Bladder Cancer Treatment

Treatment for bladder cancer comprises a variety of strategies depending on the stage of the cancer and severity. Radiation therapy is often utilized for targeting cancers, immunotherapy or chemotherapy is used to kill tumor cells, and surgery is used to remove tissues that are cancerous. While a radical cystectomy (removal of the bladder) or urinary diversion Bladder Cancer Treatment may be required in later advanced situations, transurethral removal of the bladder tumor (TURBT) may be sufficient in earlier stages. Bacillus Calmette-Guérin (BCG) injections into the urinary tract are a frequent immunotherapy medication. Customized Bladder Cancer Treatment strategies are developed taking into account the patient's overall wellness as well as the size and location of the tumor. Sufficient oversight and investigation are necessary for efficient management. 

Symptoms of Bladder Cancer

1. Blood in the Urine (Hematuria)
   • The most common symptom of bladder cancer is blood in the urine.
   • The urine may appear pink, red, or dark brown.
   • Sometimes, the blood is not visible to the naked eye and can only be detected through a urine test.
   • Even if the blood comes and goes, it’s important to see a doctor.
2. Frequent Urination
   • People with bladder cancer may feel the need to urinate more often than usual.
   • This symptom can occur even if you have not consumed a lot of liquids.
3. Painful Urination (Dysuria)
   • Pain or a burning sensation during urination is another possible symptom.
   • This discomfort is often mistaken for a urinary tract infection, but if it persists, it could be a sign of bladder cancer.
4. Urgent Need to Urinate
   • There might be a sudden, urgent need to urinate, even if the bladder isn’t full.
   • This can happen frequently and may be uncomfortable.
5. Difficulty Urinating
   • Some people with bladder cancer experience difficulty starting the urine stream or feel like their bladder isn’t completely empty after urinating.
6. Pelvic Pain
   • Pain or discomfort in the lower abdomen or pelvic area may occur.
   • This pain can vary in intensity and may feel dull or sharp.
7. Back Pain
   • Pain in the lower back, especially on one side, can be a symptom if the cancer has spread to the surrounding tissues or organs.
8. Unexplained Weight Loss
   • Sudden, unexplained weight loss can sometimes be associated with bladder cancer, especially in advanced stages.
9. Fatigue
   • Feeling unusually tired or weak without a clear reason can also be a sign, especially when combined with other symptoms.
10. Swelling in the Legs
    • In advanced stages, bladder cancer can cause swelling in the legs due to a blockage in the lymphatic system.

Causes of Bladder Cancer

Bladder cancer occurs when abnormal cells in the bladder grow uncontrollably, forming a tumor. Several factors can increase the risk of developing bladder cancer. Here are the main causes:

1. Smoking
   • Smoking is the biggest risk factor for bladder cancer. Harmful chemicals in tobacco smoke enter the bloodstream and are filtered by the kidneys into the urine. These chemicals damage the bladder lining, leading to cancer over time. Smokers are several times more likely to develop bladder cancer than non-smokers.
2. Exposure to Harmful Chemicals
   • Certain chemicals used in industries like rubber, leather, textiles, and dye manufacturing can increase the risk of bladder cancer. These chemicals, known as carcinogens, can enter the body through inhalation or skin contact and eventually reach the bladder, where they can cause damage.
3. Chronic Bladder Infections
   • Long-term bladder irritation, often caused by chronic infections or conditions like bladder stones, can increase the risk of bladder cancer. This is especially true for a specific type of bladder cancer known as squamous cell carcinoma.
4. Age and Gender
   • Bladder cancer is more common in older adults, usually affecting people over 55. Men are also at a higher risk than women, possibly due to higher rates of smoking and occupational exposure to harmful chemicals.
5. Family History
   • A family history of bladder cancer can slightly increase your risk. This may be due to inherited genetic mutations or shared environmental factors.
6. Previous Cancer Treatments
   • Certain cancer treatments, like chemotherapy or radiation therapy to the pelvic area, can increase the risk of developing bladder cancer later on. Some chemotherapy drugs, such as cyclophosphamide, are known to increase this risk.
7. Arsenic in Drinking Water
   • Long-term exposure to arsenic in drinking water has been linked to a higher risk of bladder cancer. This is more common in certain parts of the world where arsenic levels in water are high.
8. Diet and Fluid Intake
   • A diet low in fruits and vegetables and insufficient fluid intake may increase bladder cancer risk. Drinking plenty of water helps dilute harmful substances in the urine, reducing their contact with the bladder lining.

