Urinary bladder cancer

Symptoms Of Urinary Bladder Cancer

Symptoms of bladder cancer may vary from person to person. However, hematuria (the presence of blood in urine) is observed in most individuals. Urine is often slightly rusty to bright red. 

Other signs and symptoms may include:

• Frequent urination
• Pain or burning sensation while urinating 
• The feeling of incomplete emptying of the bladder
• Urinating often during the night

If the cancer has spread beyond the bladder, symptoms may also include:

• Difficulty in urination
• Back pain
• Abdominal pain
• Bone pain or tenderness
• Pelvic pain
• Unintended weight loss 
• Loss of appetite
• Tiredness
• Swelling in the feet

Note: The above symptoms can also be due to underlying urinary tract infections, kidney or bladder stones, or other kidney-related issues, as they also have similar symptoms. So, a proper diagnosis is needed to confirm them.

Types Of Urinary Bladder Cancer

Based on the invasiveness, bladder cancer is of two types:

1. Nonmuscle-invasive (Superficial bladder cancer)

• It is also called superficial bladder cancer because cancerous cells affect the bladder's lining and have not invaded the bladder wall.

• It is mainly looked at as an early-stage 

• Constitutes of almost 70-75% of cases of all diagnosed bladder cancer

2. Muscle-invasive bladder cancer 

• Cancer has spread into the bladder muscle beyond the lining

• Potentially affecting surrounding tissues or organs

• Considered as an advanced stage

• Represents 25 to 30% of all cases of bladder cancer

Stages of bladder cancer

• Stage 0: Cancer cells are found in tissue lining the inside of the bladder but have not invaded the bladder wall

• Stage 1:  Cancer has spread into the connective tissue but has not reached the muscle layers of the bladder.

• Stage 2:  Cancer has spread through the connective tissue into the muscle layers of the bladder.

• Stage 3: Cancer has spread into the layer of fat surrounding the bladder and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina) 

• Stage 4: Cancer has spread to the abdominal wall or pelvic wall

Causes Of Urinary Bladder Cancer

The bladder is a balloon-shaped organ in the lower part of the abdomen. Its main function is to store urine until it is passed from the body. Bladder cancer occurs when cells in the bladder undergo uncontrolled growth.

Changes occurring in the DNA of normal bladder cells can lead to abnormal growth and cancer formation. DNA, the fundamental chemical in our cells, comprises our genes, which regulate cellular functions beyond physical appearance. 

Our DNA, which we inherit from our parents, holds a significant influence over a wide range of cellular processes. Specific genes govern the growth, division, and survival of cells:

• Oncogenes: These genes promote cell growth, division, and longevity.

• Tumor suppressor genes: They typically regulate cell division, DNA repair, and programmed cell death.

The onset of cancer can be attributed to DNA alterations, known as gene mutations. These mutations, whether they activate oncogenes or deactivate tumor suppressor genes, are the key drivers of cancer formation. It's important to note that multiple gene mutations are typically required for a cell to progress into cancer, underscoring the complexity and seriousness of this process.

Anyone can get bladder cancer. Though unclear what causes it, research has identified some risk factors discussed under the "risk factors" section. 

Risk Factors For Urinary Bladder Cancer

Age

Older adults (≥65 years) are at a higher risk of bladder cancer. The majority of people diagnosed with bladder cancer are above 55 years of age. 

Gender

Men are more likely to be diagnosed with bladder cancer than women. This disparity could be attributed to the differences in hormonal pathways. 

Furthermore, the increased prevalence in them is also influenced by higher rates of smoking, alcohol use, and workplace exposure.

Race and ethnicity

As per some studies, white people are more prone to bladder cancer as compared to non-whites. 

Personal and family history

Individuals with a personal and family history of bladder cancer or other urothelial cancers are at increased risk of developing bladder cancer again.

Genetics

Specific genetic syndromes, such as mutations in genes like RB1 (retinoblastoma), PTEN (Cowden disease), and Lynch syndrome, can predispose individuals to bladder cancer.

Smoking

Smoking is the most important risk factor for bladder cancer, accounting for almost half of all the cases in India. The risk depends on smoking duration and intensity. The risk of bladder cancer in smokers is 2 to 6-fold more significant than that of non-smokers. 

