Bladder Cancer

Bladder Cancer

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Overview

The bladder is a hollow and balloon-shaped muscular organ in the lower abdomen. Urine is produced in the kidney and stored in the bladder until it is passed out of the body.

What causes bladder cancer?

The exact cause of bladder cancer is still not known. It occurs when the abnormal cells grow and multiply uncontrollably in the bladder.

What are the symptoms of bladder cancer?

Many symptoms may indicate bladder cancer, like weight loss, fatigue, bone tenderness, etc. However, these symptoms may also be related to other diseases. You should pay attention to the below-mentioned symptoms:

The early warning sign of bladder cancer:

Signs of advanced bladder cancer:

How is bladder cancer diagnosed?

If your doctor suspects bladder cancer, he may do a physical examination and recommend other tests to confirm the diagnosis and know about the extent of the cancer spread.

  • Physical examinations: Your doctor will ask about your medical history, family history, and possible risk factors. He might do a digital rectal exam (DRE), where he inserts the gloved and lubricated finger into the rectum. During this exam, the doctor may sometimes feel a bladder tumor and may suggest some tests to confirm the diagnosis.
  • Urine culture: This test helps determine if the urinary symptoms are due to infection or due to cancer.
  • Urine cytology for malignant (cancer) cells: Cytology means the study of cells, and this test is done to look for abnormal cells in urine. It is usually done along with various other tests to diagnose bladder cancer. In case of already diagnosed cancer, the patient may be asked to go for this test to check on the recurrence of cancer.
  • Ultrasound: It is a painless procedure that gives information about the bladder wall, bladder stone, large tumor, etc.
  • Urography: This procedure uses contrast materials and imaging techniques to evaluate and detect blood in urine, bladder stones, kidney stone, or cancer in the urinary tract. It is usually performed with magnetic resonance imaging (MRI) or computed tomography (CT) scan.
  • Computer Tomography Urogram: This test is done using a special dye medium that helps with a clear image of the bladder. It can help in seeing the detailed images of soft tissue and blood vessels.
  • Cystoscopy and Transurethral resection of bladder tumor (TURBT): It is a minimally invasive procedure. The sample obtained from resection is sent to pathology to determine the grade and spread of the tumor. The one advantage of this procedure is that it can be done multiple times with reduced risk for patients.

Differential diagnosis

Symptoms experienced by the patient for bladder cancer may also be associated with different health problems like urinary tract infection, kidney disorder, etc. It is always advisable to visit a specialist. The health care specialist will suggest specific tests, and based on the proper diagnosis, he may guide you to the right specialist like an oncologist in case of bladder cancer.

What are the next steps after confirmation of cancer?

After confirmation of cancer, your doctor may ask you to go for additional tests to determine the cancer spread to the lymph nodes or other areas of your body. They also help in determining the grade of the cancer. These tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan
  • Chest X-ray

What are the stages of bladder cancer?

Stage 0: At this stage, cancer is restricted to the lining of the tissue inside the bladder. Also known as non-invasive papillary carcinoma.

Stage 0is: Tumor at this stage is known as carcinoma in situ. The tumor is flat on the tissue lining inside the bladder during this stage.

Stage 1: At this stage, cancer has spread to the connective tissue layer next to the lining of the bladder.

Stage 2: Cancer cells have spread to the muscle layer tissue of the bladder during this stage.

Stage 3A: Cancer cells have extended spread from the bladder to the layer of fat around the bladder. It may have also spread to the vagina and uterus in women or seminal vesicles and prostate in men. Cancer cells have not spread to the lymph nodes or one lymph node in the pelvis, which is not near the common iliac arteries.

Stage 3B: At this stage, cancer has spread to more than one lymph node in the pelvis which is not near the common iliac artery or at least one lymph node which is near the common iliac artery.

Stage 4A: Cancer has spread to the pelvis or abdominal wall or to lymph nodes of the common iliac arteries.

Stage 4B: At this stage, cancer has spread to other parts of the body like bones, lungs, etc.

How is bladder cancer treated?