Types of Bladder Cancer

Bladder cancer is categorized into several types based on the cells where the cancer starts. Here are the main types:

1. Urothelial Carcinoma (Transitional Cell Carcinoma): Urothelial carcinoma is the most common type of bladder cancer, causes almost 90% of cases. Urothelial Carcinoma originates in the urothelial cells, which line the bladder. These cells can change shape and stretch to hold urine. Urothelial carcinoma can be either non-invasive or invasive. Non-invasive cancers stay within the bladder lining, while invasive cancers grow deeper into the bladder wall and can spread to other parts of the body.
2. Squamous Cell Carcinoma: Squamous cell carcinoma starts in the squamous cells, which are thin, flat cells lining the bladder. This type of cancer is less common and often linked to chronic irritation or infection, such as long-term bladder infections or bladder stones. It is more prevalent in regions where schistosomiasis (a parasitic infection) is common. This type tends to be more aggressive and may spread more quickly than urothelial carcinoma.
3. Adenocarcinoma: Adenocarcinoma begins in the glandular cells of the bladder, which produce mucus. This type of cancer is rare and may develop in the bladder’s mucus-producing glands. It can be more challenging to treat because it may not respond as well to standard treatments.
4. Small Cell Carcinoma: Small cell carcinoma is a rare and aggressive type of bladder cancer that starts in the neuroendocrine cells of the bladder. This type is similar to small cell lung cancer and tends to spread rapidly to other parts of the body. Bladder Cancer Treatment often requires a combination of chemotherapy and radiation therapy.
5. Sarcoma: Sarcoma of the bladder is extremely rare and originates from the connective tissues, such as muscles or blood vessels. This type of cancer is often more challenging to treat and may require surgery, radiation, and chemotherapy.
6. Mixed Cell Type: Mixed cell type bladder cancers contain more than one type of cancer cell, such as a combination of urothelial carcinoma with squamous cell carcinoma or adenocarcinoma. The Bladder Cancer Treatment approach may vary depending on the types and extent of the cancer.

Bladder Cancer Diagnosis

Diagnosis of bladder cancer usually requires combining the following tests and procedures: 

1. Initial Assessment: Doctor will inquire on the symptoms, risk factors, and medical background, and might conduct a physical exam as well including a rectal or vaginal exam. 

2. Urine Testing: Different tests- urinalysis checks for blood and other substances, urine cytology looks for cancer cells under a microscope, urine culture identifies infections, and urine tumor marker tests look for indicators of bladder cancer.

3. Cystoscopy: A hollow tube called a cystoscope is inserted via the urethra and into the bladder to visually inspect it for irregularities such as tumors. 

4. Biopsy: When the doctor finds areas of concern like those from cystoscopy, it can usually take a tissue sample for examination under a microscope to determine whether it has cancer cells. Usually performed together with tumor removal during a TURBT.

5. Imaging: Different imaging tests (CT urogram, retrograde pyelogram, MRI, ultrasound, bone scan, chest X-ray, PET scan) are used to help visualize the urinary tract and other areas to detect cancer spread. 

6. Pathology Assessment: A pathologist analyzes the tissue sample obtained in the biopsy or TURBT and gives a description of the type (e.g., urothelial carcinoma, squamous cell carcinoma) and grade of bladder cancer. 

Bladder Cancer Stage

According to TNM classifications, bladder cancer stages can be rated between 0 and IV, with lower stages indicating less advanced and localized cancer. Higher stages imply that cancer has spread far more widely and is likely to be more difficult to treat. 