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Workplace exposures 

Bladder cancer incidence has been linked to exposure to potential carcinogens found in the rubber, leather, printing materials, textiles, and dye industry, such as aromatic amines and carbon black dust. People who work in the following occupations are more prone to bladder cancer: 

• Steel production
• Paint
• Hairdressing
• Construction
• Dying
• Petroleum 
• Metals
• Rubber
• Leather
• Textiles
• Printing Diesel
  

Dehydration

Not drinking enough fluids, particularly water, may increase the risk of bladder cancer, possibly due to reduced bladder clearance of harmful substances.

Contaminated water consumption

The IARC (International Agency for Research on Cancer) recognizes arsenic in drinking water as a proven cause of bladder cancer. Arsenic is usually present in drinking water, and concentrations higher than 300 µg/l are reported to increase the risk of bladder cancer. 

Also, the presence of nitrate in drinking water has been linked to an elevated risk of bladder cancer in postmenopausal women.

Infections and chronic bladder irritation

The following conditions increase the risk of bladder cancer by irritating the bladder: 

• Urinary infections
• Bladder and kidney stones
• Placement of bladder catheter for a longer duration

Quick Byte!

Schistosomiasis, an infection with a parasitic worm that can get into the bladder, is a well-documented risk factor for bladder cancer. The occurrence of bladder cancer is significantly higher in countries with a high prevalence of this parasite, primarily found in Africa and the Middle East.
 

Excessive consumption of red meat

The regular consumption of red and processed meat significantly increases the risk of bladder cancer. 

Obesity

Research has shown that obesity is associated with an increased risk of bladder cancer.

Here are some common causes of obesity one should be aware of
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Certain medications and herbal supplements

Some medications, such as pioglitazone (used to treat type 2 diabetes) and herbal supplements containing aristolochic acid, have been associated with a slightly increased risk of bladder cancer.

Chemotherapy and radiation therapy 

Chemotherapy with certain drugs such as cyclophosphamide and exposure to multiple radiations are also linked with an increased incidence of bladder cancer.

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Diagnosis Of Urinary Bladder Cancer

Diagnosis of bladder cancer involves a series of steps which involve:

1. Medical history and physical examination

The doctor will gather information about personal and familial history to trace the risk factors. The doctor also inquires about clinical symptoms and recommends lab tests accordingly.

Physical examinations may include a pelvic and rectal exam.

2. Urine test

The primary investigations through a urine test include: 

• Hematuria test: A blood sample is viewed under a microscope to determine the presence of blood.

• Urine cytology involves the analysis of urine for abnormal cells using a microscope.

• A urine culture is done to determine pathogens' presence and rule out infections.

3. Imaging tests

Imaging tests that are used to confirm bladder cancer include:

• Cystoscopy: In this procedure, the doctor looks inside the bladder and urethra using a cystoscope. This tool also helps remove tiny bladder tumors or tissue samples for biopsy.
  
  

• Biopsy/transurethral resection of bladder tumor (TURBT): A small amount of tissue is studied under a microscope in a biopsy. The tissue is collected using cystoscopy. A CT scan or ultrasound helps to locate the tumor.
  
  

• Positron emission tomography (PET) or PET-CT scans involve taking pictures of the inside of the body using a scanner.
  
  

• A computed tomography (CT) urogram test captures images of the kidneys, bladder, and ureters, along with detailed pictures of nearby bones, soft tissues, and blood vessels. It helps the doctor evaluate the urinary tract's efficiency and identify potential diseases.
  
  

• Intravenous pyelogram (IVP) is an X-ray imaging test of the urinary tract. A sequence of X-ray pictures is used to identify cancer in the kidneys, ureters, and bladder.
  
  

• Magnetic resonance imaging (MRI) uses a magnetic field to produce detailed body images using a dye. The dye helps obtain a clear picture of the organs in which cancer may have spread. It is used to measure the tumor size and track colon cancer's location.
  
  

• Bone scan: This involves scanning the bone using radioactive material. It is used to detect if cancer has spread to the lungs.
  
  

• Ultrasound uses sound waves to produce a detailed image of the internal organs. It is used to find the locations in which a tumor has spread.
  
  

• Chest X-rays: An X-ray of the chest is used to detect if colon cancer has spread to the lungs.

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Prevention Of Urinary Bladder Cancer

Approximately 81.8% of cases of bladder cancer are attributed to known preventable causes. It is an ideal choice for public health prevention efforts. The following measures help prevent cases of bladder cancer. 

1. Quit smoking

Smoking cessation can reduce the risk of bladder cancer. Avoiding exposure to second-hand smoke is also crucial.

