Table of ContentsView AllTable of ContentsSigns and SymptomsCauses and Risk FactorsDiagnosisCancer StagingTreatmentDrug TherapiesPrevention
Table of ContentsView All
View All
Table of Contents
Signs and Symptoms
Causes and Risk Factors
Diagnosis
Cancer Staging
Treatment
Drug Therapies
Prevention
The most common type ofbladder canceris calledtransitional cell carcinoma(TCC).Also known asurothelial carcinoma(UCC), TCC arises from the inner lining of the urinary tract, called the transitional urothelium.
This article looks at transitional cell carcinoma, its signs and symptoms, and its causes and risk factors. It also discusses diagnosis, staging, treatment, and prevention.
John Fedele / Getty Images
TCC is a slow-developing cancer with a latency period of anywhere up to 14.5 years.The latency period is the amount of time that passes between your exposure to a toxin or disease-causing agent and the development of symptoms.
In the earlierprecancer stage, symptoms can often be vague to nonexistent. It is typically only when the cancer is advanced that many of the symptoms appear.
When symptoms do appear, they may resemble the symptoms of a severe kidney infection. You may have painful urination and lower back or kidney pain. The symptoms can also mimic those of other conditions, including:
For these reasons, TCC is usually diagnosed in older people. Around 60% of new diagnoses and 70% of deaths are in people over 65.
Depending on the stage of the disease, the symptoms of TCC may include:
Cancer of the bladderor kidneys is often related to cigarette smoke. In fact, around 50% of TCC diagnoses in males and 30% in females are associated with smoking.Moreover, the risk and stage of the disease appear directly linked to the number of years a person has smoked and the daily frequency of smoking.
Research also suggests that bladder cancer in smokers is not only more prevalent but usually more invasive than it is in nonsmokers.The cause for this association is not entirely clear, but some have hypothesized that long-term exposure to tobacco smoke causes chromosomal changes in in the tissues that give rise to lesions and cancers.The risk is seen to be highest in persons who smoke 15 or more cigarettes a day.
Other risk factors for TCC include:
In America, bladder cancer is the fourth most common cancer in males and the ninth most common in females.More than 57,000 males and 18,000 females get bladder cancer in the U.S. every year.
The first sign of TCC is often blood in the urine.Sometimes the blood is not visible, but it can be easily detected in aurinalysis (urine test). A urine cytology test can also be used to look for cancer cells in urine. This is a less reliable form of diagnosis, however.
Newer technologies can identify proteins and other substances in urine associated with TCC. These include the Urovysion and Immunocyt tests. There is even a prescription home test known as Bladderchek. This test can detect a protein calledNMP22commonly found at higher levels in people with bladder cancer.
Depending on the type of cystoscope used, the procedure may be performed under local or general anesthesia. General anesthesia may be used for males since the male urethra is longer and narrower than in females, and the procedure can be extremely painful.
The goal is to neither undertreat or overtreat the cancer. Based on these findings, your healthcare provider will stage the disease as follows:
The staging also provides a better sense of survival times. These numbers are not set in stone, and some people with advanced cancer can achievecomplete remissionirrespective of the diagnosis.
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Treatment Approaches
Treatment of TCC is largely dependent on the stage of the disease, the extent to which the cancer has spread, and the type of organs involved. Some of the treatments are relatively simple with high cure rates. Others are more extensive and may require both primary andadjunctive(secondary) therapies.
Stage 0 and I Tumors
Tumors that have not yet reached the muscle layer can often be “shaved off” in a procedure called a transurethral resection of bladder tumor (TURBT). This is done with an electrocautery device attached to the end of a cystoscope. The procedure may be followed with a short course of chemotherapy. In two out of three cases,immunotherapytreatments using a vaccine known as Bacillus Calmette-Guérin (BCG) can also lessen the risk of recurrence.
Stage II and III Cancers
Thesearemore difficult to treat. They require extensive removal of any affected tissue. In the case of the bladder, these cancers may be treated with a surgical procedure known as radical cystectomy, in which the entire bladder is removed. A partial cystectomy may be performed in a small handful of stage II cases but never stage III.
Chemotherapy may be given either before or after surgery, depending largely on the size of the tumor. Radiation may also be used as an adjuvant therapy but is almost never used on its own.
Stage IV Cancers
Stage IV cancers are very hard to get rid of. Chemotherapy with or without radiation is typically the first-line treatment with the aim of shrinking the size of tumors. In most cases, surgery will not be able to remove all of the cancer but may be used if it can extend a person’s life andquality of life.
Traditional chemotherapy drugs are commonly used in combination therapy. These may include:
Thesemonoclonal antibodiesare injected into the body. They immediately seek out cancer cells, binding to them and signaling other immune cells to attack.
This targeted form ofimmunotherapycan shrink tumors and prevent cancer from progressing. It is used primarily to extend the life of people with advanced, inoperable, or metastatic TCC. The most common side effects of these immune-stimulating drugs include:
The combination of Opdivo and Yervoy has gained popularity in recent years in cases of advanced TCC. Treatment is given intravenously over 60 minutes, usually every two weeks. The dosage and frequency depend largely on how the cancer responds to the therapy and the severity of side effects.
Prevention of TCC starts with factors you can control. Of these, cigarettes are key. The facts are simple: bladder cancer is the second most common smoking-related malignancy behind lung cancer. Quitting not only significantly reduces your risk of TCC but can prevent cancer recurrence once you’ve been successfully treated.
Quittingcan be difficult and often requires several attempts. Most insurance plans, however,cover some or all of the costof smoking cessation treatment.
Other modifiable factors can also contribute to a reduction in risk. One 10-year study involving 48,000 men found that those who drank 1.44 liters of water (roughly eight glasses) daily had a lower incidence of bladder cancer than those who drank less.
The findings were significantly limited since other factors like age and smoking were not considered. However, a 2014 meta-analysis suggested that black and green tea consumption offered a protective benefit, and for smokers, more fluid intake, in general, may help prevent bladder cancer.
While drinking water alone cannot erase the consequences of smoking, it does highlight the benefits of healthy lifestyle choices. These include proper hydration, physical activity, a healthy diet, and weight loss if you are obese.
Summary
Bladder cancer is one of the most common cancers in America. Most bladder cancers are transitional cell carcinomas (TCC).
TCC is slow growing and usually has no symptoms in the early stages. When symptoms do develop, they may include painful urination, blood in the urine, fatigue, and weight loss.
Smoking is one of the largest risk factors for TCC. Other risk factors include older age, being male, and being obese.
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