Bladder Cancer

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One of the many types of cancers, bladder cancer begins in the bladder of a patient. Bladder is an organ in the pelvic area of a person. It is a balloon shaped organ which stores urine. Cancer is caused by abnormal growth of cells in any part of the body. Bladder cancer starts in the line which is inside the bladder.

Thousands of people are diagnosed with bladder cancer every year. Bladder cancer is a highly treatable disease and can usually be diagnosed at early stages. If it’s not diagnosed early, it may be not be easily treatable. The cancer mostly occurs in people of older ages. Even the cancer which occurs in younger people can re occur later after the treatments. Patients are therefore required to go through constant follow ups to look for cancer recurrence for many years after the treatment has been done.

Bladder Cancer

Causes of Bladder Cancer

The exact cause of bladder cancer is still not known to the doctors [1]. But some of the possibilities that may cause bladder cancer are mentioned below:

  • The changes in genetic material of bladder cells might play a role in causing bladder cancer.
  • The environment of a person and smoking may also cause occurrence of bladder cancer.
  • Cell changes leading to cancer may occur when lining inside the bladder experiences irritation for a long time. The irritation may be caused due to radiation treatments, having parasites which cause schistosomiasis or having catheters placed inside for a long time.
  • Being exposed to chemicals or such other substances including dyes, paints and leather dust.
  • According to some studies and experts, the chances of bladder cancer being developed are twice in people who smoke than the people who don’t smoke. It is believed that smoking causes more than half of the cancers in people, both man and women.

Signs and Symptoms of Bladder Cancer

There are some common symptoms of bladder cancer which include the following:

  • Hemturia is a very common symptom of bladder cancer. Hemturia is a condition in which blood clots are formed in the urine. Hemturia occurs in almost every 8 people out of 10 who suffer from bladder cancer. This condition isn’t usually very painful.
  • Patients might experience pain while urinating. It is a condition called dysuria.
  • The patient might urinate frequently in very small amounts.
  • The patient might face urinary tract infections (UTIS).
  • Flank pain which is the pain in the lower back of the patient and around their kidneys may be experienced by the patient.
  • Patient might experience swelling in lower legs.
  • The pelvis near the bladder may grow.
  • Patient might be experiencing sudden weight loss.
  • Anemia may also be experienced as a symptom of bladder cancer in the patient. Anemia is a condition in which white blood cells behave abnormally.
  • Patient might experience pain in bones or pain in rectal, anal or pelvic areas.
  • Patient might experience loss of blood.

Hematuria might be a completely normal condition for some individuals. It doesn’t necessarily indicate bladder cancer. Hematuria might be very microscopic to be seen in most people.

Diagnosis of Bladder Cancer

The investigation of bladder cancer starts with the study of a thorough analysis and study of the patient’s history. Physical examination of the patient is carried out [2]. Patient will be required to answer the doctors’ questions about his personal habits which might have caused the cancer. It would help doctors to assess the patient’s profile. They should know if the patient smokes himself or hang around the people who smoke. This will determine if he is infected with first hand or passive smoking. If the patient has work which exposes him to certain chemicals, this can also be a cause of bladder cancer for him.

Hematuria can be caused due to multiple reasons in the urinary tract and is not always a symptom of bladder cancer. This is why the doctors carry out the process of radiological imaging of the patient’s kidney, bladder and ureter organs to check for any possible problems. This can be done through a CT scan.

There are various tools for checking bladder cancer:

  • The urine of the patient may be examined by the doctor under microscopic lenses. The urine will be examined to check for cancer cells. These cells may have been spread to urine from the bladder lining. The urine will also be tested for the substances which are associated closely with the cancer cells.
  • The most important tool for urologists in order to treat bladder cancer is cystoscpy. This is a procedure which allows the doctor to view the bladder directly. This procedure is most commonly performed by local anesthesia. The patient needs to be lightly sedated for this treatment. An instrument called cystoscope is then inserted inside through the urethra. This will enable the doctors to examine inner surfaces of the bladder to see signs of bladder cancer. The procedure may sound very painful to the patient but the doctors need to counsel them to make them comfortable with it. The cystoscopes of modern day are soft and comfortable and hence do not as much discomfort.
  • If there are tumors present, the doctor will check for its size and appearance. Tumors can’t be removed by the doctors under the process of local anesthesia. This will then lead to doctors carry out general anesthesia. In this process, the doctors will insert an instrument known as resectoscope inside the bladder. This is a viewing device as well but it has a wire attached at one end. The wire removes the tissue. The process is done by the doctors through the urethra. The tissue which is removed is then taken for examination by the pathologists who are specialized and interpret changed in the body tissues which are caused by this disease.
  • Apart from removing tumors that are clearly visible, the doctor will remove other suspicious looking tissues of the bladder as well.
  • If the doctors carry out a biopsy of the tissues and find out bladder cancer, the tissues will then be used to grade the cancer stage. The grades can be either high or low. The cells which have low grade tumors don’t have many abnormalities. The tumors that are of a higher grade have many apparent abnormalities.

