Bladder cancer

Bladder cancer – Definition

Bladder cancer is a disease in which cancer cells grow in the bladder. The bladder, which is located in the lower abdomen, is a hollow organ with flexible muscular walls. Its primary function is to store urine until a person is ready to urinate.

Cancer occurs when cells in the body (in this case bladder cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue, called a growth or tumor, forms. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

There are three main types of cancer that affect the bladder. They are named for the type of cell that becomes cancerous:

• Transitional cell (urothelial) carcinoma — accounts for more than 90% of bladder cancers
• Squamous cell carcinoma — accounts for about 4% of bladder cancers
• Adenocarcinoma — accounts for about 1%-2% of bladder cancers

Bladder cancer – Causes

The cause of bladder cancer is unknown. However, several risk factors have been identified.

Bladder cancer – Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing bladder cancer:

• Smoking
• Increasing age: The majority of people with bladder cancer are between 65-85 years old.
• Occupation (due to occupational exposures to certain substances)
  • Those at risk include:
    • Rubber, leather, and textile workers
    • Painters
    • Hairdressers
    • Machinists
    • Printers
    • Truck drivers
    • Petroleum industry workers
• Race: White
• Sex: male
• Genetics
• Chronic bladder inflammation or infection (eg, schistosomiasis, an infection caused by a parasitic worm)
• Personal or family history of bladder cancer
• Chemotherapeutic drugs: cyclophosphamide and ifosfamide
• Exposure to arsenic
• Radiation treatment of the pelvis
• Bladder birth defects
• Chemicals (eg, nitrosamines, benzidine)
• Urinary stones for many years
• In-dwelling catheter for many years
• Bladder diverticuli: an area of weakness in the bladder wall through which some of the lining of the bladder is forced out
• Metastasis from another cancer

Bladder cancer – Symptoms

Symptoms include:

• Blood in the urine (hematuria)
• Frequent urination, or feeling the need to urinate without being able
• Painful urination
• Lower back pain
• Weight loss, bone pain, or abdominal pain in advanced cases

These symptoms may be caused by other less serious health conditions, such as bladder stones or infection. If you are experiencing any of these symptoms, see your physician.

Bladder cancer – Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. During the exam, your doctor will feel the abdomen and pelvis for abnormalities. The physical exam may include a rectal or vaginal exam.

Tests include:

• Urine cytology — a sample of urine is examined under a microscope to look for cancerous or precancerous cells
• Urine culture — a sample of urine is cultured to look for signs of infection (ie, bacteria)
• Cystoscopy — a procedure in which a doctor looks into the bladder through the urethra using a cystoscope (a slender tube with a lens and light)
• Intravenous pyelogram (IVP) — x-rays of the bladder, kidneys, and ureters taken after contrast is injected into the bloodstream
• Computed tomography (CT) scan — a type of x-ray that uses a computer to make pictures of the inside of the bladder and surrounding structures
• Magnetic resonance imaging (MRI) scan — a test that uses magnetic waves to make pictures of the inside of the bladder and surrounding structures
• Ultrasound — a test that uses sound waves to examine the bladder
• Bone scan — a type of gamma-ray that uses a computer and a special gamma-rays detector to make pictures of the bone if metastases are suspected
• Biopsy — removal of a sample of bladder tissue to test for cancer cells

Bladder cancer – Treatment

Once bladder cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what parts of the body. Treatments for bladder cancer depend on the stage of the cancer. The stages of bladder cancer are as follows:

• Stage 0: cancer cells are found only on the surface of the inner lining of the bladder.
• Stage 1: cancer cells are found deep in the inner lining of the bladder; no lymph nodes are involved.
• Stage 2: cancer cells have spread to the muscle of the bladder; no lymph nodes are involved.
• Stage 3: cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder OR possibly to the reproductive organs including the prostate glands; no lymph nodes are involved.
• Stage 4: cancer cells extending outside the bladder to the wall of the abdomen or to the wall of the pelvis without lymph node involvement OR have spread to one or more lymph nodes and other parts of the body.

Treatment options include the following:

Surgery

Surgery involves removal of cancerous cells and nearby tissue. Types of surgery to treat bladder cancer include transurethral resection and cystectomy.

• Transurethral resection — This is done for early stage or superficial bladder cancer. A cystoscope is placed into the bladder through the urethra. At the end of the cystoscope is a small wire loop, which is used to remove cancer cells. Also, fulguration (using electrical current to burn away remaining cancer cells) can be done during this procedure.
• Cystectomy (surgical removal of all or part of the bladder) — This is done when bladder cancer is invasive. Segmental (partial) cystectomy is the removal of part of the bladder, while radical cystectomy is the removal of the entire bladder and nearby lymph nodes. In men, the prostate is usually also removed. In women, the uterus, ovaries, part of the vagina, and the fallopian tubes may be removed as well. When the bladder is removed, a form of urinary diversion must be created to store the urine.

Radiation Therapy

Radiation Therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

• External radiation therapy — Radiation is directed at the tumor from a source outside the body.
• Internal radiation therapy — Radioactive materials are placed near the cancer cells in the bladder through the urethra or through an incision in the abdomen.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including pill, injection, or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. For bladder cancer, chemotherapy is often administered directly into the bladder, called intravesical chemotherapy.

Biologic Therapy (Immunotherapy)

Biologic therapy is the use of the body’s immune system to fight cancer. Substances made by the body or in a laboratory are administered directly into the bladder to help boost, direct, or restore the body’s defenses against the cancer. This type of therapy is used only for superficial low-grade cancers that have been resected transurethrally.

Bladder cancer – Prevention

The following steps can reduce your risk of getting bladder cancer:

• Don’t smoke or use tobacco products. If you do, quit.
• Avoid or minimize occupational exposure to certain chemicals; follow good work safety practices.
• Eat a diet rich in fruits and vegetables.
• Avoid excess intake of high fat or high cholesterol.
• Minimize the use of phenacetin, a medication.