What is Bladder Cancer? Symptoms, causes, treatment
Before focusing on various aspects related and relevant to bladder cancer, it is essential to clarify, define and distinguish among the terms and concepts often used in the analysis and interpretation of facts concerning bladder cancer.
1.1) What is urinary bladder?
The urinary bladder is a muscular sac in the pelvis (the bony cavity forming the lower part of the abdomen) lying just above and behind the pubic bone. When the urinary bladder gets empty, and as such takes the shape of a pear, then the urine made in the kidneys travels down to the urinary bladder through the two tubes (ureters). The urinary bladder subsequently stores urine allowing urination to be infrequent and controlled.
1.2) What is bladder cancer?
Bladder cancer is one arising from the tissue in the urinary bladder. It is a malignant disease in which the cells grow abnormally. Bladder cancer is the 8th highest cause of cancer death.
1.3) Cancer vs. tumour:
A benign tumour is harmless and non-cancerous, although, it is an abnormal growth of cells. A benign tumour is generally localized and does not spread invading other parts of the body. When a tumour turns into “malignant “, it is called cancer.
1.4) Signs and symptoms:
The symptom is subjective evidence, while the sign is any objective evidence of disease. Therefore, the symptom is a phenomenon that is experienced by the individual affected by the disease. And the warning is is a phenomenon that can be detected by tests (and not by the experiences)
1.5) Cause vs. risk factor:
A risk factor is not necessarily a cause. A risk factor may be anything that influences a person’s chance of developing cancer (for instance), but veritably, most of the risk factors do not directly cause cancer. Many had several risk factors are found without developing any disease in their lifetime. On the contrary, others having no risk factor at all do develop cancer. Risk factor refers to surrogates for underlying causes. For bladder cancer (as), smoking is a high-risk factor and exposure to chemicals is a low-risk factor.
Again causes mainly include the agents directly responsible for the diseases, such as bacteria (these are cell organisms and are directly responsible for illness, such as urinary tract infection, tuberculosis), viruses (viruses are even smaller than bacteria and cause a multitude of diseases ranging from common cold to AIDS), fungus (it is a kind of living organism different from plants and animals which have cells with nuclei. Examples are yeasts and mushroom) and parasites (it is an organism which lives in the body of another organism known as the host. Parasites lives and benefits by deriving nutrients at the cost of the host. Examples are tapeworms, fleas, etc).
1.6) Treatment vs. cure:
Some diseases can’t be cured, such as Hepatitis. B. But medical treatment can help manage the disease. Medical therapies include medical therapy, surgery, dietary restrictions, movement restrictions and more importantly, other procedures to help reduce the symptoms and physical discomforts produced by the disease. Whereas cure implies full recovery of the illness to return to a healthy life.
1.7) Treatment vs. therapy:
Medical professionals apply to medicine, surgery, therapy, etc. for the treatment of the disease. On the other hand, healing, more specifically, psychotherapy, is applied to cure mental disorder. Therapy is a part of the overall treatment that helps the patient to feel better and stronger. For instance, chemotherapy and radiotherapy are applied to healing cancer.
1.8) Treatment vs. disease management:
Medical treatment falls under the overall plan of control of, especially chronic or malignant diseases. Management includes the method of providing total care and relief in terms of medicine intake of the right dose and at the right time. Also, Management includes changing the type and dose of medicine as well as length of period for the drug to continue depending on the level of improvement (and conversely deterioration) of the disease, restriction on diets and physical movements, surgical treatment, post-treatment care, etc. Management is an umbrella that treatment is under.
1.9) Diagnosis vs. prognosis:
Prognosis is a guess and forecast regarding the outcome of the treatment. Whereas diagnosis is Identifying the problem, named as ‘depression’, ‘obsession’ or ‘compulsion’ etc.
1.10) Urethra vs. ureter:
The two ureters run from the kidneys to the urinary bladder, while the human body having only one urethra runs from the urinary bladder downwards and is the last part of the urinary system. In contrast, ureters are located in the middle part of the urinary system. Usually, an adult ureter is 10 inch-- 12 inches long having diameter 0.12 inch -- 0.16 inch. But in the case of the urethra, it is only 2 inches long (in case of a female adult) and 8 inches long (in case of a male adult). The smooth muscles in the ureters can produce contraction (unlike tissue in the urethra).
2) Signs and symptoms of bladder cancer:
- Ten symptoms of bladder cancer, which are mostly experienced by the patients include:
- Blood or blood clot in the urine.
- Pain or burning sensation during urination.
- Frequent urination.
- Feeling the urgency to urinate frequently, particularly during the night.
- Unable to pass urine despite feeling the need.
- Lower back pain in one side of the body.
- Tiredness or weakness
- Weight loss
- Swollen feet
- Bone pain.
