Bladder cancer accounts for approximately 90% of cancers of the urinary tract (renal pelvis, ureters, bladder, and urethra). The bladder is the balloon-shaped organ located in the pelvic cavity that stores and discharges urine. Urine is produced by the kidneys, carried to the bladder by the ureters, and discharged from the bladder through the urethra.
Some bladder cancer remains confined to the lining, while other cases may invade other areas. Most of the time bladder cancer occurs in older adults — more than 90 percent of cases occur in people older than 55, and 50 percent of cases occur in people older than 73.
Smoking is the greatest single risk factor for bladder cancer. Exposure to certain toxic chemicals and drugs also makes it more likely to develop bladder cancer.
Treating bladder cancer that has spread can be difficult and involve extensive procedures.
But if the bladder cancer is detected early before it has spread beyond the lining of bladder a better chance of successful treatment with minimal side effects is possible.
Cause of Bladder Cancer
Carcinogens, cancer-causing agents in the urine may lead to the development of bladder cancer.
Majority of the cases are reported due to cigarette smoking, and smoking cigars or pipes also increases the risk. Other risk factors include the following:
- Age of the person
- Chronic bladder inflammation caused due to recurrent urinary tract infections and urinary stones
- Consumption of Aristolochia Fangchi (a medicinal herb used in some weight-loss formulas)
- Consumption of diet high in saturated fat
- Exposure to second-hand smoke which means being very close to smoking people
- External beam radiation
- Several genetic risk factors identified due to family history of bladder cancer
- Gender (male)
- Infection with Schistosoma Haematobium common parasite found in many developing countries
- Personal history of bladder cancer
- Family Race (Caucasian)
- Treatment with certain drugs such as cyclophosfamide used to treat cancer)
- Exposure to carcinogens in the workplace also increases the risk for bladder cancer. Medical workers exposed during the preparation, storage, administration, or disposal of antineoplastic drugs (used in chemotherapy) are at increased risk.
Occupational risk factors include recurrent and early exposure to hair dye, and exposure to dye containing aniline, a chemical used in medical and industrial dyes. Workers at increased risk include hairdressers, machinists, printers, painters, truck drivers, workers in rubber, chemical, textile, metal, and leather industries are more likely to get this type of cancer.
Bladder Cancer Symptoms or Bladder Cancer Sign
The primary bladder cancer symptoms or bladder cancer sign is blood in the urine (hematuria). Hematuria may be visible to the naked eye (gross) or visible only under a microscope (microscopic) and is usually painless. Other symptoms include frequent urination and dysuria, a condition where pain occurs on urination .The most common symptoms are discussed below:
- Blood in the urine (making the urine slightly rusty to deep red): This is the most common among bladder cancer symptoms and occurs in the vast majority of people with this type of cancer. This symptom does not necessarily mean a person has cancer, since other conditions (including infections) can lead to bloody urine, but blood in the urine is never normal and should always be evaluated by a doctor.
- Urinary urgency or frequent urination, or feeling the need to urinate without results.
- Pain on urination (dysuria).
- Back or abdominal pain.
- Loss of appetite and weight.
- Weakness or tiredness
These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. People with symptoms like these may see their family doctor or an urologist, a doctor who specializes in diseases of the urinary system.
Bladder Cancer Treatment
Bladder cancer treatment depends on the stage of the disease, the type of cancer, and the patient’s age and overall health. People with bladder cancer have many treatment options. Options include surgery, chemotherapy, radiation, and immunotherapy.
Some patients get a combination of therapies. The doctor is the best person to describe treatment choices and discuss the expected results of treatment.
A clinical trial, a research study of new treatment methods are an important option for people with all stages of bladder cancer.
Surgery is a common treatment for bladder cancer. The type of surgery depends on the stage of the disease and grade of the tumor. In early stages, the tumor may be removed (resected) using instruments inserted through the urethra (transurethral resection).
Bladder cancer that has spread to surrounding tissue (e.g., Stage T2 tumors, Stage T3a tumors) usually requires partial or radical removal of the bladder (cystectomy). For invasive bladder cancer, the most common type of surgery is radical cystectomy.