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2. Minimize occupational exposure

Exposure to certain chemicals increases the risk of bladder cancer. Workplaces where these chemicals are commonly used include the rubber, leather, printing materials, textiles, and paint industries.

Good work safety practices to minimize chemical exposure can also help prevent bladder cancer. 

3. Keep yourself hydrated

Proper hydration and optimum water intake also lower a person's risk of bladder cancer. 

How much water should you be drinking.
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4. Eat healthy

The following dietary habits are associated to help prevent bladder cancer: 

• Consume a balanced diet rich in fruits, vegetables, and whole grains.

• Limit intake of processed meats and foods high in saturated fats

• Higher intake of selenium, Vitamins A, D, and E, and folate is associated with a reduced incidence of bladder cancer.

Here are six tips to reap the benefits of a healthy diet.
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5. Indulge in physical activity

Physical activity exerts a protective role against bladder cancer. It is advised to indulge in some form of exercise. 

Here are the top 5 benefits of walking daily.
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6. Minimize the exposure to parasitic worms

Schistosomiasis, an infection of parasitic worms, is also responsible for bladder cancer. People are infected with these worms during agricultural, domestic, occupational, and recreational activities that expose them to infested water.

This can be prevented through:

• Disinfecting drinking and bathing water 
• Avoiding freshwater swimming 
• Limiting walking through reasonably deep water

7. Protect your skin from sun

Some studies suggest a link between sunburn and an increased risk of bladder cancer. Protect your skin from the sun's UV radiation by wearing sunscreen and protective clothing and seeking shade. 

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8. Practice safe sex

Protecting yourself from sexually transmitted infections may reduce the risk of certain types of bladder cancer associated with these infections.

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9. Manage bladder issues

Seek treatment for bladder inflammation or infections to reduce long-term irritation and potential cancer risk.

10. Know your family history

If you have a family history of bladder cancer or other related cancers, inform your healthcare provider. They may recommend additional screening or preventive measures.

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Specialist To Visit 

Cancer requires multispecialty comprehensive care. Doctors who take care of patients with bladder cancer and help in diagnosing and formulating a treatment plan are:

• General Physician
• Urologic oncologist
• Medical oncologist
• Surgeon
• Nephrologist
• Palliative care clinicians
  
  

General physician: This physician diagnoses initial symptoms, orders preliminary tests, and refers patients to specialists such as urologists for further evaluation and treatment planning.

Urologic oncologist:  This specialist specializes in diagnosing and treating cancers of the male and female urinary tract and male reproductive organs. 

Medical oncologist:  Help in management of bladder cancer through medications.

Surgeons: Help in operative procedures essential for bladder cancers. 

Nephrologist: This specialist assists in managing complications like kidney dysfunction secondary to urinary obstruction or metastasis in advanced bladder cancer cases, emphasizing kidney function preservation.

Palliative care clinicians: Focus on symptom management, incorporating diagnostic findings to provide supportive care, alleviate pain, and enhance the quality of life in advanced bladder cancer patients.

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Treatment Of Urinary Bladder Cancer

Various treatment options are available for bladder cancer, which are determined based on the patient's risk factors, grade, stage, side effects, preferences, and age. Multiple treatment options include: 

1. Surgery

It includes the removal of cancer through an operation. It is one of the most commonly used methods in all the stages of bladder cancer. The type of surgery depends on where the tumor is located and includes: 

• Transurethral resection of bladder tumor (TURBT): This procedure involves removing the cancer through a cystoscope inserted into the bladder through the urethra. It is commonly used for non-invasive or early-stage bladder cancer.

• Partial cystectomy: Removes part of the bladder, often for low-grade tumors confined to a specific area.

• Radical cystectomy with urinary diversion: Removes the entire bladder and surrounding cancerous tissue, sometimes requiring reconstruction to facilitate urine passage.

2. Radiation therapy

It involves using high-energy rays to kill cancer cells. It can be used before, during, and after surgery. In various cases, it is given along with chemotherapy (chemoradiation). 

In the advanced stages, when bladder cancer has spread to other organs such as the lungs, brain, and bones, radiotherapy is practical. It can be given in two ways: 

• External beam radiation therapy (EBRT): EBRT is the most commonly used radiation therapy for bladder cancer. Intense radiation is given from outside the body using a machine. This technique is used if there are a small number of tumors where surgery is contraindicated. 