2.2) Signs and Diagnosis:
Signs for bladder cancer are usually detected by initially examining the symptoms and then conducting a physical test (rectal test for male and vaginal; test for female). Further, the doctor will check for a lump or other irregularities. Additionally, the following diagnostic testing may be needed.
- Complete Urinalysis: It is conducted to check blood in the urine. It can help detect blood cancer early. In the test, doctors use a microscope to look for cancer cells in the urine.
- Cystoscopy: While performing the test doctor inserts a small narrow tube (cystoscope) through the urethra.
- Biopsy: A sample of tissue is taken from the urinary bladder to examine it more closely. A biopsy is recommended only when an initial test suggests that the tissue of the suspected area is not healthy.
- Urine cytology: In the experiment, doctors look at the cells collected from the urine specimen to detect infection, inflammation, cancer, etc.
- Imaging tests: The tests to be performed include X- rays, sound waves, a radioactive substance in the body to create a picture of the desired organ of the body.
Despite anatomical differences, the signs, as well as symptoms of bladder cancer for both males and females, are similar. However, females are usually observed to ignore the finding of blood in the urine (a symptom of bladder cancer) during or immediately before the menstruation period. For this reason, females, in general, get late in consulting a doctor. And consequently, more time is wasted for the cancer cells to grow and spread.
When signs and symptoms of bladder cancer arrive one after another, patients should be alert to blood detected in the urine when it is usually felt painless and found grossly red. Under such circumstances, the patient should immediately seek medical advice and never wait to hear the poor consolation “it is an only infection and nothing more“. If caught early, bladder cancer is curable; but if found late, it is difficult.
4) Causes and risk factors of bladder cancer:
4.1) Risk factors:
The following risk factors may raise a person’s risk of developing bladder cancer.
- Tobacco use: The most common risk factor is smoking. Smokers are 5- 7 times more likely to develop bladder cancer (as compared to non- smokers)
- Age: The chances of developing malignant diseases increase with age. And this holds in case of bladder cancer also. More than 70% of patients who have bladder cancer are 65 years and over.
- Gender: Males are 3-4 times more likely to develop cancer (than females). Additionally, the death rate is also high in the case of males.
- Race: Research studies reveal the fact that among bladder cancer patients, the death rate is higher in case of the black race (as compared to the white race)
- Chemical exposure: Workers employed in the rubber, textile, leather, dyeing, painting and printing industries (where chemicals are used) face a higher risk of bladder cancer.
- Chronic bladder problem: Patients suffering from bladder stones and infections as well as paralysis (affecting waist to downward part of the body and as such requiring catheters) are more likely to develop bladder cancer.
- The Previous record of bladder cancer: Patients previously had bladder cancer and subsequently have been cured are expected to develop bladder cancer again.
- Arsenic exposure: It is a naturally occurring substance and is found in drinking water. If consumed in a large amount beyond the acceptable level (through drinking water), it may invite the higher risk of bladder cancer.
Rather than growing and increasing in an orderly way, the cells develop mutations that cause them to grow out of control but never vanish. These abnormal cells form a tumour over time. About 50% of bladder cancer is first found while cancer is still confined to the inner layer of the bladder wall. These are non- invasive cancer. About 1 out of 3 (33.33%) invades into a deeper layer but is still confined within the bounds of the urinary bladder. In most of the remaining cases, cancer spreads into a deeper layer or lymph nodes outside the bladder. Hardly in 4% of cases, cancer spreads into remote parts of the body when it is difficult to cure.
5) Types of bladder cancer:
There are broadly three types of bladder cancer which are stated below.
- UCC (Urothelial Carcinoma Cancer). It accounts for 90% of bladder cancer.
- SCCC (Squamous Cell Carcinoma Cancer). The cells develop in the bladder lining in response to irritation and inflammation.
- ACC (Adeno Carcinoma cancer).
6) The prognosis for various stages of bladder cancer:
6.1) Stage- 1: If bladder cancer is detected in the primary step, it can be cured without any care and anxiety. Early stages of bladder cancer cause bleeding with little or no pain. However, blood in the urine does not necessarily mean cancer. Blood in the urine is often caused by infection, stone or benign tumours (non-cancerous)
6.2) Stage- 2: The patient has a 63% chance of survival (for five years after diagnosis)
6.3) Stage- 3: The patient has a 46% chance of survival (for five years after diagnosis).
6.4) Stage- 4: With treatment for bladder cancer at stage- 4, the patient has a 15% chance of survival (for five years after diagnosis)
7) The spread of Bladder Cancer:
So far as the range of bladder cancer is concerned, the local range will imply bladder cancer to infiltrate into the ureters, urethra, prostate, vagina or pelvis. Bladder cancer that has spread into other parts of the body is secondary cancer or metastasis when it is likely to spread to lymph, nodes, lungs, liver or bone.
