Introduction
Urinary bladder is a muscular organ in the pelvis. Urine made in the kidney travels down to the bladder through the ureters. The bladder stores this urine preventing frequent urination. Cancer involving the urinary bladder is the 4th most common cancer in men and 10th most common malignancy in women. The exact cause of this condition is not known. Exposures to chemicals at the workplace and tobacco use were the significant risk factors for this cancer.
This article provides information on the causes, clinical signs, and symptoms to identify this cancer, diagnosis, treatment, and preventive measures.
Causes
Bladder cancer is more common in men than in women. Other factors that might increase this risk include
- Exposure to chemicals in specific industries (rubber, leather, aluminum, diesel)
- Tobacco use or exposure to second-hand smoke
- A family history of bladder cancer
- Long term use of chemotherapy drug – cyclophosphamide
- Genetic factors
- Chronic urinary tract infections
Clinical Features
The initial symptoms of this cancer are similar to signs of urinary tract infection or kidney stones. The most frequent signs include
1. Hematuria
The most common sign of this cancer is blood in the urine
2. Pain
Pain may develop in the flank region. Flank pain refers to discomfort in the upper abdomen, back, and sides. The individual might also experience pain during urination (dysuria).
3. Voiding symptoms
- Frequent urination
- Rushing to the bathroom
- Inability to hold the urine
- The individual might leak urine on the way to the toilet
4. Other symptoms
- Fatigue (feeling of tiredness)
- Weight loss
- Lack of appetite
Diagnosis
The doctor evaluates individuals showing these signs of bladder cancer with the following tests. This includes
- Urine tests
- Cystourethroscopy
- Imaging test
Urine Tests
1. Urine analysis
A dipstick is used for urine analysis. This stick changes color if glucose, red blood cells or white blood cells are present in the urine.
2. Urine cytology
In this test urine sample is examined using a microscope. This test detects any abnormal cells shed from the urinary bladder. The pathologist identifies if the cells are cancerous or not.
Imaging Tests
These tests detect an abnormality in the kidneys, urethra, or bladder. Depending on the individual situation CT scan, MRI, or an intravenous pyelogram, is performed.
1. CT scan
CT scan examines the bladder using a contrast dye. This scan provides information on the extent of cancer (if cancer has spread to the other tissues).
2. MRI
This imaging provides additional information about the stage of bladder cancer. It is done in individuals with allergy to contrast dye.
3. Intravenous pyelogram (IVP)
During this procedure, a dye is injected through the vein. As the dye passes through the urinary bladder, any abnormal masses within the bladder can be seen on the X-ray.
Cystoscopy Or Cystourethroscopy
Is a procedure that examines the bladder and the urethral lining. To avoid any discomfort gel is applied to the urethra. A cystoscope is then used by the doctor to examine the urethra and the bladder lining. In case an unusual tissue is detected biopsy is performed for a definitive diagnosis.
Treatment
The most common first line of treatment for this cancer is surgery. Any abnormal masses within the bladder are removed. This is called transurethral resection of bladder tumor.
Transurethral resection of bladder tumor (TURBT)
In this procedure, the practitioner employs a cystoscope to visualize and remove any abnormal growths in the urinary bladder. It is done under anesthesia and once the procedure is done the individual can go home
However, for individuals with more advanced cancers, a second resection is done at weeks later after the first one to ensure no tumor is remaining within the bladder
Blue Light Cystoscopy
Enhanced view of tumors along with removal can be done using blue light along with a dye injected into the bladder. The main advantage of this method is a decreased recurrence of tumors as this procedure defines margins of the bladder tumor for complete removal.
Chemotherapy
Chemotherapy refers to the use of drugs to inhibit the growth of cancer cells. The most commonly used drug agent is mitomycin.
Prevention
Diet
An increased intake of cruciferous vegetables (e.g. cabbage, broccoli, and mustard) is associated with a reduced incidence of this cancer
Avoid smoking
People who smoke cigarettes are 2-4 times increased risk for this cancer compared to individuals who never smoke
Exposure to chemicals
Limit exposure to certain chemicals at your workplace by using protective equipment (gloves, face shields, safety goggles).