• Internal radiation therapy: In this therapy, a radioactive substance is placed inside the body near cancer cells. This helps to specifically expose the radiation to the targeted site. This therapy has fewer side effects.

3. Chemotherapy

• Intravesical chemotherapy: Chemotherapy drugs are delivered directly into the bladder through a catheter. This approach is often used after surgery to reduce the risk of cancer recurrence.
  Example: Mitomycin, Docetaxel, Gemcitabine, and Valrubicin
  
  

• Systemic chemotherapy: Chemotherapy drugs are administered orally or through a vein to reach cancer cells throughout the body. It may be used before or after surgery to shrink tumors, kill remaining cancer cells, or treat metastatic disease.
  Example: Carboplatin, Cisplatin, Doxorubicin, Fluorouracil, Paclitaxel, Vinblastine

4. Targeted therapy

It also involves the use of drugs to identify and kill specific cancer cells, due to which it has fewer side effects than chemotherapy and radiation therapy. 

Various drugs used in targeted therapy include:

• Enfortumab vedotin
• Erdafitinib 
• Ramucirumab 
• Sacituzumab govitecan-hziy

5. Immunotherapy

This therapy involves the use of drugs that modulate the immune system. Medications during immunotherapy boost the patient's immune system, which helps fight the cancer cells. It is mainly used in advanced stages of bladder cancer.
Some of the common examples are:

• Pembrolizumab
• Nivolumab
• Avelumab

Discover the science behind immunotherapy and its potential benefits from our expert.

Home-care For Urinary Bladder Cancer

Optimum self care after a bladder cancer diagnosis or surgery is essential for recovery and overall well-being. Here are a few tips to follow:

Follow your doctor's instructions: Adhere strictly to the treatment plan outlined by your healthcare provider. This may include medications, dietary changes, and activity restrictions.

Manage pain: If you experience pain or discomfort, follow your doctor's recommendations for pain relief medication and make sure to take it as prescribed.

Stay hydrated: Drinking fluids is crucial, especially after bladder surgery. However, consult your doctor about the appropriate amount and type of fluids.

Manage urinary symptoms: If you experience urinary incontinence or other bladder-related symptoms, discuss management strategies with your healthcare provider. These may include pelvic floor exercises, bladder training, or the use of protective pads or garments.

Monitor for signs of infection: Keep an eye out for symptoms of urinary tract infections (UTIs), such as burning with urination, frequent urination, cloudy or foul-smelling urine, and fever. Contact your doctor if you experience any of these symptoms.

Practice good hygiene: Keep the surgical incision site clean and dry to prevent infection. Follow any specific wound care instructions provided by your doctor.

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Stay active: While resting and allowing your body to heal is essential, light physical activity can promote circulation and aid recovery. Follow your doctor's recommendations regarding exercise and activity level.

Maintain a healthy diet: Eat a well-balanced diet rich in fruits, vegetables, lean proteins, and whole grains. 

 
Foods to include

• Fruits: Apples, berries, citrus fruits - rich in vitamins and antioxidants.
• Vegetables: Broccoli, kale, and non-starchy veggies.
• Whole grains: Brown rice, quinoa, and whole wheat bread are high in fiber and nutrients.
• Protein sources: Poultry, fish, beans, nuts - essential for healing and energy.
• Beneficial fats: Nuts, olive oil, fish - may lower bladder cancer risk, especially in females.
• Water: Stay hydrated with plenty of fluids, particularly water.

Foods to limit/avoid

• Red meat and processed meats
• Sugar-sweetened beverages
• Packaged and processed foods 
• White bread, pastries na other bakery items

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Note: Every individual's situation is unique, so it's crucial to consult with a dietician for personalized guidance and recommendations based on your specific needs and circumstances.

Learn more about the importance of diet during the treatment of cancer.

Complications Of Urinary Bladder Cancer

Complications of UC include symptoms related to the tumor and treatment of adverse effects. Complications related to the cancer include:

• Weight loss
• Fatigue
• Urinary tract infection 
• Urinary obstruction leading to chronic kidney failure

The adverse effects of surgical management include:

• Urinary leak
• Stones
• Urinary tract obstruction
• Vaginal narrowing
• Erectile dysfunction

7 lifestyle changes to help you fight erectile dysfunction.
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Alternative Therapies For Urinary Bladder Cancer

Bladder cancer cannot be treated and managed without surgery and chemotherapy. However, specific therapies help in managing symptoms and help cope with the side effects of chemotherapy. They also aid in relieving stress and improving overall quality of life. 

