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Bladder cancer

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Overview of bladder cancer

Bladder is the part of the urinary tract that stores urine from the kidneys before excretion. Bladder cancer is a common ‘urologic cancer’. Bladder cancer is a disease in which abnormal cells divide uncontrolably in the bladder. The cells that line the inside of the bladder is usually affected. The onset of the disease occurs at any age but usually affects the elderly. Bladder cancer can be cured if diagonsed at an early stage.

The kind of bladder cancer depends on the type of cell involved like:

Transitional cell carcinoma: The transitional cells line the inside of the bladder. When these cells turn cancerous, it is transitional cell carcinoma.

Squamous cell carcinoma: When the squamous cells of the bladder is exposed to frequent infection and irritation over the time, becomes cancerous. This is the most common type of cancer found in the world.

Adenocarcinoma: When the mucus secreting cell of the bladder turn out to be cancerous, it is called adenocarcinoma.

Apart from this, some kinds of bladder cancers occur with more than one kind of cell being affected.

Occurrence of bladder cancer in different groups

Bladder cancer is the fourth most prevalent cancer in males and eighth most prevalent cancer in females.1 Epidemiological studies suggest that the prevalence rate of bladder cancer varies by country, ethnicity, gender and age. Highest prevalent rates is seen in developed countries. Men have atleast three times more risk than women. Incidence of bladder cancer increases with age. People who are above 65 years of age have a prevalence rate of 110.8 per 100,000 population when compared to youngsters who have a prevalence rate of 6.4 per 100,000 population.2

Signs and Symptoms of bladder cancer

Signs and symptoms of bladder cancer

Causes of bladder cancer

The exact cause of bladder cancer is not known. About 80% of the causes reported were due to environmental exposure. Some of the causes may be:
Change in genetic material
Smoking accouts for 50% risk3
Exposure to chemicals, dyes, paints etc.

Risk Factors for bladder cancer

Major risk factors of bladder cancer are:4,5

  • Some carcinogens like nitrosamine, 2-naphthylamine, and 4-aminobiphenyl present in cigarette smoke
  • Age, risk increases as people get older
  • Males are at more risk than females
  • Exposure to carcinogens
  • Industrial exposure to chemicals like aromatic amines present in dyes, paints, solvents, inks etc.
  • Frequent  bladder infections
  • Diet rich in nitrates and cholesterol
  • Diets low in vitamin A and low serum carotene levels
  • Family history of bladder cancer
  • Exposure to schistosomiasis, a parasitic infection
  • Prior exposure to radiation treatment for ovarian or endometrial cancer

Chemotherapy with cyclophosphamide increases the risk of bladder

Diagnosis of bladder cancer

Diagnosis is based on the symptoms. A thorough physical examination is conducted which includes the following:

  • Examination of the rectum, prostrate for men and pelvic for women
  • Medical history
  • Family history of cancer
  • Urine test
  • Urine culture

Diagnostic tests include:

  • Cystoscopy: In this test, the bladder is visualized using a cystoscope
  • Biopsies: Here, the suspected part is sent for microbiological analysis

Cystoscopy and biopsy help the physician to know about the cancer cells, their size and extent of cancer, spreading of the cells to other parts of the body. Apart from these, the other necessary tests include:

Complete blood count:

To know whether the patient is anemic.

Chemistry screen:

This is a blood test which is done to measure certain parts of  the blood like electrolytes, albumin, bilirubin etc. required to  evalulate kidney, liver and bone functions.

Computed tomography and pelvic ultrasound:

To know the presence of mass near the kidneys, ureter or bladder.

CT scan or MRI scan

This is done to know if the cancer has spread to different parts of the body.

In order to prevent reccurence of bladder cancer, it is important to have regular examinations and cytoscopy.

Molecualr markers and tumor markers like BTA and NMP22 are very helpful in detecting bladder cancer in the early stages.7

Treatment of bladder cancer

Treatment of cancer depends on the ‘grade’ and  ‘stage’ of cancer. Patients are at high-risk of recurrance. About 80% of bladder cancer cases are curable when diagnosed at an early stage.

The goals of the treatment include the following:

  • To reduce the recurrence of the tumor
  • To lower the risk of disease progresssion
  • To improve the survival rate

Treatment involves the following.

Surgery

Surgery is opted in most cases of bladder cancer. If the tumor is small in size and  present near the surface of the bladder (superficial bladder cancer), then it can be burned using a low-voltage electrified probe called electrocautery during a cystoscopy. If large tumor is present near the surface, which have not undergone metastsis can be removed through transurethral resection. Cystectomy is surgical removal of the bladder in advanced stages. Surgery is not suggested to elderly people who have long-term medical condition.8

Radiation Therapy

In this therapy, high energy radiations from radioactive substances are given to the  affectecd parts to destroy the cancer cells.

