Bladder Cancer Diagnosis & Treatment
What are Bladder Cancer Treatments?
Bladder cancer is a type of cancer that starts in the cells of the bladder, the organ responsible for storing urine.
It can cause symptoms like blood in urine and frequent urination and requires various treatments depending on its stage and severity.
In Malaysia, there are various treatment options available for bladder cancer. The specific treatment plan will depend on multiple factors, such as the cancer stage, the tumour grade, the patient’s overall health, and other individual factors.
Surgery
Surgery is a common treatment for bladder cancer. It can involve procedures such as transurethral resection of bladder tumours (TURBT) to remove small tumours, partial or radical cystectomy to remove part or all of the bladder, and urinary diversion techniques for redirecting urine flow after bladder removal.
- Performed using a cystoscope inserted through the urethra
- Removes small tumours confined to the inner layers of the bladder
- Commonly used for diagnosing and treating early-stage bladder cancer
- Can also be used to remove larger tumours that are not deeply invasive
Partial or Radical Cystectomy:
- Partial Cystectomy
- Removes only a portion of the bladder
- Preserves some bladder function
- Suitable for localised and limited cancer
- Radical Cystectomy
- Removes the entire bladder, nearby lymph nodes, and sometimes surrounding organs
- Used when cancer has spread
- Reconstruction techniques like ileal conduit or neobladder are used for urinary diversion
Lymphadenectomy:
- Performed when there is a high risk of cancer spreading to lymph nodes
- Removes lymph nodes in the pelvis
- Aims to reduce the risk of cancer recurrence or metastasis
Radiation Therapy
Radiation therapy is a common treatment option for bladder cancer.
This involves using a machine called a linear accelerator to deliver high-energy X-rays to the tumour from outside the body. The radiation beams are carefully targeted at the bladder to kill cancer cells while minimising damage to surrounding healthy tissues.
Radioactive material, such as seeds or wires, is temporarily placed inside the bladder. These radioactive sources emit radiation directly to the tumour, delivering a concentrated dose of radiation while sparing healthy tissues.
Radiation therapy can be combined with other treatments, such as surgery or chemotherapy, to increase effectiveness. It may be used before surgery (neoadjuvant therapy) to shrink tumours or after surgery (adjuvant therapy) to target any remaining cancer cells.
In advanced cases or when bladder cancer has spread, radiation therapy can be used to help alleviate symptoms, such as pain, bleeding, or urinary obstruction, and improve the quality of life.
Chemotherapy
Chemotherapy is a treatment option for bladder cancer that uses drugs to kill cancer cells or slow down their growth.
Chemotherapy drugs are directly instilled into the bladder through a catheter. This method is often used for early-stage bladder cancer or to prevent recurrence after tumour removal. Common drugs used include mitomycin C and bacillus Calmette-Guérin (BCG).
Drugs are given intravenously or orally to target cancer cells throughout the body. Systemic chemotherapy may be used before or after surgery or in advanced cases where cancer has spread to other parts of the body. The choice of drugs and regimen depends on the specific characteristics of the tumour and the patient’s overall health.
Different chemotherapy drugs can be combined to enhance their effectiveness. Combination chemotherapy is commonly used in advanced bladder cancer to improve treatment outcomes. Platinum-based drugs, such as cisplatin or carboplatin, are often used in combination with other medications like gemcitabine or paclitaxel.
Neoadjuvant chemotherapy is given before surgery to shrink tumours and increase the likelihood of successful surgery. Adjuvant chemotherapy is administered after surgery to target any remaining cancer cells and reduce the risk of recurrence.
Targeted Therapy
Targeted therapy is an emerging treatment approach for bladder cancer aiming to target specific genetic mutations or pathways in cancer cells.
Targeted therapy drugs are designed to block specific molecules or pathways involved in the growth and spread of cancer cells. These drugs work differently from traditional chemotherapy by specifically targeting cancer cells while sparing normal cells.