Here is a simple outline of the stages:

• Stage 0: The cancer cells are confined only to the lining of the bladder; they haven't invaded the wall. Substages:
  • Stage 0a (Ta): Papillary carcinoma (with finger-like growths). 
  • Stage 0is (Tis): Carcinoma in situ (flat, high-grade tumor).
• Stage I: The cancer is only in the connective tissue without invading the muscular layer.
• Stage II (Muscle-invasive): Cancer has invaded the muscle layer. Substages:
  • Stage IIA (T2a): Superficial infiltration (inner half). 
  • Stage IIB (T2b): Deep infiltration (outer half).
• Stage III (Locally advanced): Cancer has spread through the muscle into fatty tissue and adjacent organs or lymph nodes. Substages IIIA and IIIB are based on the extent of spread.
• Stage IV (Metastatic): Cancer had spread outside the bladder into the substage IVA or IVB according to the site of metastasis.

Risk Factors of Bladder Cancer

Risk factors of bladder cancer are divided into modifiable (changeable) factors and non-modifiable (unchangeable) parameters that help people make choices regarding potential risk reduction.

Modifiable Risk Factors:

• Smoking: Smokers, especially heavy smokers, are at increased risk of bladder cancer by three times. However, the risk decreases gradually with cessation of smoking.
• Certain Chemicals Exposure: Industrial chemicals such as aromatic amines from dye, rubber, and paint industries, and arsenic in water are hazardous to the workers.
• Some Drugs and Herbal Supplements: Pioglitazone (an antidiabetic medicine) shows an increased odds risk ratio with prolonged use. Aristolochic acid (from herbs) found in dietary supplements is related to bladder cancer.
• Inadequate Fluid Intake: Hydration reduces carcinogens by increasing urine excretion. 
• Obesity: Increases the number of people who may develop bladder cancer. 
• Diet: Many studies have related the consumption of processed meats with a raised risk, while there are several vegetables and fruits protective against cancer.
• Chronic Bladder Irritations and Infections: There is a high risk of squamous cell carcinoma in people with a history of long-term UTIs, bladder stones, and even catheterization. Schistosomiasis can also be a cause of this cancer.

Non-Modifiable Risk Factors:

• Age: The risk of developing bladder cancer is higher for individuals above the age of 55.
• Sex: Men tend to have higher risks than women for bladder cancer.
• Race and Ethnicity: Whites tend to have higher rates of bladder cancer than others, with no clear reasons for such claim.
• Previous Bladder Cancer History: Those with a previous history of bladder cancer tend to have a higher risk of developing the cancer again.
• Family History of Cancer: It can increase the chances of developing bladder cancer if it runs in one's family, such as in Lynch syndrome or bladder cancer. 
• Genetic Factors: Certain inherited genetic variations may cause an increased susceptibility to bladder cancer.
• Past Cancer Treatment: Cancer treatment with specific chemotherapeutic agents and previous pelvic radiation can be expected to increase the risk of bladder carcinoma. 
• Congenital Anomalies in the Bladder: Certain congenital anomalies of the bladder may increase the chances of developing cancer.

Complications of Bladder Cancer

Bladder cancer complications may affect quality of life.  Complications may arise due to the cancer itself, a consequence of tumor progression, or result from therapeutic interventions. Below are some complications that may arise from bladder cancer: 

• Hematuria (Blood in Urine): It is an important symptom that can be of microscopic degree, sometimes leading to blocks and pain from visible clots. 
• Pain: As the tumor grows, pelvic pain arises, flank pain may arise should the tumor obstruct the ureters, and if it has spread to bones, bone pain arises. 
• Urinary Obstruction: In case of large tumors, urine obstructs bladder drainage, causes hydronephrosis and renal failure, and leads to urinary retention. 
• Increased Urinary Frequency and Urgency: The tumor irritates the bladder lining, thus causing a less tolerable need and strong, sudden urges. 
• Urinary Tract Infection: Tumors can obstruct normal urine flow, thus making the bladder susceptible to UTIs. 
• Fistulae: These are abnormal passages built by advanced tumors that have destroyed the wall of the bladder by eroding the adjacent organs that causing either urine or feces to leak. 
• Complications due to metastasis:
  • When cancer spreads, it causes bone pain and fractures. 
  • Metastasis to the lungs causes breathing difficulty and cough. 
  • Metastasis to the liver causes decreased function, jaundice, and tiredness. 
  • Enlargement of lymph nodes exerts pain; nerve compression causes numbness. 
  • With advanced cancer, there arises fatigue, weight loss, and decline.
• Treatment-Related Complications: Common complications that arise due to treatment but differ depending on the type: 
  • Surgical Complications: Bleeding, infection, pain, urinary leakage, bowel disturbance, sexual disability, and stoma complications. 
  • Chemotherapy: Nausea, weariness, baldness, mouth sores, bowel changes, and risk of infection, anemia, neuropathy, and kidney damage. 
  • Radiation Therapy: Fatigue, skin problems, bowel, irritation of bladder, erectile dysfunction, and other late sequelae. 
  • Immunotherapy: Fatigue, skin reactions, flu-like symptoms, and autoimmune-related reactions. 
  • Targeted Therapy: Fatigue, rashes, diarrhea, and hypertension.

