Bladder Cancer

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Introduction:

The bladder is a muscular organ that stores urine. The bladder is flexible and at the start of urination it contracts and forces urine out through the urethra (1).

Bladder cancer occurs in the bladder, an organ in the lower pelvis (1,2). This cancer type is more common in men than in women, and increases with age (3).

While there are different types, the most common form is bladder urothelial carcinoma (TCC), which begins in the urothelial cells lining the inside of the organ. Given the proximity of the bladder to other parts of the urinary tract, such as areas of kidneys, the ureters and urethra, bladder cancer tumors can be found in these areas as well (1).

Early diagnosis is critical for successful treatment (1). For example, the 5-year survival rate for localized bladder cancer (cancer that has not spread outside the bladder) is 70% (1). As a result, finding methods to detect the disease early is important.

Symptoms:

Bladder cancer can be found in its early stages (1), as it has some noticeable signs.

Some of the most common signs in early stage bladder cancer include changes in urination patterns:

  • Presence of blood in urine causing change in urine color
  • More frequent urination than normal, especially at night
  • Pain or burning sensation during urination

Other symptoms of bladder cancer in more advanced stages include:

  • Unable to urinate
  • Lower back pain on one side
  • Weight loss
  • Weakness
  • Swelling of feet

Causes and risk factors:

There are several factors that can increase a person’s risk of developing bladder cancer. Some include (1):

  • Smoking: Smokers are three times more likely to develop the disease than non-smokers.
  • Exposure to chemicals: Close contact with certain chemicals have been associated with an increased risk of disease.
  • Not drinking enough fluids: Poor consumption of water on a regular basis can increase chances of bladder cancer.
  • Chronic Bladder infections: Regular urine infections, or kidney or bladder stones are also associated with bladder cancer development.
  • Family History: Bladder cancer cases in the family can increase risk of disease.

Screening and Detection:

Two tests that are commonly used to detect bladder cancer include (3):

Urine cytology

Urine cytology involves observing a urine sample in the laboratory to check for abnormal cells under a microscope (3). However, this form of testing offers low sensitivity(4).

Cystoscopy

Cystoscopy involves inserting a cystoscope, a thin tube into the urethra, up to the bladder, to  observe any abnormal areas (3).

While a cystoscopy can offer high accuracy (5), it is costly, invasive and uncomfortable for the patient (6).

Further, even after initial diagnosis, surveillance and regular monitoring of bladder cancer is critical. Bladder cancer surveillance is suggested every 3-6 months in year 1 and 2, every 6-12 months in year 3 and 4, followed by yearly after this time (7).

Bladder cancer and urine detection:

As a cystoscopy may not always be practical or feasible for patients and can be a costly procedure to follow repeatedly, finding new methods to detect as well as monitor bladder cancer is actively being researched.

Urine shows promising results. In particular, micro RNA (miRNAs) have shown to be a possible biomarker in urine. Studies indicate specific miRNA levels could indicate bladder cancer as well as disease stage (4). Evidence also suggest miRNA levels in urine can suggest bladder cancer relapse (6). Other biomarkers, including circulating tumor cells (CTCs), DNA, proteins, mRNAs, long noncoding RNAs, as well as vesicles are also being investigated in its role with bladder cancer (8).

While research is ongoing, given the function of the bladder in the body, urine is particularly exciting in this field. Urine is also promising as it can be collected non-invasively, and on a regular basis for disease surveillance, an important part of bladder cancer monitoring.

The Colli-Pee® platform allows efficient and hygienic collection of urine. Additionally, various volumes can be collected depending on application.

References:

1. American Cancer Society - Bladder Cancer - https://www.cancer.org/cancer/bladder-cancer.html

2. Healthline - What Are the Risk Factors for Bladder Cancer? -  https://www.healthline.com/health/bladder-cancer-risk-factors

3. National Cancer Institute - Bladder and Other Urothelial Cancers Screening (PDQ®)–Patient Version -  https://www.cancer.gov/types/bladder/patient/bladder-screening-pdq

4. Kutwin P, Konecki T, Borkowska EM, Traczyk-Borszyńska M, Jabłonowski Z. Urine miRNA as a potential biomarker for bladder cancer detection - a meta-analysis. Cent European J Urol. 2018;71(2):177-185. doi: 10.5173/ceju.2018.1605. Epub 2018 Mar 28. Review. PubMed PMID: 30038807; PubMed Central PMCID: PMC6051360.

5. O'Sullivan P, Sharples K, Dalphin M, Davidson P, Gilling P, Cambridge L, Harvey J, Toro T, Giles N, Luxmanan C, Alves CF, Yoon HS, Hinder V, Masters J, Kennedy-Smith A, Beaven T, Guilford PJ. A multigene urine test for the detection and stratification of bladder cancer in patients presenting with hematuria. J Urol. 2012 Sep;188(3):741-7. doi: 10.1016/j.juro.2012.05.003. Epub 2012 Jul 19. PubMed PMID: 22818138.

6. Yun SJ, Jeong P, Kim WT, Kim TH, Lee YS, Song PH, Choi YH, Kim IY, Moon SK, Kim WJ. Cell-free microRNAs in urine as diagnostic and prognostic biomarkers of bladder cancer. Int J Oncol. 2012 Nov;41(5):1871-8. doi: 10.3892/ijo.2012.1622. Epub 2012 Sep 6. PubMed PMID: 22961325.

7. The Importance of Bladder Cancer Monitoring & Surveillance - https://www.cxbladder.com/us/blog/the-importance-of-bladder-cancer-monitoring-and-surveillance/

8. Batista R, Vinagre N, Meireles S, Vinagre J, Prazeres H, Leão R, Máximo V, Soares P. Biomarkers for Bladder Cancer Diagnosis and Surveillance: A Comprehensive Review. Diagnostics (Basel). 2020 Jan 13;10(1). doi: 10.3390/diagnostics10010039. Review. PubMed PMID: 31941070; PubMed Central PMCID: PMC7169395.