Bladder Cancer (Transitional cell carcinoma of the Bladder)

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What is Bladder Cancer?

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A type of bladder cancer is Transitional cell carcinoma of the Bladder.

The bladder functions as a waste storage system for urine. Urine is produced by the kidneys as they filter the blood, and then travels down the ureters into the bladder. The bladder expands and once it reaches a certain maximum volume, the urge to pass urine increases until urine is passed.

The bladder is made up of an elastic type tissue which contains a layer of muscle. The bladder is lined with epithelium called transitional cells which are tall, thin cells that protect the underlying bladder from the urine contained therein. The membrane that the epithelium sits on is called the basal membrane.

Who gets Bladder Cancer?

Bladder cancer is a relatively uncommon disease.
Bladder cancer incidence increases with increasing age.
Bladder cancer is twice as common in males as it is in females.
Bladder cancer is seen worldwide, but is more common in certain parts of Africa and the Mediterranean due to an infection caused by Schistoma (a parasite in that region).
90% of bladder tumours are of the transitional cell carcinoma type.

Predisposing Factors

Cigarette smoking predisposes people to bladder cancer. Smoking cigarettes increases a persons risk of developing bladder cancer approximately 5 fold.

Industrial exposure to certain chemicals such as analine in the dye industry increases the risk. Other organic chemicals used in rubber and other manufacturing processes can also increase the risk.

Exposure to the chemotherapy agent Cyclophosphamide (occasionally used in younger people to treat either lymphoma or autoimmune diseases) is associated with a higher risk of developing bladder cancer.

Chronic irritation of the bladder appears to provoke development of bladder cancer. The bladder can be irritated by reoccurring infections and bladder stones. In certain parts of Africa and in the Mediterranean area, a parasitic infection called schistosomiasis causes irritation of the lining of the bladder. The parasites that burrow into the bladder appear to stimulate the tumour.

Progression

This type of bladder cancer tumour spreads by different mechanisms, depending on the type.

Superficial transitional cell carcinoma (or superficial bladder cancer, bladder warts) tend to spread only within the bladder unless they are left untreated for a long period of time. They may spread along the lining of the bladder but not penetrate deeply into the bladder unless left.

Invasive bladder cancer spreads via the lymphatics to the regional lymph nodes in either the groin or pelvis and then upwards into the abdomen. Blood borne spread is to the bones, lung, liver and occasionally brain.