BLADDER CANCER

When cells in the bladder become abnormal and start to grow without control, over time, a tumor forms there, which is referred to as bladder cancer. Even though doctors are not sure about bladder cancer causes, risk factors do play their role. Bladder cancer symptoms include blood in urine, painful urination. Bladder cancer treatment in most cases includes a combination of the following options: surgery, chemotherapy and radiation. More detailed information about this condition, symptoms it causes, diagnostic services and bladder cancer treatment options, is presented below.

Bladder cancer often starts in the cells of your bladder lining. It typically occurs in older patients but can occur at any age.
bladder cancer; bladder cancer causes; Bladder cancer symptoms; Bladder cancer treatment

BLADDER CANCER CAUSES AND RISK FACTORS

It is unclear what causes bladder cancer but it has been linked to smoking, parasitic infections, radiation and chemical exposure. Most of the time, bladder cancer is detected in the early stages and are enclosed in the epithelial lining of the bladder. The solution to cure the condition is endoscopic removal and all that’s required is regular monitoring with cystoscopy to detect any recurrences.

Bladder cancer that has affected the muscular wall of the bladder are more aggressive and without definitive surgical treatment, it will spread quickly to the lymphatic system and nearby organs.

Once that happens, the only effective cure is to radically remove the entire bladder and the surrounding lymph nodes and provide diverting of urine outside of the body either through an artificial conduit using a loop of intestines or fashioning a new pouch from intestine (neobladder).

Patients with muscle invasive bladder cancer (MIBC) find it difficult to agree to proceed with surgery as they find it hard to accept the loss of natural functions of their bladder and the fact that they will wear a permanent pouch for urinary diversion. Many patients start to deny the suggested plan and do no follow up with their doctors after diagnosis and in turn lose valuable time and the chance for curative surgery.

BLADDER CANCER SYMPTOMS

The signs and symptoms for bladder cancer are:

  • Presence of blood in urine (hematuria)
  • Frequent urination
  • Painful urination
  • Pain in back
  • Pain in pelvic

BLADDER CANCER TREATMENT OPTIONS

When bladder cancer is confirmed, the treatments include:

Radical cystectomy

The removal of the entire bladder and nearby lymph nodes is necessary. Male patients will also have their prostate removed as bladder cancer has been known to reoccur in this area. For women, the removal of the womb and ovaries is necessary. Over the last ten years, there has been established three significant advances in muscle-invasive bladder cancer, which helped to improve the outcomes:

  • Neoadjuvant Chemotherapy for MIBC: Over the past decade, medical scientists have come to a conclusion that a combination of chemotherapy containing cisplatin with MIBC increases overall survival rate by five to eight percent. Receiving chemotherapy before surgery instead of after operation means that it is delivered at the earliest point in time where the burden of the micro metastasis is at its lowest and the cancer cells are most sensitive to treatment. It also helps to reduce the residual tumor as well as decrease positive margins and lymph node involvement. Unless the patient has impaired kidneys or overall function, neoadjuvant chemotherapy is routinely recommended before radical surgery by most international guidelines.
  • Extended Pelvic Lymph Node Dissection during Radical Surgery: Lymph nodes can be found throughout the body. They serve as police stations that filter and trap harmful particles like infections and cancer cells and are jam-packed with defence cells known as lymphocytes or macrophages. Bladder cancer cells usually spread to pelvic lymph nodes around the bladder first in MIBC patients. Surgeons have been aggressively extending the removal of lymph nodes during surgery with curative intent over recent years. Most published studies have shown that patients with lymph node dissection performed at the time of surgery have demonstrated improved survival and reduced cancer recurrence.
  • Robotic-Assisted Surgery to Remove the Bladder: In curative surgery for MIBC, it involves the removal of the bladder, prostate (men), womb and ovaries (women), extended removal of the surrounding lymph nodes and reconstructing the urinary tract with urinary diversion through an artificial conduit or a pouch (orthotopic neobladder). This is a challenging surgery that is routinely performed through a lower midline incision under general anaesthesia. It is also often linked to significant blood loss and need for blood transfusion.  Urologists have been developing new techniques to perform the same surgery through small incisions using the da Vinci® surgical robot in recent years. This will allow better vision and dexterity during surgery which will result in less blood loss and perioperative complications, faster recovery of the bowel function and shortened hospitalisation. Recent studies have shown that it is safe to perform this surgery on older patients above seventy. (widely attributed to less blood loss) There is an increasing number of centres worldwide adopting this technique to deliver improved outcomes.

Chemotherapy

This treatment option involves the usage of drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually required a combination of two or more chemo drugs to increase the success rate.

Doctors usually suggest to consider having a course of chemotherapy before the surgery to remove bladder to increase the chances of curing the cancer. Chemotherapy may also be used to kill cancer cells that might remain after surgery.

Radiation therapy

Radiation therapy applies high-energy beams aimed at the tumor to destroy the cancer cells. Radiation therapy for bladder cancer is usually delivered with the help of a machine that moves around the body, directing the radiation beams to precise points.

In some cases, usually when bladder cancer is advanced, radiation therapy may be combined with chemotherapy as an alternative to surgery or when a patient is not suitable for surgery.

DIAGNOSING BLADDER CANCER

When it comes to diagnosing bladder cancer, there are multiple procedures and tests that are used. They include:

  • Cystoscopy: A cystoscope (narrow tube) is inserted through the urethra, it has a lens and a fibre-optic lighting system that enables the doctor to see and examine inside the urethra and bladder.

    • bladder cancer diagnosis

  • Urine cytology: Urine sample is observed under a microscope to check for cancer cells.
  • Uroflowmetry: The patient may be asked to pass urine into an uroflowmeter so that the volume and speed of the urination can be measured electronically and the flow rate is calculated as millimetres or urine passed per second.
  • Post-void Residual Urine Volume: A screening test used for the measurement of the residual urine left in the bladder after voluntary void.
  • Imagining tests: This is helpful when examining the urinary tract structure. These tests include intravenous pyelogram (a type of X-ray that involves using dye) and CT scan.