According to statistics from the National Cancer Institute, bladder cancer ranks as one of the top 10 most common cancers in the country. The majority of patients are aged 50 and older, and found in men more than in women.
The cause and risk of bladder cancer
Smoking has been found to be a significant factor that increases the risk of bladder cancer by about 3-4 times because the toxic substances in cigarette smoke cause damage and inflammation in the bladder tissue, leading to abnormal cell division. Additionally, frequent exposure to certain chemicals, such as aromatic amines in industries producing dyes, plastics, rubber, metals, or petrochemicals, as well as infections from bacteria, fungi, viruses, and parasites like schistosomiasis and genetic factors, are also contributing factors that increase the risk of developing the disease.
While there are several other factors that have not been definitively linked to an increased risk, they should still be considered cautiously. These include exposure to arsenic, often found in drinking water contaminated by agricultural activities, pelvic radiation therapy for prostate cancer or gynecological cancers, and certain chemotherapy drugs.
Symptoms of bladder cancer
The symptoms of bladder cancer depend on the stage of the disease. The most common symptom is painless hematuria, which can be seen as visible blood in the urine or red blood cells may be detected through a urine exam. Some patients may present with symptoms of frequent urination, as well as pain in the lower abdomen or at the tip of the urethra during urination. If the cancer invades the muscle layer, patients may experience lower abdominal pain even when not urinating, as well as back pain in the lumbar region or side of the CV due to tumor compression of the ureters. Renal failure presents as nausea, vomiting and less urination. In cases where the cancer spreads to the lymph nodes and bones, patients may experience severe pain in the pelvic region and lower back, leg swelling, weight loss, and noticeable fatigue.
Bladder cancer diagnosis
Bladder cancer diagnosis typically involves several methods, as follows:
• History taking and physical examination. The doctor will ask about symptoms, particularly those related to urination, and inquire about risk factors. If any suspicious conditions are found, further examination of the abdomen or pelvic area may be required to detect abnormalities.
• Urine exam such as checking for red blood cells in the urine and examining the urine under a microscope (urine cytology) to detect cancer cells.
• Cystoscopy that uses a scope to examine the bladder lining for abnormalities. If any suspicious areas are found, a biopsy will be taken and sent to a laboratory to determine if cancer cells are present and what type they are.
• Ultrasound, CT scan, or MRI: These imaging tests help identify tumors or the spread of the cancer to the surrounding organs.
Treatment of bladder cancer
In general, treatment of bladder cancer is divided into two main groups based on the symptoms and stage of the disease, as follows:
1. Non-muscle invasive bladder cancer: NMIBC
If the cancer cells are confined to the lining of the bladder, the doctor will insert a small instrument through the urethra and use electrical current to destroy the tumor. A tissue sample will then be sent to a laboratory to determine if the cancer has invaded the muscle layer of the bladder. After surgery, immunotherapy or chemotherapy may be used to kill any remaining cancer cells, depending on the severity of the disease and the number of tumors. The patient will then be monitored with regular cystoscopy every 3-6 months for the first 2-3 years after surgery.
2. Muscle invasive bladder cancer: MIBC
If the cancer has spread to the bladder muscle, outer lining, surrounding fat, and adjacent organs, treatment becomes more complex. One of the primary treatments is a total cystectomy, which may involve removing the distal ureters, pelvic lymph nodes, and, in men, the prostate and seminal vesicles. In women, the uterus, fallopian tubes, ovaries, and part of the vagina may also need to be removed. After removing the bladder, the intestine is used to create a new bladder.
Following surgery, radiation therapy and chemotherapy are used to eliminate any remaining cancer cells. Immunotherapy may be considered for patients who do not respond to chemotherapy. In addition, radiation therapy and chemotherapy may be used in cases where the cancer has metastasized
In cases where a patient is unable to undergo major surgery due to poor health or other underlying conditions, the doctor may administer chemotherapy to shrink the tumor first. Afterwards, the doctor will reassess the possibility of surgery or consider other appropriate treatment options. This approach is taken to ensure the patient's safety and achieve the best possible outcomes.
Bladder cancer, when detected in its early stages, has a high chance of being cured. Therefore, individuals aged 50 and above, or even younger individuals with a history of smoking, frequent exposure to chemicals, or other risk factors, should undergo regular health check-ups. If any suspicious symptoms present, consulting a doctor for a thorough examination can lead to early diagnosis and timely treatment. Early detection also tends to be less costly than treating advanced stages of the disease.