Bladder Cancer: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Outlook and Prevention

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A CT Scan for Bladder Cancer

1Overview

Each year, there are 68,000 males in the United States of America that are affected by bladder cancer. It can occur at any age but this happens mostly in older adults especially in men than in women.

When the cells of the bladder uncontrollably grow and do not die, bladder cancer starts to develop. Normally, the cells in the body follow the same growth process, cell division and apoptosis or programmed cell death (apoptosis).

If the programmed cell death stops, cancer starts to develop. A tumor can be formed from these cancer cells as they grow and spread to different parts of the body. This tumor or mass can be benign, meaning it can grow but will not invade the surrounding tissue or can also be cancerous which grows uncontrollably and invades distant parts of the body.

The bladder, a hollow muscular organ in the pelvis, stores urine before it leaves the body. The kidney makes urine that is carried to the bladder through the ureters (duct by which urine passes). When an individual urinates, the bladder contracts and urine is forced out of the bladder through the urethra, a tube connecting the bladder to the urinary meatus.

The bladder cancer starts in the urothelium that lines the innermost lining of the bladder.
If it grows through the other layers of the bladder wall, it can be difficult to manage.
But this cancer is highly treatable if it is diagnosed at an early stage. This cancer is most common in the bladder but this can also happen in other parts of the urinary tract drainage system. For a period of time, cancer might spread to the lymph nodes and other parts of the body like the bones, the lungs or the liver.

2Types

The different types of bladder cancer are the following:

Urothelial carcinoma or Transitional cell carcinoma (TCC)

This is the most common type of bladder cancer that begins in the urothelial cells lining inside the bladder. Clients with bladder cancer can sometimes have tumors in other parts of the urinary tract like ureters and the urethra.

Adenocarcinoma

This type of bladder cancer develops from glandular cells and has similar features with the gland-forming cells of colon cancers which are also invasive.

Small cell carcinoma

This is a rare type of bladder cancer. It starts in neuroendocrine cells and grows quickly and need chemotherapy as a form of management or treatment.

Sarcoma

Sarcoma is an unusual type of bladder cancer that begins in the muscle cells of the bladder.

Squamous cell carcinoma

This progresses in the lining of the bladder in response to an inflammation or an irritation. In this type of bladder cancer, the cells look like flat cells found on the surface of the skin and are considered to be invasive which are more likely to spread and difficult to treat.

3Symptoms

The signs and symptoms of bladder cancer are:

  • Hematuria or blood in the urine (bright red or cola in color)
  • Dysuria or painful urination
  • Pelvic pain
  • Back pain
  • Polyuria or frequent urination
  • Fatigue
  • Incontinence (urine leakage)
  • Weight loss

4Causes

When there is an abnormal growth of the cells in the bladder, these cells may uncontrollably mutate and form a tumor. When the cell death breaks down, it causes now to develop bladder cancer. These tumors are categorized based on how they grow. Papillary tumors are attached to the epithelial layer of the bladder and have a wart-like form; while nonpapillary are flat and more invasive.

5Risk Factors

The following are risk factors that might contribute to developing bladder cancer:

Smoking and tobacco use

There are harmful chemicals that may accumulate in the urine once an individual is smoking cigarettes, pipes or cigars. Some of the harmful chemicals in cigarettes or any other form of tobacco smoking are being processed by the body and some of them are excreted in the urine thus damaging the lining of the bladder.

Age and gender

As you age, the risk of having bladder cancer increases. This can happen at any age but its common in older adults and seldom seen in people younger than 40. Men are commonly affected by bladder cancer than women.

Exposure to certain chemicals especially at workplace

There are several chemicals used in the dye industry that can be linked to bladder cancer. The kidney filters these unsafe chemicals from the bloodstream and moves them into the bladder. These are the benzidine and anta- naphthylamine which is called aromatic amines.

Some harmful chemicals can also be found in industries manufacturing rubbers, textiles, leathers, and paints. So workers working on these areas like the painters, printers, machinists, truck drivers, and hairdressers have an increased chance of contracting bladder cancer.

Arsenic

Found in drinking water have been associated with having an increased risk of bladder cancer in some parts of the world. This chance of exposure depends on where an individual lives and where they get their water either from a public water system (low arsenic content) or from a well.    

Bladder inflammation (chronic)

A repeated cystitis (inflammation of the bladder) or urinary infections due to prolonged use of the urinary catheter may increase the chance of having squamous bladder cancer.

In some parts of the world, squamous cell carcinoma is associated with chronic bladder inflammation caused by schistosomiasis, a parasitic infection whereby the parasitic worm gets inside the bladder.

