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BLADDER CANCER

The bladder an organ, located in the pelvis, is part of the urinary system that stores urine. Bladder cancer is an uncontrollable growth of normal cells in the lining of the bladder. 

Bladder cancer is also one of the most common form of cancer. It is more common in men in comparison to women. According to research, the prevalence of bladder cancer in Africa was 7.0. for over 100,000 male population. On the other hand, this incidence is 1.8 for 100,000 women. Based on this research, we can conclude that bladder cancer is growing rapidly in the region. 

Types of Bladder cancer

Experts classify bladder cancer based on how the cells appear under a microscope. The type of bladder cancer decides the treatment strategy. Some of the bladder cancers respond to radiation. On the other hand, some may respond to chemotherapy. Some of the common types of bladder cancers are 

Transitional cell carcinoma

Transitional cell carcinoma also called urothelial cancer, is one of the common types of bladder cancer. It starts from the inner layer of the bladder. This type of cancer involves transitional cells. These types of cells can change their shape. This alteration does not damage the cells even when the tissues expand. 

Squamous cell bladder cancer

Squamous cell carcinoma is a rare type of bladder cancer. It involves squamous cells. These cells are thin and flat in shape.  This type of cancer infection is more common in areas where a parasitic infection (schistosomiasis) is the common cause of bladder infections. 

Adenocarcinoma

This is also another rare type of cancer. It starts in the mucus producing cells that line the bladder and is usually invasive.

 However, there are some bladder cancers that involve more than one cell type.

Symptoms of Bladder Cancer

People with bladder cancer can have urine in their blood. Feeling pain is not necessary for some patients. Many symptoms are an indication of bladder cancer. This includes weakness, loss of weight. Moreover, in advanced cases, there may be tenderness in bones. There are certain symptoms that one must pay particular attention to 

  • Blood in the urine. 
  • Pain when passing urine. 
  • Frequent need to urinate. 
  • Feeling of urgency to urinate. 
  • Urinary incontinence. It means that the patient may lose control of their bladder. 
  • Pain in the abdominal area. 
  • Pain in the lower back. 

Causes of Bladder Cancer

The leading cause behind bladder cancer is the abnormal growth of cells in the bladder. Cells grow and divide in an order. However, in cases of bladder cancer, their multiplication gets out of control. This imbalance of the normal cell process may form a tumor.  

Smoking and Use of Tobacco

Smoking makes a person more prone to developing bladder cancer. People with highest risk are those who have started smoking from a young age and also those that smoke a lot.

Chemical Exposure

This involves working in jobs that could expose you to dangerous chemicals.  Some of the chemicals that may cause bladder cancer include 

  1. Arylamines
  2. Aniline Dye
  3. Phenacetin
  4. Cyclophosphamide
  5. Arsenic
Some parasitic infections
Bladder cancer may be linked to a inherited faulty gene though this is quite rare.
Being overweight can increase your chances of getting cancer
Past radiation exposure to the bladder

Diagnosis

There are several ways to diagnose bladder cancer:

Physical Examination

The doctor may physically examine the bladder. Physical examination helps to find if there is any  growth in the bladder. Further tests will then be carried out to check the nature of the tumor.

Urine Tests 

A test called urine cytology is carried out to analyse urine under a microscope to check for cancer cells. This is a type of non–invasive technology. It has a high sensitivity to high–grade tumors. However, it has low sensitivity for low–grade tumors.  

Cystoscopy 

It involves inserting a narrow tube called a cystoscope through the urethra to have a clear view of the urethra and bladder. This test has low sensitivity, which means that it cannot detect minor abnormalities. Because of this, doctors may miss bladder cancer. 

Biomarkers 

Experts also suggest urine–based biomarkers. It is an alternative and non-invasive technology. The biomarkers also have high sensitivity and are also specific to bladder cancer. The urinary biomarkers are directly in contact with the bladder. The presence of these biomarkers is a strong indication of bladder cancer.  

Imaging tests

Your physician can use imaging tests like CT urogram to examine inside the urinary tract.

Staging

The system used to classify bladder cancer is the tumor node metastases (TNM) system. International Union Against Cancer (IUCC) developed the system in the year 1997. The American Urologic Association (AUA) has also had the same staging system. Doctors use a combination of both systems.  

The T-stage in the classification refers to the depth of penetration. The T stage is as follows 

  • Tx: This is a type of primary tumor. Evaluation of this type is difficult 
  • To: There is no primary tumor 
  • Ta: This is a non-invasive type of papillary carcinoma. In this type of tumor, the cancerous cells remain limited to the innermost lining. 
  • Tis: This is a type of flat tumor. The other name for this type of tumor is Carcinoma in situ 
  • T1: In this type, the tumors invade under the epithelium. 
  • T2: In this type, the tumor invades the bladder muscles. This type is further subdivided into two types; T2a and T2b. T2a refers to the type that affects the inner half of the muscles. T2b refers to the type that affects the outer half.  
  • T3: In this type, the tumor invades the fatty tissues around the bladder. T3a is only visible upon microscopic examination. T3b is visible even without a microscope. 
  • T4: In this type, the tumor spreads to other parts such as the vagina, uterus prostate, and others.  

The second classification is dependent on the involvement of the lymph nodes. It is the N classification 

  • Nx: Evaluation of lymph nodes in this region is not possible. 
  • No: No metastasis is observed in the lymph nodes of the region. 
  • N1: Metastasis in the regional lymph nodes is less than 2 centimeters 
  • N2: Metastasis in the regional lymph nodes is between 2 to 5 centimeters in size. 
  • N3: Metastasis in the regional lymph nodes is more than 5cm in size. 

M stage classification helps in evaluating the tendency of metastasis in the bladder cancer 

  • Mx: Evaluation of metastasis is not possible. 
  • Mo: There is no metastasis. 
  • M1: Distant metastasis is present

Treatment

The treatment of bladder cancer depends on all factors. Treatment strategies depend on the grades of cancer. The doctor may even consider your health.  

Surgery

Surgery is used to remove the  cancerous tissues from the bladder.  

Intravesical chemotherapy

This is the other name for chemotherapy in the bladder. It helps in the treatment of bladder cancer that is limited to the lining and have a high chance of recurring.

Reconstruction

In certain cases, the doctor may have to remove the entire bladder surgically. Reconstruction surgery may help in forming a canal to excrete urine. 

Chemotherapy

This is a type of systemic chemotherapy. It is especially applicable to a patient wherein cancer spread to other organs of the body. 

Radiation 

Radiation therapy focuses on high-energy rays on the bladder. It destroys the cancerous cells.

Immunotherapy

This is used to trigger the body’s immune response to fight cancer cells in the body

BCG Vaccine 

Bacillus Calmette Guerin vaccine is helpful for the treatment of tuberculosis. Studies show that it helps in decreasing the recurrence of the disease. Moreover, it also helps in slowing down the progress of the disease.  

REFERENCES 

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