Bladder Cancer

Bladder Cancer 

Bladder cancer is a type of cancer that develops in the tissues of the bladder, which is a hollow organ located in the pelvis. The bladder’s primary function is to store urine produced by the kidneys until it is excreted from the body through the urethra. Bladder cancer occurs when abnormal cells in the bladder multiply uncontrollably, leading to the formation of a tumor.

Types of Bladder Cancer

There are several types of bladder cancer, including –

1. Transitional cell carcinoma (TCC) or urothelial carcinoma – This is the most common type of bladder cancer, accounting for about 90% of all cases. It develops in the cells that line the inside of the bladder.
2. Squamous cell carcinoma – This type of bladder cancer develops in the thin, flat cells that line the bladder after chronic irritation or inflammation.
3. Adenocarcinoma – This rare type of bladder cancer develops in the cells that produce mucus in the bladder lining.

Risk Factors

The risks of bladder cancer are not yet known, but there are some risk factors that can increase the chances of developing bladder cancer including – 

1. Smoking or tobacco use – Smoking is the most significant risk factor for bladder cancer, as it exposes the bladder to harmful chemicals.

Bladder Cancer

2. Exposure to certain chemicals – Exposure to chemicals such as arsenic, benzidine, and cyclophosphamide, which are used in some industries, can increase the risk of bladder cancer.

3. Age – Bladder cancer is more common in people over the age of 55.

4. Gender– Men are more likely to develop bladder cancer than women.

5. Family history – Bladder cancer can run in families, and having a close relative with the disease increases the risk.

6. Chronic bladder inflammation – Chronic infections or inflammation of the bladder, such as from catheter use, may increase the risk of bladder cancer.

7. Radiation exposure – People who have undergone radiation treatment for other cancers in the pelvic region may have an increased risk of bladder cancer.

Having one or more of these risk factors does not necessarily mean that a person will develop bladder cancer, and some people without any known risk factors can still develop bladder cancer. Regular check-ups and screenings can help detect bladder cancer early and improve the chances of successful treatment.

Signs and Symptoms

Bladder cancer often causes no symptoms in its early stages. However, as the cancer grows and spreads, it can cause a range of signs and symptoms, which may include –

1. Blood in the urine – This is the most common symptom of bladder cancer. It may appear as pink, red, or brown urine.
2. Painful or frequent urination – Bladder cancer can cause changes in urination, such as a burning sensation or an increased frequency of urination.
3. Urinary urgency – Bladder cancer can also cause a sudden urge to urinate that may be difficult to control.
4. Pain in the lower back or abdomen – Bladder cancer can cause pain in the lower back or abdomen, especially if the cancer has spread to nearby tissues or organs.
5. Unexplained weight loss – Advanced bladder cancer can cause unexplained weight loss and fatigue.

These symptoms may also be caused by other conditions, such as urinary tract infections or kidney stones. However, if any of these symptoms persist or worsen over time, it is important to see a healthcare professional for evaluation and possible testing. Early detection and treatment of bladder cancer can improve the chances of successful treatment and recovery.

Diagnosis and Tests

The diagnosis of bladder cancer typically involves a combination of medical history evaluation, physical examination, and various diagnostic tests. Here are the common methods used to assess and diagnose bladder cancer –

1. Medical history and physical examination – Your healthcare provider will begin by taking a detailed medical history, including any symptoms you may be experiencing. They will inquire about risk factors, such as smoking history, occupational exposures, and family history of bladder cancer. A physical examination may also be performed to assess for any visible signs or abnormalities.

2. Urine tests – Urine samples are collected and analyzed to detect the presence of blood (hematuria) or abnormal cells. Various tests may be performed, including a urine dipstick test, microscopic examination of urine sediment, and urine cytology. Urine cytology involves examining the urine sample under a microscope to identify abnormal cells that may suggest bladder cancer. 

3. Imaging tests

• Ultrasound – An ultrasound of the bladder uses sound waves to create images of the bladder and surrounding structures. It can help identify tumors or abnormalities in the bladder. 
• CT (Computed tomography) scan – It provides detailed cross-sectional images of the bladder, allowing for a more precise assessment of the tumor’s size, location, and spread to nearby structures or lymph nodes. 
• MRI (Magnetic resonance imaging) – It can provide detailed images of the bladder and surrounding structures. It may be used to evaluate the extent of the tumor and help determine the appropriate treatment approach. 
• Bone scan – It performs bone X-rays to detect signs of cancer spread in bones.

4. Cystoscopy – Cystoscopy is a procedure that involves inserting a thin, flexible tube with a camera (cystoscope) into the bladder through the urethra. This allows the doctor to visualize the inside of the bladder and identify any suspicious areas or tumors. Biopsies may be taken during cystoscopy to confirm the presence of bladder cancer and determine its characteristics.

