Doris Obinna
In the abdomen, there is a muscular sac that receives urine from the kidneys and stores it for discharge.
It is located in the pelvis, above and behind the pubic bone. It is the size and shape of a pear when empty. Urine is made in the kidneys and travels through two tubes called ureters to the bladder.
The bladder could have problems, which cause pain. There are three conditions that cause bladder pain: interstitial cystitis, urinary tract infection and bladder cancer.
The latter begins most often in the cells that line the inside of the bladder. It typically affects older adults, though it can occur at any age. However, the great majority of bladder cancers are diagnosed at an early stage when bladder cancer is highly treatable.
According to an oncologist, Moshe Ornstein, bladder cancer can occur at any age, but it’s more common in older men and much less frequently an issue in younger men and women.
He said: “Time gives you more chances to become exposed to harmful chemicals that get processed through your system. These chemicals collect in urine in the bladder before leaving the body.
“Elderly age is a significant risk factor for cancer in general; repeated exposures to risk factors, including smoking, may result in an accumulation of genetic changes that can contribute to bladder cancer development.”
The expert said about 90 per cent of those with bladder cancer are men whose age is 55 and above.
“The average age of diagnosis is 73 years. We do not know exactly what causes bladder cancer. It may develop related to changes in DNA (the material in cells that makes up genes and controls how cells work),” he said.
Such changes, according to Ornstein, may be inherited (passed on from parents) or acquired as a result of certain risk factors.
Types of bladder cancer
Different types of cells in the bladder can become cancerous. The type of bladder cell, where cancer begins, determines the type of bladder cancer. The bladder cancer type also determines which treatments may work.
Transitional cell carcinoma: Transitional cell carcinoma occurs in the cells that line the inside of your bladder. Transitional cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra. Tumors can form in those places as well. Transitional cell carcinoma is the most common type of bladder cancer in the United States.
Squamous cell carcinoma: Squamous cells appear in your bladder in response to infection and irritation. Over time, they can become cancerous. Squamous cell bladder cancer is more common in parts of the world where a certain parasitic infection (schistosomiasis) is a prevalent cause of bladder infections.
Adenocarcinoma: Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder.
Causes
Ornstein said causes bladder cancer is not always clear. However, he said it had been linked to smoking, a parasitic infection, radiation and chemical exposure.
Research showed that bladder cancer develops when cells in the bladder begin to grow abnormally. 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.
Although a number of chemicals (carcinogens) have been identified as potential causes, especially in cigarette smoke, there are factors that increase a person’s risk of developing a bladder cancer.
Experts say a man has about 1 in 27 chances of developing bladder cancer during his lifetime, while a woman’s risk is about 1 in 89.
According to Omstein, “men may develop bladder cancer more frequently than women because more men smoke tobacco and more may choose careers that involve incidental or chronic exposure to dangerous fumes and compounds.
“Certain professions, such as firefighting, machining and truck driving may increase risk because people in these professions have more exposure to toxins and chemicals; smoking can further increase this risk.
Signs and symptoms
Signs of bladder cancer may include blood in urine (hematuria). In this situation, urine may appear dark yellow, bright red or cola coloured. It may appear normal, but blood may be detected in a microscopic examination of the urine
Others signs are frequent urination, painful urination, back pain and pelvic pain.
Tests and diagnosis
According to study, tests and procedures used to diagnose bladder cancer may include:
Cystoscopy: During cystoscopy, your doctor inserts a narrow tube (cystoscope) through your urethra. The cystoscope has a lens and fiber-optic lighting system, allowing your doctor to see the inside of your urethra and bladder. You usually receive a local anesthetic during cystoscopy to help make you comfortable.
Biopsy: During cystoscopy, your doctor may pass a special tool through the scope and into your bladder in order to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection (TUR). TUR can also be used to treat bladder cancer. It is usually performed under general anesthesia.
Urine cytology: A sample of your urine is analysed under a microscope to check for cancer cells in a procedure called urine cytology.
Imaging tests: Imaging tests allow your doctor to examine the structures of your urinary tract. Tests to highlight the urinary tract sometimes use a dye, which is injected into a vein before the procedure. This procedure is called intravenous pyelogram, which is a type of x-ray imaging test that uses a dye to highlight the kidneys, ureters and bladder.
