Bladder Cancer

Bladder cancer, as the name indicates, originates within the cells that lines the urinary bladder. According to latest estimates, about 50% of the bladder cancer cases are diagnosed at an early stage where treatment is possible. It is also noteworthy that 90% of the bladder cancer cases are found in people aged above 55 years or more, which aggravates the risk of morbidity and mortality. Men are generally at greater risk of developing bladder malignancy as compared to women.

Clinical Varieties Of Bladder Cancer

The most commonly frequently reported variety of bladder cancer is transitional cell carcinoma (TCC) as it originates within the urothelial cells that lines the interior of bladder. TCC may be invasive or non-invasive depending upon the degree of distant spread (or metastasis). Invasive cancer may spread to the muscle layer rather than being confined to the bladder epithelium and it is also very difficult to treat.

TCC may be further classified as:

• Papillary carcinomas: This is a non-invasive variety and have a minimal risk of distant spread.
• Flat carcinomas: This is also a non-invasive variety and in most cases cancerous mass remain confined to the inner layer of the bladder.

Other rare types of cancers that originates in the bladder include:

• Squamous cell carcinoma
• Small cell carcinoma
• Sarcoma
• Adenocarcinoma

What Causes Bladder Cancer?

Following are some common risk factors that may trigger bladder cancer development:

• Smoking
• Severe bladder infection
• Exposure to chemicals like aromatic amines
• Family history of bladder cancer
• Reduced fluid intake

• Radiation and chemotherapy
• Defects in the bladder from birth
• People working as truck drivers, hairdressers, mechanists and painters or people working in rubber, leather or textile industries are also at risk because of occupational hazards
• Arsenic present in the drinking water may also serve as a contributing risk factor

Symptoms Of Bladder Cancer

Symptoms of bladder cancer are usually associated with urination. Given below are some classic signs and symptoms of bladder malignancy:

• Hematuria; onset of blood in the urine; may be concealed or gross (visible discoloration of urine)
• Altered patterns of urination
• Weight loss
• Back pain
• Swollen feet
• Bone pain
• Loss of urinary stream
• Dysuria

Treatment And Diagnosis Of Bladder Cancer

After thorough physical examination and medical history, the doctor may recommend following diagnostic tests:

• Cystoscopy: A cystoscope is used to examine the interior of your urinary bladder. Usually a local anesthetic is given while carrying out this test.
• Imaging tests: These tests help in pinpointing the cancer metastasis. Following imaging tests may also be done:

• Pyelogram
• Computerized tomography (CT scan)
• Ultrasound

• Urine tests: Urine examination may be done via following urine tests:

• Urine cytology
• Urine culture
• Urine tumor marker test

• Biopsy: biopsy helps in determining the invasiveness of cancer and its grade.

Treatment Approaches

There are four approaches to treating bladder cancer which may also be used in a form of combination therapy; these are:

• Surgery: it is a common treatment approach and the main aim of surgery is to remove the tumor cells
• Chemotherapy: it involves the use of drugs that target the cancer cells and kills them. However, it causes many adverse reactions like loss of hair, bruising, mouth sores etc.
• Biological therapy: Also referred to as immunotherapy; its main target is to boost the body’s natural immune system to fight against the cancer.
• Radiation therapy: it employs the use of radiations to kill the cancer cells particularly in invasive cancer.

References

• Witjes, J. A., Compérat, E., Cowan, N. C., De Santis, M., Gakis, G., Lebret, T., ... & Sherif, A. (2014). EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. European urology, 65(4), 778-792.
• Burger, M., Catto, J. W., Dalbagni, G., Grossman, H. B., Herr, H., Karakiewicz, P., ... & Lotan, Y. (2013). Epidemiology and risk factors of urothelial bladder cancer. European urology, 63(2), 234-241.