Biological Therapy

This therapy involves boosting the body’s immume system using medication which is suggested after a transurethral resection to prevent recurrence of cancer.

Complementary Therapy

Along with the standard treatment, complementary treatment like the following can be considered but cannot be substituted.

Acupunture—This is a chinese therapy used to relieve pain.

Dietary supplements—This involves using herbal medicines and natural products which contains vitamins, aminoacids and minerals. It may be in the form of pills, liquid, capsule or tablet.

Biofeedback—This is a relaxation technique or method that uses mind to control the body functions.

Meditation—This helps to keep the mind calm and give clear awarness of life.

Yoga—Yoga helps to improve flexibility and breathing, decrease stress, and maintains health.

Side-Effects

Bladder cancer treatment give rise to a lot of side-effects which are discussed below.

Side effects of chemotherapy include:

  • Loss of hair
  • Mouth sores
  • Diarrhea
  • Vomiting
  • Nausea
  • Loss of appetite
  • Chances of getting infected seriously

Side-effects of surgery

Depends on the stage of the treatment. Men may have erection problem if bladder is removed. An alternate way is made to store and pass urine. A neobladder is constructed which is referred as ‘urinary diversion technique’. This technique involves using a part of the intestine to construct a tube that carries the urine from the ureter to an opening called ‘stoma’ which is outside the body. The stoma is constructed using a procedure called ‘urostomy’.

Treatment of bladder cancer

Prevention of bladder cancer

Cancer cannot always be prevented, as it may affect the person without known reasons. Certain care should surely be taken by changing the lifestyles and increasing the knowledge about cancer causing agents.

The following are some measures which may help us to reduce risk of getting affected with bladder cancer.

  • Smoking cessation, as it contains some carcinogens.
  • Following safety instructions when getting exposed to chemicals.
  • Drinking plenty of fluids especially water, as it removes the toxic substances from the body.
  • Diet with high vitamin A and vitamin C.10
  • Consuming soy proteins, garlic extracts, green tea.
  • Consuming a healthy diet rich in fruits and vegetables.
  • Using antischistosomal agents which inhibits nitrosamine carcinogenesis.11

Living with the bladder cancer

People living with bladder cancer will always have the fear or the stress of recurrence which can be managed by:

  • Regular checkups and cytoscopy
  • Having a mind set to fight the disease when it recurs
  • Talking with bladder cancer survivors

References

1. Dyrskjot L, Zieger K, Orntoft TF. Recent advances in high-throughput molecular marker identification for superficial and invasive bladder cancers. Front Biosci. 2007; 1(12): 2063–2073.

2. Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Cleg L. SEER Cancer Statistics Review, 1973-1997. Bethesda, MD: National Cancer Institute, 2000.

3. Fleshner N, Garland J, Moadel A, Herr H, Ostroff J, Trambert R. Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder. Cancer. 1999; 86(11): 2337–2345.

4. Small EJ, Grossfeld GD. Bladder. In Dollinger M et al. (eds). Everyone's Guide to Cancer Therapy. 2003, 4th edn, pp. 401–411.

5. Messing EM. Urothelial tumors of the urinary tract. In: Walsh PC et al. (eds). Campbell's Urology. 2002, 8th edn, vol. 4, pp. 2732–2784.

6. Pashos CL, Botteman MF, Laskin BL, Redaelli A. Bladder cancer epidemiology, diagnosis, and management. Cancer Practice. 2002; 10(6): 311–322.

7. Black PC, et al. Molecular markers of urothelial cancer and their use in the monitoring of superficial urothelial cancer. J  Clin Oncol. 2006; 24(35): 5528–5535.

8. Lamm DL, Griffith JG, Pettit LL, Nseyo UO. Current prospectives on the diagnosis and treatment of superficial bladder cancer. Urology. 1992; 39(4): 301.

9. Vale CL, et al. Neoadjuvant chemotherapy in invasive bladder cancer: A systemic review and meta-analysis. Lancet. 2003; 361(9373): 1927–1934.

10. Kamat AM, Lamm DL. Chemoprevention of urological cancer. J Urol. 1999; 161(6): 1748–1760.

11. Lamm DL, Riggs DR, Shriver JS, vanGilder PF, Rach JF, DeHaven JL. Megadose vitamins in bladder cancer: A double blind clinical trial. J Urol. 1994; 151(1): 21–26.

Written by: healthplus24.com team

Date last updated: December 24, 2014