Radical cystectomy also involves the removal of nearby lymph nodes and may require a urostomy (opening in the abdomen created for the discharge of urine). The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. .
In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed. Complications include infection, urinary stones, and urine blockages. Newer surgical methods may eliminate the need for an external urinary appliance.
Segmental cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.
Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, the surgeon removes the bladder but does not try to get rid of all the cancer. Or, the surgeon does not remove the bladder but makes another way for urine to leave the body.
The goal of the surgery may be to relieve urinary blockage or other symptoms caused by the cancer. When the entire bladder is removed, the surgeon makes another way to collect urine. The patient may wear a bag outside the body, or the surgeon may create a pouch inside the body with part of the intestine.
Radiation therapy (also called radiotherapy) uses high-energy x-rays to destroy cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area. External beam radiation is emitted from a machine (external radiation) outside the body and internal radiation is emitted from radioactive “seeds” implanted into the tumor.
Either type of radiation therapy may be used after surgery to destroy cancer cells that may remain. Radiation therapy is also used to relieve symptoms (palliative treatment) of advanced bladder. Some patients with bladder cancer receive both kinds of radiation therapy.
Chemotherapy is a systemic treatment meaning that the drugs flow through the entire bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.
This treatment affects the entire body that uses drugs to destroy cancer cells. It is administered orally or intravenously. If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs it is administered intravenously i.e. through a vein.
In early bladder cancer, may be infused into the bladder through the urethra. This procedure is called intravesical chemotherapy. This is local therapy. Chemotherapy also may be administered before surgery .This is called neoadjuvant therapy .Chemotherapy administered after surgery is called adjuvant therapy. The doctor may use one drug or a combination of drugs. Any drugs prescribed should be used as the doctor directs to avoid leading to a prescription drug addiction.
For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter.
The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.
Side effects of chemotherapy can be severe which include the following:
- Abdominal pain
- Bladder irritation
- Blurred vision
- Excessive bleeding or bruising
- Fatigue and Weakness
- Loss of appetite
- Nausea and vomiting
Biological therapy (also called immunotherapy) uses the body’s natural ability (immune system) to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back.
The doctor may use intravesical biological therapy with BCG solution. BCG solution contains live, weakened bacteria. The bacteria stimulate the immune system to kill cancer cells in the bladder. The doctor uses a catheter to put the solution in the bladder. The patient must hold the solution in the bladder for about 2 hours. BCG treatment is usually done once a week for 6 weeks.
Bladder cancer has a high rate of recurrence, thus a follow up is must and should. Urine cytology and cystoscopy are performed every 3 months for 2 years, every 6 months for the next 2 years, and then yearly.
Bladder Cancer Prognosis and Bladder Cancer Survival Rate
Superficial bladder cancer has a 5-year survival rate of about 85%. Invasive bladder cancer has a less favorable prognosis. Approximately 5% of patients with metastasized bladder cancer live 2 years after diagnosis. Cases of recurrent bladder cancer indicate an aggressive tumor and a poor bladder cancer prognosis.
Bladder Cancer Prevention
Studies reveal that Bladder cancer prevention is not possible. Not to smoke is the ultimate best way to lower the risk. Drinking plenty of fluids daily also lowers the risk for bladder cancer.
As mentioned above though bladder cancer can’t always be prevented, some of these steps along with the above mentioned should help to reduce the risk:
- Be careful with chemicals and private water sources: While working with chemicals, one should follow all safety instructions to avoid exposure. Well, should be tested for high levels of arsenic in the water.
- Learn to love broccoli: Researchers indicate that a high intake of cruciferous vegetables, such as broccoli and cabbage, may help to cut the risk of bladder cancer in men.
- Although eating plenty of fresh vegetables and fruits is important for overall health, only broccoli and cabbage seem to affect bladder cancer risk.
- Seek medical attention early: On notice of blood in urine, immediately one should see a doctor.