Bladder cancer develops when the cells in bladder tissue start to divide uncontrollably. Rather than grow and divide in an orderly way, these cells develop mutations that cause them to grow out of control and not die. These abnormal cells form a tumor. Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder - the hollow, muscular organ in your lower abdomen that stores urine.
What causes bladder cancer?
Certain changes in the DNA inside normal bladder cells can make them grow abnormally and form cancers. DNA is the chemical in our cells that makes up our genes, which control how our cells function.
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about bladder cancer.
Many people with bladder cancer can have blood in their urine but no pain while urinating. There are a number of symptoms that might indicate bladder cancer and are as follows:
Blood in the urine
Changes in bladder habits or symptoms of irritation
Having to urinate more often than usual
Pain or burning sensation during urination
Feeling as if you need to go right away, even when your bladder isn't full
Having trouble urinating or having a weak urine stream
Having to get up to urinate many times during the night
Bladder cancers that have grown large or have spread to other parts of the body can sometimes cause other symptoms, such as:
Being unable to urinate
Lower back pain on one side
Loss of appetite and weight loss
Feeling tired or weak
Swelling in the feet
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A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. It's important to know about the risk factors for bladder cancer because there may be things you can do that might lower your risk of getting it.
Smoking and other tobacco use: Smoking is the most important risk factor for bladder cancer. It increase the risk of bladder cancer by causing harmful chemicals to accumulate in the urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
Workplace exposures: Certain industrial chemicals have been linked with bladder cancer.
Arsenic in drinking water: Arsenic in drinking water has been linked with a higher risk of bladder cancer. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a public water system that meets the standards for low arsenic content.
Not drinking enough fluids: People who drink a lot of fluids, especially water, each day tend to have lower rates of bladder cancer.
Chronic bladder inflammation: Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer.
Types of bladder cancer are:
Urothelial carcinoma (transitional cell carcinoma): Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is by far the most common type of bladder cancer. In fact, if you have bladder cancer it's almost certain to be an urothelial carcinoma. These cancers start in the urothelial cells that line the inside of the bladder. Urothelial cells also line other parts of the urinary tract, such as the part of the kidney that connects to the ureter (called the renal pelvis), the ureters, and the urethra. People with bladder cancer sometimes have tumors in these places, too, so all of the urinary tract needs to be checked for tumors.
Other types of bladder cancer are:
Other types of cancer can start in the bladder, but these are all much less common than urothelial (transitional cell) cancer.
Squamous cell carcinoma: Bladder cancers are squamous cell carcinomas. Seen with a microscope, the cells look much like the flat cells that are found on the surface of the skin. Nearly all squamous cell carcinomas of the bladder are invasive.
Adenocarcinoma: Some of bladder cancers are adenocarcinomas. These cancer cells have a lot in common with gland-forming cells of colon cancers. Nearly all adenocarcinomas of the bladder are invasive.
Small cell carcinoma: Less than 1% of bladder cancers are small-cell carcinomas. They start in nerve-like cells called neuroendocrine cells. These cancers often grow quickly.
Sarcoma: Sarcomas start in the muscle cells of the bladder, but they are very rare.
Tests and procedures used to diagnose bladder cancer may include:
Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (has a lens) is inserted through the urethra into the bladder to see the inside of urethra and bladder, to examine these structures for signs of disease.
Urine cytology: A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
Biopsy: During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.
Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
Imaging tests: Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, are used to examine the structures of your urinary tract.
Internal exam: An exam of the vagina and/or rectum. The doctor inserts lubricated, gloved fingers into the vagina and/or rectum to feel for lumps.
Intravenous Pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs.
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After someone is diagnosed with bladder cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent (amount) of cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.
T describes how far the main (primary) tumor has grown through the bladder wall and whether it has grown into nearby tissues.
N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.
M indicates if the cancer has spread (metastasized) to distant sites, such as other organs, like the lungs or liver, or lymph nodes that are not near the bladder.
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There is no sure way to prevent bladder cancer but you can take steps to help reduce your risk.
Don't smoke: Smoking is thought to cause about half of all bladder cancers (this includes any type of smoking - cigarettes, cigars, or pipes).
Limit exposure to certain chemicals in the workplace: Workers in industries that use certain organic chemicals have a higher risk of bladder cancer. If you work in a place where you might be exposed to some chemicals, be sure to follow good work safety practices.
Drink plenty of liquids: Drinking a lot of fluids - mainly water - might lower a person's risk of bladder cancer.
Eat lots of fruits and vegetables: A diet high in fruits and vegetables might help protect against bladder cancer. Eating a healthy diet has been shown to have many benefits, including lowering the risk of some other types of cancer.
Take caution around chemicals: If you work with chemicals, follow all safety instructions to avoid exposure.
If you've been diagnosed with bladder cancer, it's important to know the benefits of each treatment option against the possible risks and side effects. We at CAN-C are specializing in the comprehensive multidisciplinary care for the treatment of bladder cancer in Bangalore. The most common types of treatments used for bladder cancer are listed below.
