10 Jul Bladder Cancer
Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
Bladder cancer is a form of cancer that develops in the lining of the bladder. The bladder is a hollow, muscular, balloon-shaped organ with an elastic muscular wall that allows it to get larger or smaller.The bladder is located in the lower part of the abdomen (pelvis), and is part of the urinary system, the body’s system that filters waste products out of the blood and makes urine. The bladder’s role is to store urine until it is ready to be eliminated from the body. Bladder cancer begins in the cells. Normally, the cells grow and divide to produce new cells only when the body needs them. In some cases, this process is impaired and new cells form (the already existing cells divide uncontrollably) when the body does not need them, causing a tumor to form.
There are two types of tumors:
benign (term that refers to a tissue growth which is not life threatening, because it does not spread damaging adjacent tissues, structures, and organs) and
malignant (a term that refers to a cancerous mass or growth which can invade and destroy adjacent tissues and organs inside the body causing death). Bladder cancer is successfully treated with minimal side effects if detected in the early stages. When the cancer is more advanced, it is difficult to treat and involves extensive procedures.
Signs and Symptoms
Bladder cancer can be asymptomatic in its early stages. However, the most common symptoms include:
- Blood in urine (hematuria). This is the most common symptom. Approximately, 4 in 5 patients with bladder cancer have blood in their urine.
- Pelvic pain
- Urination pain
- Burning sensation during urination
- Frequent urination
- A feeling of incomplete bladder emptying
- Feeling the need to urinate without being able to do so
Most of these symptoms can be caused by other medical conditions (such as urinary tract infections, kidney disease, kidney or bladder stones, prostate problems) and only a doctor can establish a correct diagnosis.
Bladder cancer is classified according to three main criteria:
- The cell’s type where the cancer starts.
- Transitional cell carcinoma: This type of cancer develops in the innermost tissue layer of the bladder called transitional epithelium or urothelium. About 99 percent of all bladder cancer cases are transitional cell carcinoma. The cells that form the transitional epithelium are able to stretch when the bladder is full and shrink when the bladder is empty.
- Squamous cell carcinoma: This is a type of cancer that starts in the flat cells (called squamous cells) that may form in the bladder after-long term infections or irritations.
- Adenocarcinoma: This type of cancer develops in the glandular cells that may form in the bladder after a long-term inflammation or irritation.
- The cancer extent (how far the cancer has spread).
- Superficial bladder cancer: Cancer that is confined to the lining of the bladder.
- Invasive bladder cancer: Cancer that has spread either to the muscle wall of the bladder, or to adjacent organs or lymph nodes.
- The tumor’s growth pattern.
- Papillary tumors: This is a wart-like or mushroom-like, non-invasive tumor that has a short stem attached to the lining of the bladder.
- Nonpapillary tumor: This is a less common, invasive type of tumor that is hard to be treated.
Medical Tests & Diagnosis
Anamnesis (detailed medical review of past health state): One of the first steps in establishing a bladder cancer diagnosis is a detailed and complex medical review of a patient’s past health problems and general health state, family medical history, bladder cancer risk factors, and symptoms.
Physical examination: The doctor will examine the patient internally for signs of bladder cancer.
Urine cytology: A sample of urine is examined under microscope to check for abnormal cells. The main disadvantage of this test is that it can miss low-grade cancer.
Urinalysis: This test checks the urine color and measure its components such as sugar, proteins, red and white blood cells.
Tumor marker tests: These are urine tests that measures the level of the substances released by the tumors (called tumor makers).
Cystoscopy:This is the most common and reliable test used to detect bladder cancer. During this test, a thin tube with a camera attached at one end (cytoscope) is inserted into the bladder through the urethra to examine the inside walls of the bladder.
Computed Tomography (CT): This imaging test is similar with an x-ray test, and creates a detailed cross-sectional image of the body. This test can identify abnormal mass tissues.
Magnetic Resonance Imaging (MRI): An MRI is an advanced technique that uses radio waves and strong magnets to reveal a complete image of a targeted area of the body.
Chest X-ray: An x-ray test uses high energy electromagnetic radiation to penetrate the body and creates its image on a film. The chest x-ray is performed only in women with advanced stages of bladder cancer in order to establish whether or not the cancer has spread to the lungs.
Bone Scan: This test is used to detect if the cancer has affected the bones.
Intravenous Pyelogram (IVP): This imaging test is an x-ray of the urinary tract.
Fluorescence In Situ Hybridization (FISH): This is a cytogenetic technique (the study of the structure of chromosome material) used to detect and localize the presence of certain chromosomal abnormalities often found in transitional cell cancer.
Ultrasound Scan: Ultrasound imaging is a medical technique that uses high-frequency sound waves to create an interior image of the body on a special computer screen. This image is formed from the echoes of the sound waves on the surface of the organs. Abnormal tissue masses and organs reflect sound waves differently.
Biopsy:Biopsy is a medical procedure where a tissue sample is removed from the tumor or abnormal looking surface of an organ for a microscopic examination. In bladder cancer patients, the biopsy is removed during cystoscopy.
There are several types of treatment available for bladder cancer patients. The treatment varies from patient to patient and takes in consideration certain factors: (1) the tumor type and size, (2) the cancer stage, (3) the cancer extent (how far the cancer has spread) (4) the general health state of the patient, and (5) the patient’s age.
The treatment options for bladder cancer patients include: surgery, chemotherapy, biological therapy, radiation therapy, and photodynamic therapy.
Surgery There are five types of surgeries that can be performed in patients with bladder cancer:
1. Transurethral resection (TUR): This is a type of surgery where the tumor is removed with a small wire loop while any remaining cancerous cells are burned with an electric current.
2. Segmental cystectomy: This is a type of surgery where part of the bladder is removed together with the tumor.
3. Radical cystectomy: This is a type of surgery where the entire bladder is removed together with adjacent lymph nodes, part of the urethra, the prostate gland, seminal vesicles (which produce part of the fluid in the semen), and part of the vas deferens (a duct that carries sperm from the testes tubes to the ejaculatory duct) in men, and ovaries, fallopian tubes, and part of the vagina in women.
4. Bladder reconstruction surgery: This is a type of surgery where a new bladder is made, after the cancerous bladder is completely removed.
5. Urostomy: This is a type of surgery where a new draining urinary channel is built.
Chemotherapy Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them.
Radiation Therapy or Radiotherapy Radiation therapy or radiotherapy uses high-energy rays or particles to destroy cancerous cells.Radiation therapy can be administrated in two ways to the bladder cancer patients:
External radiation therapy: This form of radiation therapy uses a device called a linear accelerator that generates an external beam that is concentrated on the tumor area and breaks it up into smaller pieces. Sessions last between 10 and 15 minutes and are administered every day for 4 to 7 weeks. Internal radiation therapy or brachytherapy: The radiation is administrated from radioactive materials such as seeds, by a capsule inserted into the tumor or through thin tubes or wires inserted into the tumor.
Biological Therapy or Immunotherapy This is a systemic type of treatment (affects cells throughout the entire body) used to improve the body’s natural defenses.
Photodynamic Therapy This is a cancer treatment that involves two steps. First, the patient receives a special drug that is absorbed mostly by the cancerous cells. Then, the cells are exposed to a light from a laser which makes the drug active. This way, only the cancerous cells are destroyed or severely damaged.