Basics of Squamous Cell Bladder Cancer

Receiving a cancer diagnosis is a life-altering event. For patients diagnosed with squamous cell carcinoma of the bladder, understanding the specific nature of this disease is the first step toward navigating treatment.

This overview is designed to provide foundational knowledge about squamous cell bladder cancer, detailing its characteristics, diagnosis, treatment options and potential side effects. The information aims to prepare patients for constructive, detailed conversations with their oncology care team.

Overview

Bladder cancer is not a single disease but a group of cancers categorized by the type of cell where they begin. The most common type in the United States is urothelial carcinoma.

Squamous cell carcinoma (SCC) of the bladder is a distinct and rarer form, accounting for approximately 2% to 5% of all bladder cancers in the U.S. It develops in the flat, thin squamous cells that can line the bladder after long-term irritation or inflammation.

Unlike urothelial carcinoma, SCC is often associated with chronic bladder conditions. Risk factors include long-term use of urinary catheters, recurrent bladder infections, bladder stones, or certain parasitic infections more common in developing nations, such as schistosomiasis.

Because SCC is often linked to chronic irritation, it is frequently diagnosed at a later, more invasive stage than other types of bladder cancer. The cancerous cells tend to be aggressive and can grow deep into the bladder wall.

Diagnosis

The diagnostic process typically begins when a patient presents with symptoms, most commonly visible blood in the urine (hematuria), frequent urination, pain during urination or pelvic discomfort.

To confirm a diagnosis, urologists employ several tests:

• Cystoscopy: This is the primary diagnostic tool. A doctor inserts a thin, lighted tube with a camera through the urethra into the bladder to visualize the lining.
• Biopsy: During a cystoscopy, if suspicious tissue is seen, a small sample is removed for laboratory analysis. A pathologist examines the tissue under a microscope to determine the specific cell type. Confirming the presence of pure squamous cells versus a mix with other cancer types is crucial for treatment planning.
• Imaging: Once cancer is diagnosed, imaging tests such as CT scans, MRIs or PET scans are used to determine the "stage" of the cancer. Staging determines if the cancer has spread beyond the bladder to nearby lymph nodes or distant organs.

Treatment Options

Treatment plans for squamous cell bladder cancer are highly individualized based on the cancer's stage, the patient's overall health and personal preferences. It is important to note that SCC responds differently to treatments than the more common urothelial carcinoma.

• Surgery: Because SCC is often invasive and less responsive to non-surgical therapies, surgery is frequently the primary treatment for localized disease. The standard procedure is a radical cystectomy, involving the removal of the entire bladder, nearby lymph nodes, and adjacent organs (prostate and seminal vesicles in men; uterus, ovaries, and part of the vagina in women).
• Following bladder removal, the surgeon must create a new way for urine to leave the body, known as a urinary diversion. Options include creating a conduit that drains to a bag outside the body or constructing a new internal reservoir from a section of the intestine.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells. While commonly used for other bladder cancers, standard chemotherapy regimens are generally less effective against pure squamous cell carcinoma. However, it may still be recommended in certain situations, such as before surgery to shrink a tumor or for advanced disease that has spread.
• Radiation Therapy: Radiation uses high-energy beams to target cancer cells. Like chemotherapy, it is often less effective as a primary treatment for SCC compared to other bladder cancers. It may be used in patients who are not candidates for surgery or to relieve symptoms in advanced cases.
• Clinical Trials: Patients should discuss the availability of clinical trials with their oncologist. These studies test new treatments or new combinations of existing therapies that may not yet be widely available.

Side Effects of Treatment

All cancer treatments carry the risk of side effects. The specific effects depend on the treatment type, duration, and the patient's health.

• Surgery: Radical cystectomy is a major operation. Immediate risks include infection, bleeding and blood clots. Long-term effects relate primarily to the urinary diversion, requiring patients to adapt to new methods of managing urine. This can impact body image and daily routine. Sexual dysfunction is also a common long-term side effect for both men and women due to nerve damage and the removal of reproductive organs.
• Chemotherapy: Side effects depend on the specific drugs used but often include fatigue, nausea, vomiting, hair loss, loss of appetite and an increased risk of infection due to lowered blood cell counts.
• Radiation Therapy: Side effects tend to be localized to the treated area. They can include bladder irritation resulting in frequent or painful urination, bowel irritation (diarrhea or rectal urgency), fatigue and temporary skin changes similar to a sunburn.

Conclusion

A diagnosis of squamous cell bladder cancer requires a focused and prompt treatment approach due to its aggressive nature and distinct response to therapy compared to more common bladder cancers.

Patients are encouraged to take an active role in their care decisions. This overview serves as a starting point for open dialogue with an oncology team.

Key questions for patients to ask their oncologist include:

• What is the exact stage of my cancer, and what does that mean for my prognosis?
• Why is a specific treatment plan being recommended over others?
• What are the specific risks and benefits of radical surgery versus other options?
• How will the recommended treatment affect my daily life, including urinary and sexual function?
• Are there clinical trials available that would be appropriate for my specific condition?

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

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