Non-muscle Invasive Bladder Cancer: Symptoms, Risk Factors, Diagnosis And Treatment

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Non-muscle invasive bladder cancer (NMIBC) is a type of cancer that develops in the tissues of the bladder but has not spread into the muscular wall of the bladder. The muscular wall of the bladder is called the detrusor muscle. NMIBC is considered a less aggressive form of bladder cancer compared to muscle invasive bladder cancer (MIBC). NMIBC is typically treated with transurethral resection of bladder tumor (TURBT) to remove visible tumors followed by intravesical therapy to reduce the risk of recurrence and progression to MIBC.

Symptoms Of NMIBC

The most common symptom of Non-Muscle Invasive Bladder Cancer is blood or blood clots in the urine, which appears reddish or brown in color. The person may see blood in the urine after urinating or in the toilet. Other potential symptoms include frequent urination, painful urination, pressure or discomfort in the lower abdomen or back, pain during sex. However, in the early stages, NMIBC may not cause any noticeable symptoms. Any persistent symptom of blood in urine should not be ignored and requires prompt medical attention.

Risk Factors For NMIBC

Some ...
... of the risk factors associated with non-muscle invasive bladder cancer include:

- Age and gender: NMIBC is more common in older individuals, especially after age 60. Men are nearly 3-4 times more likely to develop bladder cancer than women.

- Smoking: Smoking tobacco, including cigarettes, pipes, cigars is a major risk factor. Smokers are 2-4 times more at risk than non-smokers.

- Exposure to chemicals: Long term exposure to aromatic amines or other chemicals used in industries like rubber, dye, paint increase the risk.

- Previous pelvic radiation: Pelvic radiotherapy received previously for cancers may damage DNA and increase NMIBC risk later in life.

- Inherited conditions: Rare inherited conditions like Balkan endemic nephropathy and hereditary non-polyposis colorectal cancer syndrome are associated with higher risk.

- Chronic bladder conditions: Long term bladder infections, chronic bladder inflammation, bladder stones, etc. are risk factors.

Diagnosis Of NMIBC

The diagnosis of NMIBC requires a biopsy of the suspicious bladder tumor/lesions. Some of the common diagnostic tests and procedures include:

- Urine cytology test: To detect cancer cells under microscope in urine sample. Has low sensitivity for early NMIBC.

- Cystoscopy: Inspection of inner bladder surface using a lighted scope passed via urethra to directly visualize tumors.

- Biopsy: Collecting small sample of tumor tissue using biopsy forceps during cystoscopy for histopathological examination.

- TURBT: Surgical procedure to fully remove visible tumors in the bladder using an electrosurgical resectoscope passed through urethra under anesthesia. Resected tumor sent for thorough pathological analysis.

Staging And Grading Of NMIBC

The TNM staging system is used to classify NMIBC based on tumor size, number and location. Grading classifies tumor cell characteristics on a scale of G1 to G3. The most important prognostic factors are type, grade and stage of the tumor. Based on these, the risk of recurrence and progression to MIBC can be determined to plan further treatment.

Treatment Options For NMIBC

The main treatment options for non-muscle invasive bladder cancer include:

- Transurethral resection of bladder tumor (TURBT): As mentioned earlier, it is the primary treatment to remove all visible tumors in the bladder. Considered a definitive treatment if diagnosis is of a NMIBC.

- Intravesical chemotherapy: Instillation of chemotherapy drugs like Mitomycin C, Gemcitabine or chemotherapy directly into the bladder through a catheter for 1-2 hours to destroy remaining cancer cells not seen during TURBT. Given immediately after TURBT or in maintenance doses later to reduce recurrence risk.

- Intravesical immunotherapy: Bacillus Calmette-Guérin (BCG) therapy involves instillation of live attenuated Mycobacterium bovis directly into bladder to stimulate immune response against cancer cells. Considered standard of care due to better efficacy than chemotherapy for high grade NMIBC. May need long term maintenance therapy.

- Bladder surveillance: Periodic cystoscopy checkups and urine cytology tests for several years to monitor recurrence/progression. Follow up frequency depends on risk level. May need repeat TURBT or intravesical therapy if disease returns.

- Radical cystectomy: Rarely considered for high risk NMIBC, it removes entire bladder and nearby lymph nodes surgically. Replacement urinary diversion like urostomy/ileal conduit needed for urine drainage.

- Chemotherapy or immunotherapy pills: May be used in certain high risk cases as adjuvant (additional) therapy before or after intravesical therapy to better control the disease.

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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it