Stages of Bladder Cancer

The T will refer to the primary tumor [3].

  • TX refers to the primary tumor which can’t be assessed.
  • T0 refers to the absence of evidence of the tumor.
  • Ta refers to non invasive papillary carcinoma.
  • T1 Tumor means it has invaded to the subepithelial tissues
  • T2a Tumor means that is has superficial muscle (inner half)
  • T2b Tumor means that tumor has invaded the deep muscle (outer half)
  • T3 Tumor means that the tumor has invaded  perivesical tissue
  • T3a Microscopically
  • T3b Macroscopically (extravesical mass)
  • T4a Tumor has invaded prostate, uterus or vagina
  • T4b Tumor has invaded pelvic wall or abdominal wall

Treatment of Bladder Cancer

Bladder cancer treatment depends upon the stage the cancer is in. A number of options are available for the treatment in stage one. The three options are:

  • Chemeotherapy: Chemotherapy is done by inserting the medicine directly into the bladder using a Foley catheter. The patient may feel bladder wall irritation and pain when urinating.
  • Immunotherapy: It is one of the common treatments of bladder cancers. In immunotherapy a medication that attacks the immune system is given to attack and eradicate the cancer cells. It is mostly performed using the Bacille Calmette-Guerin vaccine also known as BCG. Another medicine interferon is also used and given directly through a Foley catheter inside the bladder. Interferon is given to patients when patients don’t respond to BCG. Immunotherapy, along with other treatments also has its side effects that should be discussed with the doctor before any treatment.
  • Surgery: The patient can chose to get the cancer treated either by surgery whereas the tumor can be removed without taking out the entire bladder. The cancerous tissues inside the bladder are removed using a urethra in Transurethral resection of the bladder.

In stage two and three surgery is a better and a more common option because of the spread of cancer. Radical cystectomy can be performed whereas the complete bladder or the affected part of the bladder is removed. Even after this surgery radiation and chemotherapy is advised to the patients. Also, some cancer patients are prescribed to have chemotherapy before the surgery so that the tumor shrinks in size in advance of the surgery. Patients on whom surgery is not advised or a unwilling to get it done are gone through radiation and chemotherapy.

Bladder cancer in stage four is not treatable via surgery and is incurable. These patients are advised chemotherapy for survival.

After the bladder has been removed, another surgery can be performed to help the body drain the urine. There are three kinds of surgeries that can be done:

  1. Ileal conduit: A small reservoir for urine is created by taking a little piece from the small intestine. To one end of this piece a ureters is attached that channels urine from the kidneys. The other end is taken out through the skin called stoma which allows the patient to pass out the collected urine inside the reservoir.
  2. Continent urinary reservoir: A pouch is made using a piece of the intestine inside the body. A tube will be needed to go through the stoma inside the pouch to drain the urine.
  3. Orthopedic neobladder: This is one of the most common surgeries amongst bladder cancer patients these days that had their bladders removed. A pouch is made by folding a part of the bowel to gather urine inside. It is attached where urine is emptied from the bladder. This keeps normal urinary control.

Complications of Bladder Cancer

Bladder cancer is a relatively more common type of cancer than other types of cancers. Even though the cancer can be diagnosed and treated, there are problems after the treatments as well. The cancer has reported to re occur in many patients a few years after the treatment. This is why the survivors of bladder cancer often go through follow up testing for many years after their treatments have been successful.

The doctor will be required to prepare a follow up plan for the patient. A cystoscopy which examines the inside of the urethra is recommended to be done by the doctors every three to six months [4]. This is necessary for the few initial years after the treatment of cancer. After that, the patient can have a cystoscopy once every year. The doctors may recommend other tests for the patient at various intervals as well.

People who have had more severe cases of bladder cancers may have to go through much more frequent screening processes. People with lesser aggressive cancers may have to go through fewer screening processes.

Prevention of Bladder Cancer

Prevention is always better than cure. The risks of bladder cancer may be reduced by very simple steps. These include:

  • By avoiding smoking the person can avoid the risk of cancer as the smoke chemicals will not collect in the bladder. Support groups and medications may help you quit smoking.
  • People who work with chemicals should follow safety instructions to avoid over exposure.
  • A healthy lifestyle consisting of a lot fruits and vegetables will help reduce the risk of cancer. People should include a lot of water intake in their every day routines. Water can prevent many diseases.

Patients suffering from bladder cancer should keep a lot of care of themselves after the treatment is done. Patients can become very overwhelmed with all the physical and emotional traumas they have to deal with because of the disease. Support of friends and family can be a very big deal for them and make them feel much better.