Stages bladder cancer
Once it’s confirmed that you have bladder cancer, your doctor may order additional tests to determine the extent (stage) of the cancer. Staging tests may include: CT scan, magnetic resonance imaging (MRI), bone scan, and chest X-ray.
However, there are stages of bladder cancer that must be noted:
Stage 1: Cancer at this stage occurs in the bladder’s inner lining but hasn’t invaded the muscular bladder wall.
Stage 2: At this stage, cancer has invaded the bladder wall but is still confined to the bladder.
Stage 3: The cancer cells have spread through the bladder wall to surrounding tissue. They may also have spread to the prostate in men or the uterus or vagina in women.
Stage 4: By this stage, cancer cells may have spread to the lymph nodes and other organs, such as your lungs, bones or liver.
Treatments and drugs
Ornstein disclosed that treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer, the overall health, and treatment preferences.
Surgical procedures
The types of surgical procedures available to you may be based on factors such as the stage of your bladder cancer, your overall health and your preferences.
Surgery for early-stage bladder cancer: If your cancer is very small and hasn’t invaded the wall of your bladder, your doctor may recommend surgery to remove the tumor. Transurethral resection (TUR) is often used to remove bladder cancers that are confined to inner layers of the bladder. During TUR, your doctor passes a small wire loop through a cystoscope into your bladder. The loop is used to burn away cancer cells with an electric current. In some cases, a high-energy laser may be used instead of electric current. TUR may cause painful or bloody urination for a few days following the procedure.
Surgery to remove the tumor and a small portion of the bladder: During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy may be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function.
Surgery carries a risk of bleeding and infection. You may experience more frequent urination after segmental cystectomy, since the operation reduces the size of your bladder. Over time, this may improve.
Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider surgery to remove the entire bladder through radical cystectomy, which is an operation to remove the entire bladder and surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.
Cystectomy carries a risk of infection and bleeding. In men, removal of the prostate and seminal vesicles may cause erectile dysfunction. But in many cases, your surgeon can attempt to spare the nerves necessary for erection. In women, removal of the ovaries causes infertility and premature menopause.
There is also surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for you to expel urine. Several options exist. Which option is best for you depend on your situation and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your kidneys to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen.
In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.
In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your neobladder.
Biological therapy (immunotherapy)
Biological therapy, sometimes called immunotherapy, works by signaling your body’s immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).
Biological therapy drugs used to treat bladder cancer include: An immune-stimulating bacterium – Bacille Calmette-Guerin (BCG) – a bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
There is also a synthetic version of an immune system protein. Interferon is a protein that your immune system makes to help your body fight infections. A synthetic version of interferon, called interferon alfa-2b (Intron A), may be used to treat bladder cancer. Interferon alfa-2b is sometimes used in combination with BCG. Interferon alfa-2b can cause flu-like symptoms.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing a tube through your urethra (intravesical therapy).
Chemotherapy may be used to kill cancer cells that might remain after surgery. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy.
Radiation therapy
Radiation therapy is used infrequently in people with bladder cancer. Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy for bladder cancer usually comes from a machine that moves around your body, directing the energy beams to precise points.
Radiation therapy can be used after surgery to kill cancer cells that might remain. Radiation therapy is sometimes combined with chemotherapy.
Prevention
On prevention tips, Ornstein admonished patients to cautions. He said while you don’t have any control over some of your bladder cancer risk factors, you could take steps in some areas to reduce risk. His remedy include:
Don’t smoke: This means that cancer-causing chemicals contained in smoke won’t have a chance to collect in your bladder. If you currently smoke, do what you can to stop. Talk to your doctor about smoking cessation programmes and support.
Take care with chemicals: If you work with or around chemicals, follow all safety rules to avoid exposure.
Drink water: Stay properly hydrated. Drinking water may dilute harmful substances in your urine and flush them out of your bladder faster. Experts have not found conclusive evidence showing drinking water reduces bladder cancer risk, but it may help, says Ornstein.
Eat a well-balanced diet: Eat a diverse variety of fruits and vegetables, nuts and fish rich in omega-3 fatty acids as well as lean protein; reduce fat and red meat.