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oncology1

Bladder Cancer

Bladder cancer is a disease in which abnormal cells multiply without control in the bladder.

Signs & Symptoms:

  • Hematuria – Blood (redness) in the urine may be visible to the naked eye
  • Pain during urination
  • Frequent urination, or feeling the need to urinate without being able to do so
  • Prostate infections
  • Over-active bladder and cystitis

Risk Factors:

  • Smoking
  • Increasing age
  • Being white
  • Being a man
  • Exposure to certain chemicals
  • Previous cancer treatment
  • Taking a certain diabetes medication
  • Chronic bladder inflammation

Common Types:

  • Transitional cell bladder cancer
  • Non muscle invasive (superficial) bladder cancer
  • Invasive bladder cancer
  • Squamous cell bladder cancer
  • Adenocarcinoma of the bladder
  • Rare types of bladder cancer
  • Cancer that has spread to the bladder – Metastatic Cancer

Diagnosis:

  • Urine microscopy
  • Ultrasound Scan
  • Cystoscopy + Biopsy
  • Computed Tomography (CT) Scan
  • MRI
  • PET-CT Scan

Stages:

  • T (Primary tumour)
    • TX Primary tumour cannot be assessed
    • T0 No evidence of primary tumour
    • Ta Non-invasive papillary carcinoma
    • Tis Carcinoma in situ (‘flat tumour’)
    • T1 Tumour invades subepithelial connective tissue
    • T2a Tumour invades superficial muscle (inner half)
    • T2b Tumour invades deep muscle (outer half)
    • T3 Tumour invades perivesical tissue:
      • T3a Microscopically
      • T3b Macroscopically (extravesical mass)
      • T4a Tumour invades prostate, uterus or vagina
      • T4b Tumour invades pelvic wall or abdominal wall
  • N (Lymph nodes)
    • NX Regional lymph nodes cannot be assessed
    • No regional lymph node metastasis
    • N1 Metastasis in a single lymph node 2 cm or less in greatest dimension
    • N2 Metastasis in a single lymph node more than 2 cm but not more than 5 cm in greatest dimension,or multiple lymph nodes, none more than 5 cm in greatest dimension
    • N3 Metastasis in a lymph node more than 5 cm in greatest dimension
  • M (Distant metastasis)
    • MX Distant metastasis cannot be assessed
    • M0 No distant metastasis
    • M1 Distant metastasis.

Prevention

  • Stop smoking. Cigarette smokers are much more likely to get bladder cancer than nonsmokers.
  • Avoid exposure to industrial chemicals, such as benzene substances and arylamines.
  • Avoid exposure to arsenic.
  • Eat healthy foods.

Management:

Treatment options and recommendations depend on several factors, including the type, stage, and grade of bladder cancer; possible side effects; and the patient’s preferences and overall health. Treatment care plan may also include treatment for symptoms and side effects, an important part of cancer care.

  • Surgery
    Surgery is removal of the tumor and surrounding tissue during an operation. There are different types of surgery for bladder cancer, and the most beneficial option usually depends on the stage and grade of the disease. Surgical options to treat bladder cancer include:
  • Transurethral bladder tumor resection (TURBT) – This procedure is used for diagnosis and staging, as well as treatment. During TURBT, a surgeon inserts a cystoscope through the urethra into the bladder and removes the tumor using a tool with a small wire loop or using a laser or fulguration (high-energy electricity). The patient is given medication to block the awareness of pain, known as an anesthetic.

    For patients with non-muscle-invasive bladder cancer, TURBT may be able to eliminate the cancer. However, the doctor may recommend additional treatments to prevent cancer recurrence, such as intravesical (into the bladder) chemotherapy or immunotherapy (see below).  For patients with muscle-invasive bladder cancer, additional treatments involving surgery to remove the bladder or, less commonly, radiation therapy are necessary.

  • Cystectomy - A radical cystectomy is removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina also may be removed. In addition, lymph nodes in the pelvis are removed for both men and women. This is called a pelvic lymph node dissection. A thorough pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called partial cystectomy.

    If the bladder is removed, the doctor will create a new way to pass urine out of the body by using a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient will need to wear a bag attached to the stoma to collect and drain urine.

  • Chemotherapy
    Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. A chemotherapy regimen typically consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

    There are two types of chemotherapy that may be used to treat bladder cancer. The type the doctor recommends and when it is given depends on the stage of the cancer.

    Intravesical Chemotherapy - Intravesical (local) chemotherapy is usually given by a urologist. During this type of therapy, drugs are delivered into the bladder through a catheter that has been inserted through the urethra. Local treatment only destroys superficial tumor cells that come in contact with the solution. It cannot reach tumor cells in the bladder wall or tumor cells that have spread to other organs.

    Systemic Chemotherapy - Systemic (whole body) chemotherapy is usually prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

  • Immunotherapy
    Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. The standard immunotherapy drug for bladder cancer is a weakened bacterium called bacillus Calmette-Guerin (BCG), which is similar to a form of the bacteria that causes tuberculosis. BCG is placed directly into the bladder through a catheter, which is called intravesical therapy. BCG attaches to the inside lining of the bladder and triggers the patient’s immune system to destroy the tumor. BCG can cause flu-like symptoms, chills, mild fever, fatigue, a burning sensation in the bladder, and bleeding from the bladder.
  • Radiation therapy
    Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.
    Radiation therapy is usually not used by itself as a primary treatment for bladder cancer, but it may be given in combination with chemotherapy. However, some patients who cannot receive chemotherapy might receive radiation therapy alone. The combination of radiation therapy and chemotherapy may be used to treat cancer that is located only in the bladder for the following reasons:
  • To destroy any remaining tumor after TURBT while sparing the bladder
  • To relieve symptoms caused by a tumor, such as pain, bleeding, or blockage
  • To treat a metastasis located in one area, such as the brain or bone

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