There are different treatment options available. Patients are usually given a combination of treatments like radiotherapy, chemotherapy, surgery, etc. The best option of treatment depends on various parameters such as stage of cancer, patient’s response to treatment, etc. Below are some common treatment options available:

  • Radiation therapy: Radiation therapy utilizes high-energy x-rays or other types of radiation to kill the cancer cells and keeps them from growing. Radiations that come from outside the body are called external beam radiation, while placing several small radioactive seeds in the tissue that emit high-energy radiation is known as brachytherapy.
  • Chemotherapy: Chemotherapy utilises drugs to prevent cancer cells from growing, either by killing the cancer cells or by inhibiting them from multiplying. Chemotherapy is an option for treating cancers that are not responding to hormone therapy.
  • Immunotherapy: In this procedure, the patient’s own immune system is used as a tool to fight against the disease. Substances that boost the immunity of a person are made in the laboratory and then used to enhance the person's immunity to help fight cancer. This treatment is also known as biological therapy or biotherapy.
  • Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. This treatment targets cancer cells and is less harmful in comparison to radiation and chemotherapy.
  • Surgery: There are different types of surgical procedures done, depending upon the grading and type of the tumor.
    • Transurethral resection (TUR) with fulguration: In this procedure, a thin, lighted tube called a cystoscope is inserted into the bladder through the urethra. The tumor is either removed or burnt with the help of a small wire attached at the end of a cystoscope. This process is known as fulguration.
    • Cystectomy: This is a procedure of removal of the bladder and a part of the urethra along with some lymph nodes. This can be performed as an open, minimally invasive, or robotic procedure. This procedure is usually followed by another surgery in order to make a new route for urine to pass out of the body.
    • Radical cystectomy: This is a process of removal of the bladder and any lymph node and nearby organs that have cancer. This surgery is usually done when cancer invades the muscle wall or when there is the involvement of a large part of the bladder.
    • Partial cystectomy: In this procedure, a part of the bladder is removed. Patients with low-grade tumors and involvement of the bladder wall, which is limited to one area only, are usually considered for this procedure. Because only one part is removed, the patient does not have any problem while urinating. This process is also called segmental cystectomy.
    • Urinary diversion: The process of making a new path for the body to store and pass urine is known as Urinary diversion.

Treatment depending on the stage of the cancer

  • Stage 0 or 1: The tumor is surgically removed. Post-surgery, chemotherapy or immunotherapy is started.
  • Stage 2 and 3: These stages can be treated differently depending upon the size of the tumor. Treatment at this stage can be done either way:
    • Part of the bladder is removed, and chemotherapy is started.
    • Whole bladder is removed, followed by surgery to create a new way for urine to exit from the body.
    • Before the surgery, chemotherapy, radiation therapy or immunotherapy is done to shrink the tumor. Chemotherapy and radiation therapy are also used in cases where surgery is not an option and also used post-surgery to kill the remaining cells.
  • Stage 4: At this stage, various combinations of treatments are used to get the best result. Treatment at this stage can be done either way:
    • Chemotherapy is done to relieve the symptoms and extend life of the patient.
    • Radical cystectomy and removing the surrounding lymph nodes, followed by the surgery for creating a new way for urine to exit the body.
    • Chemotherapy, radiation therapy, and immunotherapy are done after surgery to kill the remaining cells.

What happens after the surgery?

You may have to stay in the hospital for 5 to 6 days. This is the time where your body is in the recovery phase. You may experience some complications like shivering, sore throat, sleepiness, nausea, vomiting, etc. These may last for a few days but will eventually subside. You may also experience pain and discomfort around the incision that will gradually heal. Before leaving for the home, discuss with your doctor about the medications and other ways to improve your comfort.

What is the survival rate of bladder cancer?

The survival rate of the patient depends on the factors like type and stage of cancer.

  • 5-year survival rate for patients with Stage 0 bladder cancer is 98%.
  • 5-year survival rate for patients with Stage 1 bladder cancer is 88%.
  • 5-year survival rate for patients with Stage 2 bladder cancer is 63%.
  • 5-year survival rate for patients with Stage 3 bladder cancer is 46%.
  • 5-year survival rate for patients with Stage 4 bladder cancer is 15%.

Treatments for all stages are available. Also, survival rates don’t always predict your future. It is always advisable to discuss with your doctor about the diagnosis and best treatment option available.

How to keep a check on reoccurrence?

Bladder cancer has a high chance of recurrence even if it is superficial. Tests that were done initially to diagnose cancer will be done frequently to monitor the cancer status after treatment. Any change in the reports may trigger the need to devise a new treatment plan.

Tips for prevention

There is no way that can assure the prevention of bladder cancer. There are certain factors that can help in reducing the risk of it:

  • Avoid smoking.
  • Limit exposure to certain chemicals like chemicals used in dyes, etc.
  • Drink plenty of water.
  • Eat fruits and vegetables (eating healthy strengthens the immune system).

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