1. Tai chi

It is a form of physical activity that helps reduce stress, and alleviate pain by improving flexibility, strength, and balance. 

2. Acupuncture 

It is an ancient technique used in China and Japan. Fine metal needles are inserted into the skin at specific points. This helps alleviate symptoms of ovarian cancer, such as pain, and cope with the side effects of chemotherapy. 

Sometimes, needles are stimulated by electricity, which is known as electro-acupuncture. 

3. Relaxation response

This technique reduces stress. It involves methods such as quiet sitting, progressive muscle relaxation, and repetition of a particular word during inhale and exhale. Practicing for 10-20 minutes daily helps provide emotional stability.

4. Biofeedback

The technique records the individuals' responses, such as heart rate, muscle tension, brain activity, etc., after stimulation. By analyzing the triggers, it helps alleviate physical and emotional symptoms. 

5. Guided imagery

In this, the practitioner hallucinates the person to create mental pictures. These mental images calm the person down and help relieve stress.

Living With Urinary Bladder Cancer

Living with urinary bladder cancer poses unique challenges for patients and caregivers alike. Recognizing that you're not alone is crucial. Caregivers provide vital support, including physical, emotional, and practical assistance. 

Key considerations for managing the situation include:

1. Coping with emotional turmoil

• Receiving a bladder cancer diagnosis can trigger emotions like shock, sadness, anxiety, and anger.

• Seek support from loved ones, join support groups, and explore palliative care options to manage emotional turmoil effectively.

2. Addressing physical side effects

• Monitor and document any new or changing side effects of bladder cancer treatment.

• Promptly inform healthcare providers to prevent worsening

• Maintain detailed records for effective communication with the healthcare team

• Seek treatment for long-term or late-developing side effects to support post-treatment well-being

3. Coping with physical changes and challenges:

• Bladder cancer and its treatments may lead to physical alterations like urinary issues and appearance changes

• Seek guidance from doctors on managing physical changes and gather information about post-treatment life

• Discuss concerns regarding intimacy (relationships and sex) and self-esteem openly with a doctor

4. Managing the financial stress

• Understand the full scope of treatment costs associated with bladder cancer

• Discuss financial concerns openly with loved ones or healthcare providers

• Explore support from organizations offering assistance with treatment-related expenses

5. Ensuring follow-up care

• Adhere to recommended follow-up appointments post-treatment.

• Schedule medical history reviews and physical examinations every 3 to 6 months for 1 to 2 years

• Continue with less frequent appointments after that for ongoing monitoring

Tips for minimizing post-surgery side effects

Some nutrition strategies may help you cope with the symptoms of your cancer and the side effects of treatment.

1. Reduce nausea

Eat room temperature food, avoid spicy or greasy meals, and opt for cooked over raw fruits and vegetables.

2. Manage bloating and wind

Consume smaller meals, sip warm beverages, and limit gas-producing foods like beans and cabbage.

3. Address diarrhea

Stay hydrated, limit caffeine and spicy foods, and avoid fried foods and alcohol.

4. Combat constipation 

Increase fluid intake, consider adding fiber to your diet, and engage in gentle exercise like walking.

6. Relieve dry mouth

Sip water regularly, suck on ice chips, and opt for sharp flavors like lemon.

7. Metallic taste in your mouth

Cancer itself and chemo can alter how food tastes - it may taste metallic or just weird. Use plastic utensils, enjoy sharp flavors like lemon, and experiment with sweeteners or marinades.

FASS Foods Tip:

Enhance flavor during cancer treatment by focusing on FASS:

• Fats: Opt for quality oils or butter like olive, rapeseed, sunflower, or nut.

• Acid: Add citrus juice for zest.

• Salt: Use sea salt flakes for texture and flavor bursts.

• Sugar: Add dates or honey for a subtle sweetness boost.

Role of caregiver

Caregivers play a vital role in the overall recovery of the person. The caregivers can help through: 

• Providing consistent support and encouragement 
• Participating actively in doctor appointments 
• Providing medications
• Assisting in meals
• Helping with household chores
• Handling insurance and billing issues
• Accompanying in exercises such as walking 

Cancer can drain a person physically and mentally.
Gaining knowledge and awareness about cancer and the myths that surround it is necessary to enable timely diagnosis and treatment.
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