Surgery is part of the treatment for most bladder cancers. The type of surgery done depends on the stage (extent) of the cancer.
Transurethral resection of bladder tumor (TURBT): It is often used to find out if someone has bladder cancer and, if so, whether the cancer has spread into (invaded) the muscle layer of the bladder wall. TURBT is also the most common treatment for early-stage or superficial (non-muscle invasive) bladder cancers. The goal is to take out the cancer cells and nearby tissues down to the muscle layer of the bladder wall.
Cystectomy: When bladder cancer is invasive, all or part of the bladder may need to be removed. This operation is called a cystectomy. Most of the time, chemotherapy is given before cystectomy is done.
Partial cystectomy: If the cancer has invaded the muscle layer of the bladder wall but is not very large and is only in one place, it can sometimes be removed along with part of the bladder wall without taking out the whole bladder. Nearby lymph nodes are also removed and tested for cancer spread.
Radical cystectomy: If the cancer is larger or is in more than one part of the bladder, a radical cystectomy will be needed. This operation removes the entire bladder and nearby lymph nodes.
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Radiation therapy uses high-energy radiation to kill cancer cells.
Radiation therapy can be used:
1. As part of the treatment for some early-stage bladder cancers, after surgery that doesn't remove the whole bladder (such as TURBT)
2. As the main treatment for people with earlier-stage cancers who can't have surgery or chemotherapy
3. To try to avoid cystectomy (surgery to take out the bladder)
4. As part of treatment for advanced bladder cancer (cancer that has spread beyond the bladder)
5. To help prevent or treat symptoms caused by advanced bladder cancer
6. Radiation therapy is often given along with chemotherapy to help the radiation work better. This is called chemoradiation.
How is radiation therapy given?
The type of radiation most often used to treat bladder cancer is called external beam radiation therapy. It focuses radiation from a source outside of the body on the cancer.
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Chemotherapy (chemo) is the use of drugs to treat cancer. Chemo for bladder cancer can be given in 2 different ways:
Intravesical chemotherapy: For this treatment, the chemo drug is put right into the bladder. This type of chemo is used for bladder cancer that's only in the lining of the bladder.
Systemic chemotherapy: When chemo drugs are given in pill form or injected into a vein (IV) or muscle (IM), the drugs go into the bloodstream and travel throughout the body. This is called systemic chemotherapy. Systemic chemo can affect cancer cells anywhere in the body.
When is chemotherapy used?
Systemic chemo can be used:
1. Before surgery to try to shrink a tumor so that it's easier to remove and to help lower the chance the cancer will come back. Giving chemo before surgery is called neoadjuvant therapy.
2. After surgery (or sometimes after radiation therapy). This is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that may remain after other treatments. This can lower the chance that the cancer will come back later.
3. In people getting radiation therapy, to help the radiation work better.
4. As the main treatment for bladder cancers that have spread to distant parts of the body.
Chemo drugs may be used alone or in combination, depending on what they're being used for, a person's overall health, and other factors.
When chemo is given with radiation, the most common drugs used include:
Cisplatin, Cisplatin plus fluorouracil (5-FU), Mitomycin with 5-FU
When chemo is used without radiation, the most common combinations include:
Gemcitabine and cisplatin, Dose-dense methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (DDMVAC), Cisplatin, methotrexate, and vinblastine (CMV), Gemcitabine and paclitaxel
Newer drugs have developed to target some changes inside the cells. Targeted drugs work differently from other types of treatment, such as chemotherapy (chemo).
Fibroblast growth factor receptors (FGFRs) are a group of proteins on bladder cancer cells that can help them grow. In some bladder cancers, the cells have changes in FGFR genes (which control how much of the FGFR proteins are made). Drugs that target cells with FGFR gene changes (called FGFR inhibitors) can help treat some people with bladder cancer.
This FGFR inhibitor can be used to treat locally advanced or metastatic bladder cancer that has certain changes in the FGFR2 or FGFR3 gene, and that is still growing despite treatment with chemo. It is taken by mouth as tablets.
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BCG is a type of bacteria related to the one that causes tuberculosis. While it doesn't usually cause a person to get sick, it can help trigger an immune response. BCG can be put right into the bladder as a liquid. This activates immune system cells in the bladder, which then attack bladder cancer cells.
Immune checkpoint inhibitors (for advanced cancers)
An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses "checkpoints" - molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system. But newer drugs that target these checkpoints hold a lot of promise as cancer treatments. At this time, these drugs are used to treat bladder cancers that have spread to other parts of the body.
Atezolizumab (Tecentriq®), durvalumab (Imfinzi®), and avelumab (Bavencio®) are drugs that target PD-L1, a protein on cells (including some cancer cells) that helps keep the immune system from attacking them. By blocking PD-L1, these drugs boost the immune system's response against the cancer cells. This can shrink some tumors or slow their growth.
Nivolumab (Opdivo®) and pembrolizumab (Keytruda®) target PD-1, another protein that normally helps keep the immune system in check. Blocking PD-1 can allow the immune system to attack the cancer cells.
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