5. Cytology – It examines microscopic cells inside the bladder for signs of cancer.

6. Biopsy – If suspicious areas are identified during cystoscopy or imaging tests, a biopsy may be performed. During a biopsy, a small sample of tissue is collected from the bladder for laboratory examination. The tissue sample is analyzed by a pathologist to determine if cancer cells are present and to determine the type and grade of bladder cancer.

Once the diagnosis of bladder cancer is confirmed, further tests may be conducted to determine the stage and grade of the cancer. This information helps guide treatment decisions and prognosis.

It is necessary to consult with a healthcare professional, typically a urologist or oncologist, who specializes in the diagnosis and treatment of bladder cancer. They will be able to evaluate your specific situation and recommend the most appropriate diagnostic tests for an accurate diagnosis.

Treatments

There are four types of treatments performed for treating bladder cancer. Your healthcare provider may recommend one or a combination of treatments on the patient’s medical condition –

1. Surgery – It is the most common choice of treatment for bladder cancer. Your healthcare provider may provide surgical options based on the cancer stage. It uses TURBT to treat bladder cancer that hasn’t spread. The high-energy electricity is used to remove the tumor from the cancer cells with a process known as fulguration.
Radical cystectomy is another treatment option that is widely used to treat tumors that have already spread to other organs or are at the early stage of bladder cancer. Providers may also adopt a combination approach of surgery with chemotherapy or radiation therapy to kill any remaining cancer cells

2. Chemotherapy – It uses drugs called “chemo” to kill cancer cells. Providers may use intravesical therapy to directly target bladder cancer via a tube inserted in the urethra.

3. Immunotherapy – It uses your own immune system to attack cancer cells. There are different types of immunotherapy –

• Bacillus Calmette-Guerin (BCG) – A vaccine that helps to boost the immune system.
• PD-1 and PD-L1 inhibitor therapy – PD-1 is located on the surface of T-cells that help to regulate the body’s immune system. PD-L1 is a protein found on the surface of cancer cells. When these two proteins connect, it keeps T-cells from killing cancer cells. Inhibitor therapy helps in the prevention of two cells from connecting, resulting in T-cells killing cancer cells. 

4. Radiation Therapy – It is an alternative approach to surgery. It takes into consideration factors such as tumor growth and tumor characteristics before recommending this treatment. 

5. Targeted Therapy – It focuses on the genetic changes that turn healthy cells into cancer cells. FGFR gene inhibitor target cells with gene changes that help cancer cells to grow.

Prevention

While it is not always possible to prevent bladder cancer, there are several measures that can be taken to reduce the risk of developing the disease. Here are some prevention strategies that may help lower the risk of bladder cancer –

1. Quit smoking – Smoking is the most significant risk factor for bladder cancer. If you smoke, quitting is the best way to reduce your risk. Avoiding exposure to secondhand smoke is also important in the prevention of bladder cancer.
2. Avoid exposure to harmful chemicals – Minimize exposure to chemicals that are known or suspected to increase the risk of bladder cancer. If you work in an industry where you may be exposed to certain chemicals, follow proper safety protocols, use protective equipment, and adhere to workplace regulations.
3. Stay hydrated – Drink plenty of fluids, particularly water, to help dilute any potentially harmful substances in the urine.
4. Practice good hygiene – Take measures to prevent urinary tract infections, such as maintaining good personal hygiene by drinking plenty of fluids.
5. Eat a healthy diet – Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Some studies suggest that a diet high in fruits and vegetables, particularly those containing antioxidants, may help reduce the risk of bladder cancer.
6. Stay physically active – Engage in regular physical activity as it may help reduce the risk of various types of cancer, including bladder cancer. Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.
7. Stay informed about occupational hazards – If you work in an industry associated with an increased risk of bladder cancer, be aware of the potential hazards and follow recommended safety guidelines and protocols.
8. Seek prompt treatment for urinary symptoms – If you experience persistent urinary symptoms such as blood in the urine, frequent urination, or pain during urination, seek medical attention promptly. Early detection and treatment of any underlying conditions or abnormalities can help prevent the progression of bladder cancer.

These prevention strategies may reduce the risk of bladder cancer, but they do not guarantee complete prevention. Regular medical check-ups and screenings are essential for early detection and prompt treatment if any abnormalities are detected.

If you have specific concerns or an increased risk of bladder cancer due to personal or family history, it is advisable to consult with a healthcare professional who can provide personalized advice and guidance based on your individual circumstances.

Outlook

Bladder cancer if left untreated for a longer period of time may spread to other parts of the body. Cancer that has already spread or metastasized may affect how long you’ll live with bladder cancer. Early detection and treatment can increase the chances of living longer with bladder cancer. Based on cancer research and studies, 96% of people who received treatment for early-stage cancer have survived five years after diagnosis. Overall 77% of people with bladder cancer were alive after five-year of diagnosis.