Bladder Cancer: Overview and Treatment Options

Bladder cancer tends to start in the innermost lining of the transitional epithelium. Cancer of this layer, transitional cell carcinoma (TCC), is the most common type, according to the American Cancer Association. TCC begins in urothelial cells. These cells are found in the lining of the bladder, the ureters, the urethra, and the renal pelvis (the connecting piece between the kidney and ureters). Bladder cancer is considered invasive when it penetrates the deeper layers of this wall.

Causes and Risk Factors

There are some risk factors that cannot be changed, such as age, ethnicity, and sex. Most people who develop bladder cancer are older. Caucasians are more likely to have bladder cancer than African Americans; however, Black patients are more likely to be in an advanced stage of cancer at the time of diagnosis. Rates are higher for men than for women; it is the fourth most common type of cancer observed in males.

It may be comforting to know that other risk factors can be controlled. Like most cancers, this disease can be caused by an unhealthy lifestyle. Smoking greatly increases the risk of bladder cancer for example. Eating a healthy diet is also shown to greatly reduce the likelihood of developing many types of cancers.

Workers in industries that make rubber, leather, textiles, prints, or paint also have an increased risk of bladder cancer. This is due to aromatic amines, chemicals that are often used in dyes. Truck drivers also present a high risk of bladder cancer, probably because of their exposure to diesel fuel.

Drinking plenty of fluid, particularly water, is associated with lower rates of bladder cancer. This is because when the bladder is emptied frequently, harmful compounds may not linger. One important caveat is that the drinking water must not contain arsenic. For most Americans, this is a non-issue; however, some locales that use well water may have higher arsenic levels.

Diagnosis

Most bladder cancers are detected while they are still non-invasive. This can be achieved by health screening, or by consulting a doctor about related symptoms.

There is currently no recommendation for the general public to be screened for this type of cancer; however, high-risk individuals might be advised to be screened regularly. This group includes people who have had bladder cancer in the past, were born with certain bladder defects, or are exposed to certain workplace chemicals.

Symptoms are often easily identified because they are related to urination. These symptoms include: blood in urine (although this alone does not always indicate cancer); more frequent or painful urination; a weak urine stream; and a sensation of “needing to go,” even when the bladder is empty. These symptoms are reminiscent of a urinary tract infection; in fact, they are more likely to be a UTI than cancer. It is still important to see a doctor to rule out cancer and treat the UTI, if this is the case.

About a third of cases are invasive. In these advanced stages, a person might experience bone pain, inability to urinate, swollen feet, loss of appetite, or lower back pain isolated to one side. These symptoms can also be related to other conditions. A doctor can help patients determine the cause of their symptoms.

If bladder cancer is suspected, several tests can confirm it. The most common are physical exams and urine labs. Less common tests include a cystoscopy or imaging tests to find tumors. If bladder cancer is confirmed, doctors will stage the cancer to decide on an appropriate treatment. The standard staging system for bladder cancer is TNM, which describes the primary tumor, indicates whether the cancer has spread to lymph nodes, and indicates if it has spread. It is quite rare for bladder cancer to spread to distant parts of the body before being detected.

Treatment Options

Bladder cancer may be treated like most cancers, using methods like surgery, chemotherapy, radiation, or immunotherapy. Many pharmacies and online retailers offer coupons or other discounts to make medications for this type of cancer more affordable. Some drugs commonly used to facilitate treatment are:

Keytruda is used for immunotherapy. It blocks the PD-1 pathway, which cancer cells may use to “hide” from T cells. It is administered via IV. It typically costs $12,500/month. Some patients with no health insurance are still eligible to receive it for free or at significantly reduced costs.

Imfinzi is another immunotherapy drug. Though it can help treat lung cancer, it works for the bladder because both organs contain similar cells. Pricing is typically $15,000/month. However, please note that the company offers a program where certain individuals might receive the drug for free or eligible patients can save up to $26,000 annually.

Cyramza is paired with chemotherapy to treat advanced cancer. Pricing is typically $35,859/month (co-pay allows savings of up to $25,000). The developers of this drug offer a co-pay program in which eligible patients pay no more than $25 per dose.

Tecentriq also blocks the PD-1 pathway. Pricing is typically $12,500/month. It is also available to eligible patients at no or reduced charge.

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