Prior use of anti-cancer drug for cancer treatment

Cyclophosphamide (Cytoxan), used as an anti-cancer drug, increases the chance of contracting bladder cancer. Drink plenty of fluids if you are using this drug. Those who have prior cancer and have received radiation treatment directly at the pelvis have an increased risk of having bladder cancer.

History of cancer (family or personal)

Although it’s rare for bladder cancer to run in the family, Cowden Disease, mutation of retinoblastoma, and Lynch syndrome (nonpolyposis colorectal cancer) can escalate the risk of developing cancer in the urinary system, colon, ovaries and uterus and other organs. Likewise, if you have had bladder cancer (urothelial cancer), you are more prone again to contract the disease.

Decrease fluid or water intake

Those who have increased fluid intake tend to have lower rates of bladder cancer may be because they empty their bladders frequently which keeps the chemicals from staying in their bladder.

Race and ethnicity

Whites, African and Hispanics have a lower risk of developing the disease than American Indians and Asian Americans. Until now, the reason behind this is still unknown.

6Complications

If untreated early, bladder cancer may spread to pelvic lymph nodes and to other adjacent organs like lungs, liver, and bones. It could also lead to other complications like:

  • Anemia
  • Hydronephrosis or swelling of ureters
  • Urethral stricture or the narrowing of the urethra due to tissue inflammation or scar formation
  • Urinary incontinence

7Diagnosis

Consult your doctor immediately if you have hematuria or other symptoms associated with bladder cancer that worries you.

The doctor may ask questions regarding your past and present medical condition, about your work, habits and even lifestyle. He or she may also perform physical examination together with rectal and pelvic exam to feel for any lumps or to determine causes of bleeding

He may also order the following screening tests:

Urinalysis

This is done to test for some abnormalities in the urine like a presence of blood (haematuria), protein and glucose or sugar. Hematuria may need further evaluation because of its association with bladder cancer.

Cytology

The cells in the inner lining of the bladder slough off in the urine and evacuated from the body during urination. Using a microscope, a sample of urine will be examined for the presence of abnormal cells that might suggest cancer.

Cystoscopy

This is done to examine the inside of the bladder to see if tumors are present.
The healthcare provider inserts the cystoscope (a narrow tube with a light and a camera on the end) into the bladder through the urethra and the camera transmits pictures to a monitor that allows direct viewing of the bladder wall.

Fluorescence cystoscopy or blue light cystoscopy

This is done by placing a light-activated drug inside the bladder where it is absorbed by the cancer cells (fluorescent cells) and these cells will be identified as blue light through the cystoscope.

CT scan

This gives a much greater detail and a 3D view of the bladder. It is done to identify if there are abnormalities and any masses in your bladder, and other parts of the urinary tract and the pelvis.

Magnetic Resonance Imaging (MRI)

This is also used to view the bladder, the kidneys, and ureters. This can be performed without contrast which is much safer for those people who are allergic to dyes and is also suitable in staging bladder cancer.

Biopsy

This procedure requires removal of small samples of the bladder. Tiny tumors are removed through the transurethral resection of bladder tumor (TURBT). The pathologist then examines these samples at the laboratory.

Bone scan

This scan uses a small amount of radioactive substance being introduced into the veins. It will display a full body scan where the bones may have been affected by cancer.

8Treatment

The management or treatment depends on the stages of bladder cancer.

Early Stages

  • Chemotherapy or immunotherapy placed straight into the bladder. The medicine can be delivered into the bladder directly via the Foley catheter. The side effects include bladder wall irritation and dysuria (pain when urinating).
  • Surgery in order to remove the tumor without removing the rest of the bladder

Stage II and III treatments:

  • Chemotherapy is considered to shrink the mass or tumor before surgery and to help avoid the re-occurrence of the tumor.
  • Radical cystectomy, a surgical procedure to remove the entire bladder and adjacent lymph nodes
  • Surgery to remove a part of the bladder, followed by radiation and chemotherapy
  • A combination of radiation and chemotherapy (for  people who cannot have surgery)

Stage IV

At this stage, tumors cannot be cured and surgery is not an option

Chemotherapy is considered but the medicine is usually given intravenously (using the vein).

9Outlook

If the bladder cancer is diagnosed and treated right away, then the prognosis of stage 0 or 1 is good.  If cancer returns back, tumors can be surgically removed and be cured. For stage III, the cure rate is less than 50% and for stage IV, the bladder cancer is rarely cured.

10Prevention

  • Consult the doctor right away if you have experienced hematuria, frequent and painful urination, and if there’s an urgency to urinate.
  • Quit smoking for it can increase your risk for bladder cancer.
  • Avoidance of chemicals that linked to bladder cancer.
  • Avoid exposure to arsenic by having your drinking water tested.