Bladder Cancer: Understanding Risk Factors, Cure & Quality of Life

Bladder cancer is a serious condition that affects thousands of individuals each year, with several risk factors contributing to its development. Over time, bladder cancer incidence has increased in Delhi, Bangalore and Mumbai.

Understanding these risks and adopting preventive measures can significantly impact outcomes and improve quality of life. This guide covers everything from identifying risk factors to essential questions for your doctor.

Bladder cancer occurs when abnormal cells grow uncontrollably in the bladder lining. Recognizing the risk factors can help in early detection and prevention:

• Smoking: Smoking is the leading cause of bladder cancer, responsible for approximately half of all cases. Carcinogens in tobacco enter the bloodstream, filter through the kidneys, and affect the bladder lining. Risk for smokers is 3–4-fold higher compared to non-smokers and is estimated to cause 31% of bladder cancer deaths among men and 16% among women.
• Exposure to Chemicals: Workers in industries with high exposure to harmful chemicals, such as dye manufacturers, hairdressers, and painters, are particularly susceptible. Further, prolonged exposure to industrial chemicals, especially in rubber, leather industries, also increases the risk of bladder cancer. Most paint chemicals, known as aromatic amines, can linger in the bladder and cause cellular mutations.
• Chronic Bladder Inflammation: Chronic bladder conditions, such as urinary tract infections, bladder stones, or long-term use of urinary catheters, can irritate the bladder lining, increasing cancer risk.
• Age and Gender: Bladder cancer is more common in individuals over 55, and men are at a significantly higher risk than women, with men being three to four times more likely to develop the disease. This is partly due to increased smoking and more occupational exposure to carcinogens in male population.
• Family History: A family history of bladder cancer or genetic mutations like Lynch syndrome can elevate risk levels.
• Previous Cancer Treatments: Radiation therapy near the bladder or chemotherapy drugs like cyclophosphamide can increase the likelihood of developing bladder cancer.
• Lifestyle Factors: Poor hydration, lack of fruits and vegetables, and obesity can increase bladder cancer risks due to reduced flushing of carcinogens through urine.

Risk classification helps categorise bladder cancer patients based on the likelihood of disease progression and recurrence, guiding personalised treatment approaches:

• Low-Risk Bladder Cancer: Typically characterised by small, non-invasive tumours. These cancers are less likely to spread but require regular monitoring after endoscopic removal of bladder tumour.
• Intermediate-Risk Bladder Cancer: These tumours have higher recurrence rates and might invade deeper into the bladder wall. They often require more intensive treatment (aggressive endoscopic removal of bladder tumour) and surveillance.
• High-Risk Bladder Cancer: Involves larger, invasive tumours with a high likelihood of recurrence and progression. These cases may require aggressive treatment, including surgery (radical cystectomy - removal of bladder), chemotherapy, or immunotherapy.

Untreated bladder cancer can lead to severe consequences:

• Tumour Growth and Spread: Without treatment, bladder cancer cells can grow uncontrollably, invading deeper bladder layers and spreading to nearby organs and lymph nodes.
• Severe Symptoms: Untreated cancer can cause frequent and painful urination, blood in urine, lower back pain, and weight loss.
• Reduced Survival Rates: Early-stage bladder cancer is often highly treatable. However, delaying or avoiding treatment significantly reduces survival rates, as the tumour progresses to more advanced and less manageable stages.

Bladder cancer is a major cause of cancer deaths in developed countries, contributing to 3.4% of the global cancer burden. According to a research study, India is projected to see a 79.6% increase in bladder cancer cases by 2040 compared to 2018.

Bladder cancer has one of the highest recurrence rates among cancers, and recurrence within a year of treatment is common.

• Frequent Monitoring: Patients require regular cystoscopies, urine cytology, and imaging to detect any signs of recurrence early.
• Risk Factors for Recurrence: High-grade tumours, multiple tumours at initial diagnosis, and incomplete initial treatment can increase the likelihood of recurrence.
• Treatment Adjustments: Recurrent bladder cancer often necessitates more aggressive treatments, such as additional surgeries, chemotherapy, or immune-boosting drugs.

The diagnosis and treatment of bladder cancer can impact the quality of life significantly:

• Physical Impacts: Symptoms like frequent urination, urge incontinence, and fatigue from treatments can disrupt daily activities.
• Emotional Well-being: Anxiety about recurrence, body image issues from surgeries, and the psychological impact of a cancer diagnosis can affect mental health.
• Support Systems: Counselling, support groups, and rehabilitation programs can help patients cope with the physical and emotional challenges of bladder cancer.