Prevention of Bladder Cancer:

Preventing bladder cancer involves making healthy lifestyle choices and avoiding known risk factors. Here are some easy ways to reduce your risk:

• Quit Smoking: Smoking is the biggest risk factor for bladder cancer. If you smoke, quitting can significantly lower your risk. Avoid exposure to secondhand smoke as well.
• Stay Hydrated: Drinking plenty of water helps flush out harmful substances from your bladder. Aim for at least 8 glasses of water a day to keep your bladder healthy.
• Avoid Harmful Chemicals: If you work with chemicals, such as in industries like dye or rubber manufacturing, follow safety guidelines and use protective gear. Reducing exposure to harmful substances can lower your risk of bladder cancer.
• Healthy Diet: Eat a diet rich in fruits, vegetables, and whole grains. These foods contain antioxidants and nutrients that help protect against cancer. Limit processed foods and red meats, which may increase cancer risk.
• Regular Check-ups: Regular health check-ups can help detect any problems early. If you have a history of bladder infections or other bladder issues, make sure to discuss them with your doctor.
• Manage Chronic Conditions: If you have chronic bladder infections or conditions, seek Bladder Cancer Treatment to manage them effectively. Chronic irritation or infection can increase the risk of bladder cancer.
• Be Cautious with Medications: Some medications used in cancer treatment can increase the risk of bladder cancer. If you are undergoing treatment, discuss any concerns with your doctor.

Treatment options include immunotherapy, radiation therapy, chemotherapy, operation to remove malignant tissues, targeted therapeutic medications, and immunotherapy to boost the body's immune system against cancer cells. A good diet and giving up cigarettes are two other modifications to your lifestyle that may help avoid recurrence.

• Diagnosis and Staging: To confirm the diagnosis of bladder cancer and ascertain the stage of the disease, the patient has tests like a cystoscopy, biopsy, and imaging scans (MRI, CT).
• Transurethral Resection of Bladder Tumor (TURBT): This procedure may be used for early-stage or non-invasive bladder cancer. A cystoscope is placed into the urethra during this surgery in order to remove the tumor along with a small margin of healthy tissue surrounding it.
• Intravesical Therapy: To eradicate any leftover cancer cells and lower the chance of recurrence, some patients may have intravesical therapy after TURBT. This involves injecting medication straight into the bladder. Chemotherapy medicines or Bacillus Calmette-Guérin (BCG) are often used as pharmaceuticals.
• Radical cystectomy: If the bladder cancer is more advanced or aggressive, this operation might be recommended. This means that the entire bladder, along with any nearby organs and lymph nodes, may need to be surgically removed.
• Urinary Diversion: Urinary diversion surgery is performed to create an alternative route for urine to exit the body following a radical cystectomy. The ileal conduit (urostomy), continent cutaneous diversion (continent ileal reservoir), or continent urinary diversion (neobladder) are the available options.
• Chemotherapy and Radiation Therapy: In certain instances, these Bladder Cancer Treatment may be administered either prior to or following surgery with the goal of reducing tumor size, eliminating cancerous cells that remain, or reducing symptoms.
• Follow-up and Monitoring: Following treatment, routine follow-up consultations are crucial for managing side effects, keeping an eye out for recurrence, and evaluating general health. Periodically, urine tests and imaging scans may be carried out to look for any indications of cancer recurrence.