The bladder is a hollow organ at the lower part of the abdomen, where the urine collects. Bladder cancer is the second most common neoplasm (tumor) of the genitourinary tract. It occurs 4 times more frequently in men than in women.The most usual type is Transitional Cell Carcinoma (TCC) arising from the transitional epithelium lining the urinary bladder.
Causes – Risk Factors
The exact etiology for the development of bladder cancer is unknown. However, there are some risk factors increasing the chances for its occurrence. For example:
- Advanced age favors the development of bladder cancer; more than 70% of patients are above 65 years old.
- Smoking significantly increases the risk for bladder cancer. Smokers run 2,5 higher risk for developing bladder cancer, compared to non-smokers.
- Exposure to chemicals in the working environment. People working on leather processing, industrial tyres and dyes, as well as truck drivers, run higher risk.
- Chemotherapy with pharmaceutical agents, such as Cyclophosphamide.
- Pelvic radiation (lower abdomen) for the treatment of uterine cervical cancer may increase the risk for bladder cancer.
- Long-term bladder infections, such as infections occurring in patients having permanent urocatheter.
Most times bladder cancer has no noticeable symptoms, other than hematuria. And very often there occurs only one episode of hematuria and from then on the urine appears to be clear. So, the patient forgets it for a long period of time (probably for one whole year) and, when the next episode of hematuria recurs, cancer has already advanced.
Other more severe symptoms of bladder cancer are:
- Abdominal pain
- Weakness - fatigue
- Loss of body weight
- Painful urination
- Urinary frequency/ Urgency
Similar symptoms may also occur in many other diseases.
Once blood appears in the urine, it is imperative to visit the Urologist without any delay.
Diagnosis - Staging
Following clinical examination, your doctor will ask you to undergo some diagnostic tests. These may include:
- General urine test (Urinalysis)
- Cystoscopy (the bladder wall is examined with the use of scope -a special tube with a small camera on the end)
- Urine Cytology Test (for identifying cancer cells)
- Intravenous Urography
- Upper-Lower Abdominal CT scan
- Bladder Biopsy (if necessary, specimen is obtained during cystoscopy)
In case you are diagnosed with bladder cancer, further screening tests will be required for staging the disease (defining its severity degree). Depending on the stage, the physician will decide on the treatment. Bladder cancer is initially classified in two major types, whose treatment is completely different one from the other.
- Superficial or Non-Invasive Bladder Cancer. This type is non-invasive bladder cancer limited to the superficial bladder wall. It is the most common type diagnosed, developing pedunculated lesions in the bladder. Even after surgical removal, new lesions tend to recur very often; therefore, regular follow-up with cystoscopy is necessary for many years.
- Invasive Bladder Cancer. This is the most threatening type of cancer, for it has invaded (spread into) deeper muscle layers of the bladder. This invasion increases the risk for metastasis to lymphnodes or other organs (liver, lungs, bones).
Τhe type of treatment depends on the stage of the disease and the patient's general medical condition.
Treatment of Superficial/ Non-invasive Cancer
Superficial tumors are removed surgically (resected) through the urethra. The procedure is called Transurethral Resection of Bladder Tumor (TURBT). A special scope (resectoscope) is passed through the urethra into the bladder. The tumor is seen through a camera that is placed at the end of the scope and then is cut and removed with a special attachment on the scope. The tumor is totally resected from its base. Specimens obtained are sent for pathologoanatomical examination, so as to identify the depth (stage) of the tumor invasion. In case cancer is found to be superficial, there may be need for adjunctive intravesical chemotherapy or immunotherapy. Intravesical injections are done periodically (e.g. every week or month); the drug is infused (injected) with the use of a fine urocatheter into the bladder and then the catheter is removed.
- Intravesical BCG Immunotherapy (Bacillus Calmette-Guerin vaccine). The most common adjunctive therapy following tumor removal. BCG is composed of weakened forms of bacterial strains providing immunity against cancerous cells. Adverse events of the therapy are urinary frequency, hematuria and, more rarely, fever.
- Intravesical Chemotherapy. It is performed in the same way as Immunotherapy. It presents fewer and milder adverse events than Immunotherapy.
The frequency and duration of intravesical injections will be determined by the therapist physician. Also, a regular follow-up protocol with cystoscopies will be recommended aiming at the early detection of new lesions and their timely resection.
Treatment of Invasive Cancer
- Radical Cystectomy. The whole bladder is removed. Also, in males, prostate and seminal vesicles are removed along, while in females the uterus, appendix and part of the vagina are removed respectively. It is a heavy procedure with long hospital stay required. Following bladder removal, there is need to restore release of urine from the body. This can be done either with its release through the skin (with the use of a sachet) or by creating a new bladder with part of the small intestine. There are many repair versions, each one presenting both advantages and disadvantages. The most appropriate treatment should be decided by both the physician and patient after thorough discussion.
- Systemic Intravenous Chemotherapy. If, during cystectomy, it is detected that lymphnodes have been affected, chemotherapy is imperative. In some cases, it may also have to be administered preoperatively.
- Combined Chemotherapy with Radiotherapy. Following removal of the tumor, combined chemotherapy and radiotherapy are applied, in order to avoid bladder removal. This method is used in patients who refuse or are not allowed by their general medical condition to undergo cystectomy.
After invasive cancer therapy, you should be closely followed up by your therapist physician, so that any potentially occurring complication or recurrence of the disease will be timely treated.