BLADDER CANCER

The bladder is a hollow organ in the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. Bladder cancer happens when normal cells in the bladder change into abnormal cells, and grow out of control.

Bladder cancer is the ninth most common cancer in the world, with 430,000 new cases diagnosed in 2012. In the United States, approximately 81,000 new cases and 17,000 deaths occur each year due to bladder cancer. In Europe, there were an estimated 118,000 cases and 52,000 deaths in 2012.

In Pakistan, urinary bladder cancer is one of the top ten malignancies in men and the most common urological malignancy in both sexes. According to the report of Shaukat Khanum Memorial Trust carried out during Jan 2016 to Dec 2016 which included patients registered at the centers, bladder cancer is found to be the 8th common cancer in males accounting for 5.10%.

A risk factor is anything that changes your chance of getting a disease such as cancer.

• Smoking: Smoking is the most important risk factor for bladder cancer. Smokers are at least 3 times as likely to get bladder cancer as nonsmokers. Smoking causes about half of the bladder cancers in both men and women.
• Workplace exposure: Certain industrial chemicals have been linked with bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, which are sometimes used in the dye industry, can cause bladder cancer.
• Race and ethnicity: Whites are about twice as likely to develop bladder cancer as African Americans. Hispanics, Asian Americans, and American Indians have slightly lower rates of bladder cancer. The reasons for these differences are not well understood.
• Increasing age: Bladder cancer risk increases as you age. Bladder cancer can occur at any age, but it’s rarely found in people younger than 40.
• Being a man: Men are more likely to develop bladder cancer than women are.
• Previous cancer treatment: Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have an elevated risk of developing bladder cancer.
• Chronic bladder inflammation: Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis.

Personal or family history of cancer: If you’ve had bladder cancer, you’re more likely to get it again. If one of your first-degree relatives — a parent, sibling or child — has a history of bladder cancer, you may have an increased risk of the disease, although it’s rare for bladder cancer to run in families. A family history of hereditary nonpolyposis colorectal cancer, also called Lynch syndrome, can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organs.

Bladder cancer signs and symptoms may include:

• Blood in urine (hematuria)
• Painful urination
• Pelvic pain

If you have hematuria, your urine may appear bright red or cola colored. Sometimes, urine may not look any different, but blood in urine may be detected during a microscopic exam of the urine.

People with bladder cancer might also experience:

• Back pain
• Frequent urination

But, these symptoms often occur because of something other than bladder cancer.

Doctors can use different types of tests to look for bladder cancer. These include:

Urine tests: Urine tests can show what kind of cells are in the urine.

X-rays, CT scans, or other imaging tests: These tests create images of the entire urinary tract, which includes the kidneys, ureters, and the bladder. They can show tumors or abnormal growths.

Cystoscopy: Cystoscopy is a procedure that allows the doctor to look directly inside the bladder. To do a cystoscopy, the doctor inserts a small tube into the urethral opening, the opening through which urine leaves the body. Then he or she pushes the tube up into the bladder. The tube has a tiny camera that projects images of the bladder onto a screen. If the doctor sees anything unusual, he or she might take a sample of tissue (called a biopsy) to look at under the microscope.

People with bladder cancer often have 1 or more of the following treatments:

Surgery: Bladder cancer is usually treated with surgery. Depending on how large the cancer is and how far it has spread, doctors can do 1 of 3 things:

• Take out the cancer and leave the bladder in place. In many cases this is done through cystoscopy. Usually this procedure has no impact on the ability to urinate.
• Take out the cancer and a part of the bladder. This option depends on how much of the bladder is involved. After this procedure, people can often urinate normally.
• Take out the cancer, the bladder, and nearby internal organs. This option might be necessary for people with advanced bladder cancer. With this type of surgery, the surgeon also has to create a new way for urine to leave the body, because the bladder has been removed

Medical therapy – Medicines are an important part of treatment for people with bladder cancer. Doctors use different medicines depending on the extent of the cancer.

• For people with very early bladder cancer that has not spread into the bladder muscle (called “superficial bladder cancer”), medicine is given directly into the bladder.
• For people with cancer that invades the bladder muscle, chemotherapy should be given before surgery. This can shrink the cancer and make it easier to remove.
• For people with invasive bladder cancer who did not go through chemotherapy before surgery, chemotherapy can be given once they are healed from surgery.

Radiation therapy: Radiation kills cancer cells.

There is no sure way to prevent bladder cancer, but there may be things you can do that could lower your risk.

• Don’t smoke – Smoking is believed to cause about half of bladder cancer cases among men and women.
• Limit exposure to certain chemicals in the workplace – If you work with a class of chemicals called aromatic amines, be sure to follow good work safety practices. Industries where these chemicals are commonly used include the makers of rubber, leather, printing materials, textiles, and paint products. Aromatic amines are also found in many hair dyes, so it is important for hairdressers and barbers who are exposed to these products regularly to use them safely.
• Drink plenty of liquids – There is some evidence that drinking a lot of fluids – mainly water – might lower a person’s risk of bladder cancer.

Eat lots of fruits and vegetables – Some studies have suggested that a diet high in fruits and vegetables might help protect against bladder cancer, but other studies have not found this. Still, eating such a diet has been shown to have many health benefits, including lowering the risk of several other types of cancer.

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• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68:7.
• Marcos-Gragera R, Mallone S, Kiemeney LA, et al. Urinary tract cancer survival in Europe 1999-2007: Results of the population-based study EUROCARE-5. Eur J Cancer 2015.
• Rafique M, Javed AA. Role of itravenous urography and transabdominal ultrasonography in the diagnosis of bladder carcinoma. Int Braz J Urol 2004; 30: 185-91.
• Mahmood S, Faraz R et al. Annual Cancer Registry Report-2016, of the Shaukat Khanum Memorial Cancer Hospital & Research Center, Pakistan [Internet]. Available from: http://shaukatkhanum.org.pk/wp-content/uploads/2015/06/acrr-2016.pdf [Accessed on 2019 Jan 18)
• http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-risk-factors
• https://www.mayoclinic.org/diseases-conditions/bladder-cancer/symptoms-causes/syc-20356104
• http://www.uptodate.com/contents/bladder-cancer-the-basics?source=search_result&search=bladder+cancer+patient+information&selectedTitle=1~150