8)Treatment of bladder cancer:
Treatments for bladder cancer depend on the stage of disease during diagnosis, overall health condition, age, gender, etc. The effective treatment method includes the following measures.
- Transurethral resections with figuration: The method uses a cystoscope in which the doctors enter the urinary bladder through the urethra. The tumour formed can be destroyed with high electricity energy.
- Partial (segmented) cystectomy: This is a surgical procedure to remove the cancerous part of the urinary bladder.
- Radical cystectomy: In this surgery, the entire bladder is removed. If nearby tissues or lymph nodes contain cancer, they can be removed as well. The surgeon constructs an alternative route for the passage of urine known as urinary diversion.
Even after successful surgery, doctors may recommend chemotherapy to destroy any cancer cell left behind or migrated elsewhere. Treatment is generally given intravenously.
8.3) Radiation treatment:
Depending on how serious the cancer is, doctors may recommend radiation treatments. The surgeon can place a radioactive substance near cancer during surgery known as internal radiation therapy. The high energy X- rays can kill cancer cells or prevent them from growing.
It is an artificial stimulation of the immune system to improve the natural ability to fight cancer. The own immune system in the body is used to kill cancer cells. In immunotherapy to treat bladder cancer, the drug used is called BCG (Bacillus Calmette Guerin), which is a vaccine used to protect the urinary bladder against further deterioration. The medications used in the immunotherapy include:
- Ipilimumab (Yervoy)
- Nivolumab (Opdivo)
- Pembrolizumab (Key Truda)
- Atezolizumab (Tecentriq)
- Avelumab (Bavenci)
- Durvalumab (Imfinzi)
9) Post-treatment side effects:
Every dark, dense cloud is followed by a silver lining alternately. So also, after the removal of dangers of bladder cancer through various treatment methods, the patients are observed to have a great sigh of relief. But after that, some side effects will crop up with each type of treatment which is stated below:
9.1) After partial cystectomy, it may not be possible to hold as much urine as before.
9.2) For a radical cystectomy, females will get their uterus, ovaries, and part of their vagina removed. After that, they will experience immediate menopause (The time comes in most women’s lives when menstrual periods stop permanently, and as such, they are no longer able to bear children. It occurs within the age of 49—52 years).
In the case of males, they will have their prostate and seminal vesicles removed. This may cause impotence afterwards.
9.3) The possible side effects of immunotherapy include
- Feeling tired (fatigue)
- Shortness of breath
- Blisters covering about 10% of the body
10) The implication of the survival rate of bladder cancer:
In the case of the bladder cancer, if the tumour is invasive but has not yet spread beyond the urinary bladder, the chances of a 5-year survival rate are 70%. If the tumour extends through the bladder to the surrounding areas, such as lymph, nodes or organs, the chances of a 5-year survival rate are 35%.
For example,, if the patient suffering from bladder cancer the chances of survival (to live at least for 5 years after diagnosis) is 70%, then the implication is that as compared to the people who do not have bladder cancer, the chance of survival for the bladder cancer patients (to live at least for 5 years) is 30% less.
11) Key world statistics on bladder cancer:
- On average the chances for falling prey to bladder cancer is 1 out of 27 (3.7% for any male) and for any female, it is only 1 out of 89 (1.12%)
- About 90% of patients having bladder cancer are over 55 years.
- on average, out of 100 bladder cancer patients, 21 dies (15 males and six females).
- In recent years death rates from bladder cancer have been found declining in case of females (but the death rate is found stable for the males)
- Bladder cancer is the 4TH most common cancer in the USA. (for male). But it is less common in female.
12) Concluding remarks:
12.1) A person suffering from a malignant disease like bladder cancer, detected at an early stage, need not worry at all. Because every dark tunnel of mental anxiety emits golden ray of hope at the far end of the dark tunnel. Fortunately, one can live without a urinary bladder. As such many are found to undergo surgery for complete removal of the urinary bladder to get rid of cancer spread, provided it is detected at an early stage. For satisfying the need, a new route will be created to pass urine. In this connection, doctors usually recommend 3- 4 weeks of healing before returning to normal activities that may include intense exercise or lifting a weight. Moreover, it may take six weeks to resume sexual activities.
12.2) “Prevention is better than cure“- this wise saying holds in case of all the fatal diseases including bladder cancer. As humans, we can easily defer and delay the “inevitable arrival of the “Angel of Death “by practising a healthy lifestyle. This includes following healthy dietary habits, building good habits of rising early in the morning to perform physical exercise, enjoying quality sleep, performing a regular physical check-up under a medical specialist even if there is no health problem and more importantly, avoiding expensive bad habits like smoking and alcohol. Smoking is branded as the prime and primary cause of almost all fatal diseases, including bladder cancer. In this connection, it needs to be mentioned that only due to smoking-related diseases on average, one person dies every 10 seconds globally (i.e.3.16 million deaths annually according to the source of the World Health Organization).