifest themselves with the development of tumors in the bladder. There are:

• chronic persistent fatigue;
• unmotivated general weakness;
• drastic weight loss in a short period of time without changes in lifestyle and diet;
• changes in the appearance of a person – the constant paleness of the skin and mucous membranes, suffering expression of the face, unpleasant specific body odor and clothing;
• sleep disorders;
• loss of appetite.

Stages of a bladder cancer

Bladder cancer always starts in the mucosa. In the earliest stages it is confined to this layer and is called carcinoma in situ. For a time the cancer grows only towards the interior of the bladder. At this stage, if detected, it can be cured by simple local treatment without opening the bladder.

The next stage is for the cancer to spread outwards, deeper into the muscular layer of the bladder. At the same time the cancer will become larger on the interior surface and will spread sideways.

The advancing cancer will next grow right through the wall of the bladder to invade the peritoneum or the other tissues on the outside of the bladder. While the cancer is confined to the mucosa, spread to distant lymph nodes or further is unlikely.

But by the time the muscle of the bladder wall is invaded, about 13 per cent of cancers will also have spread to lymph nodes.

Once the cancer has penetrated the wall and is in the surrounding tissue, in almost 90 per cent of cases it has also spread to the lymph nodes.

Causes of bladder cancer

The causes of most bladder cancers remain uncertain, but some causes are known.

These include:

• The products of tobacco tars acquired by cigarette smoking and excreted in the urine
• Certain chemicals such as aniline dyes, beta-naphthylamine and benzidine
• Some chemicals encountered in rubber manufacture
• Drugs such as phenacetin and cyclophosphamide
• Long-term bladder inflammation
• The African parasitic disease schistosomiasis
• The presence of bladder stones

The changes in the bladder lining that lead to cancer occur gradually and progressively. The most important of the known causal factors are the substances alpha and beta naphthylamine, which are excreted into the urine of cigarette smokers.

Heavy cigarette smoking is believed to be the cause in half the cases in men and a third of the cases in women.

Exposure to occupational chemicals, especially in the rubber, petroleum, leather and dye industries, probably cause about 30 per cent of cases in men. Artificial sweeteners were at one time suspected of causing bladder cancer, but several research projects have failed to confirm any causal link.

In almost all bladder cancers, the cancer cells show a loss of part of the long arm of chromosome number 9. Many bladder cancers also show loss of the short arms of chromosomes 11 and 17.

The supposition is that the cancer may be caused by loss of suppressor genes on these chromosomes.

How to diagnose bladder cancer?

The main tasks are to determine the presence of the disease and the stage of the tumor process. Mandatory studies include urinalysis, cystoscopy, tissue biopsy, ultrasound of the bladder. In some cases, using computed tomography.

The urine can be examined for the presence of cancer cells.

X-rays taken after injection of a radio-opaque dye may show a mass in the bladder. The diagnosis can be confirmed by looking directly at the inside of the bladder through a viewing tube called a cystoscope.

Another method of confirmation uses CT scanning or ultrasound scanning. The use of the cystoscope allows a sample of tissue (biopsy) to be taken for examination and a positive diagnosis.

A very important measure for detecting a tumor in the initial asymptomatic stage is the annual completion of the clinical examination with a full examination.

Treatment options for bladder cancer

Depends on many factors, can be conservative and operational. Conservative methods include drug and radiation therapy. During surgery, part or whole of the bladder is removed. Most often, both methods are combined, conducting radiation therapy before or after surgery.

In about half of those people presenting with signs of bladder cancer, the tumor is still in the early stages and is confined to the inner lining of the bladder and can readily treated.

Such early cancers can be destroyed by laser beam or by snipping off the tumor and burning with a hot wire (cautery) passed through a cystoscope. This procedure is known as a transuretral resection of a bladder tumor (TURBT) Some cases are treated by inserting anticancer drugs directly into the bladder.

Anti-cancer drugs may be put directly into the bladder to try to prevent the cancer from recurring.

If the cancer is first discovered at a stage when it has already spread deeply into the wall of the bladder, locally in the lower abdomen or widely throughout the body, major surgery and/or radiotherapy will be necessary. The whole bladder may have to be removed.

Radiotherapy may be used to treat invasive bladder cancer to try and avoid having to remove the bladder.

Surgical removal of the bladder is called cystectomy. After cystectomy, the ureters, which constantly bring urine down from the kidneys, have to be connected elsewhere.

They may be implanted into the colon so that the urine passes out with the feces, or they may be implanted into an artificial bladder made from an isolated segment of bowel which drains out through the skin. Such transplantation is called urinary diversion.

Chemotherapy (use of drugs) is rarely used as an independent referral. Usually goes in a complex of other activities, improving the cure. The best results are obtained by the combination of such anticancer drugs as adriablastin, methotrexate, cisplatin, vinblastin.

Prevention

The first step is to remove provocative factors:

• time to cure inflammatory diseases of the bladder;
• get rid of smoking and other bad habits;
• exclude contact with those chemicals that cause the development of tumors: solvents, dyes, aniline, benzene.

Do not despair if you have bladder cancer. In most cases, it is a completely treatable disease, especially with the increased level of modern medicine.