Fibroblast growth factor receptor (FGFR) inhibitors are a type of targeted therapy used for bladder cancer with specific genetic alterations in FGFR genes. FGFR Inhibitors are used to inhibit abnormal FGFR signalling and slow down cancer growth.
Bladder cancers that overexpress human epidermal growth factor receptor 2 (HER2) may benefit from targeted therapy drugs. These drugs specifically target HER2-positive cancer cells and interfere with their growth signals.
Targeted therapy drugs can be combined with other treatment modalities like chemotherapy or immunotherapy to maximise effectiveness.
Immunotherapy
Immunotherapy is a type of cancer treatment that boosts the body’s immune system to recognise and attack cancer cells.
Immunotherapy drugs, known as immune checkpoint inhibitors, are used in bladder cancer treatment and can lead to durable responses and long-term control. It is used in advanced cases when cancer has spread or as an option when other treatments have not been effective. However, not all patients respond to immunotherapy, and its effectiveness may vary from person to person.
Side Effects of Surgery
Like any medical procedure, surgery can have potential side effects. Here are some common ones associated with bladder cancer surgery:
Following surgery, it is normal to experience pain and discomfort at the surgical site.
Depending on the extent of the surgery, there may be temporary or permanent changes in urinary control, leading to urinary leakage or incontinence.
Surgery may result in difficulty emptying the bladder completely, requiring the use of a catheter or other interventions.
In both men and women, bladder cancer surgery can affect sexual function. This may include changes in sexual desire, erectile dysfunction in men, or vaginal dryness and discomfort in women.
Surgery involving the bladder can affect bowel function. Some individuals may experience changes in bowel movements, such as diarrhoea or constipation.
As with any surgical procedure, there is a risk of potential complications, such as bleeding, infection, blood clots, or damage to surrounding organs or structures.
Side Effects of Radiation Therapy
Radiation therapy can cause certain side effects:
- Increased Frequency and Urgency: Radiation therapy can cause irritation and inflammation of the bladder, leading to increased frequency and urgency of urination.
- Painful or Burning Sensation: Some patients may experience discomfort or a burning sensation during urination.
Radiation therapy can cause fatigue, making patients feel tired and lacking energy.
The skin in the treated area may become red, irritated, or sensitive. It may resemble a sunburn and may be itchy or dry.
- Gastrointestinal Issues: Radiation therapy to the pelvic area can affect the gastrointestinal system, resulting in side effects such as:
- Diarrhoea: Radiation can cause an increase in bowel movements and loose stools.
- Rectal Discomfort: Some patients may experience rectal pain, irritation, or bleeding.
Radiation therapy to the pelvic region can sometimes affect sexual function, leading to erectile dysfunction in men or vaginal dryness and discomfort in women.
In some cases, radiation therapy can cause scarring or narrowing of the bladder or bowel, leading to difficulties with urination or bowel movements.
Rarely, radiation therapy for bladder cancer may result in long-term side effects such as bladder or bowel damage, chronic inflammation, or an increased risk of secondary cancers.
Side Effects of Chemotherapy
Chemotherapy can also have side effects:
Chemotherapy drugs can affect the digestive system, leading to nausea and vomiting. Medications can be prescribed to help manage these side effects.
Some chemotherapy drugs can cause temporary hair loss, including hair on the scalp, eyebrows, and body. Hair usually grows back once treatment is completed.
Chemotherapy can cause fatigue, making patients feel tired, weak, or lacking energy.
- Anaemia: Chemotherapy can lower red blood cell counts, resulting in anaemia. This can cause fatigue, shortness of breath, and weakness.
- Increased Risk of Infection: Chemotherapy can reduce the number of white blood cells, which are essential for fighting infections. This can increase the risk of infections.
Chemotherapy can affect platelet counts, increasing the risk of bruising or bleeding.
Some chemotherapy drugs can cause mouth sores or ulcers, making it uncomfortable to eat or drink.
Certain chemotherapy drugs can cause peripheral neuropathy, characterised by numbness, tingling, or pain in the hands and feet.
Chemotherapy can affect the sense of taste, causing changes in appetite or taste preferences.
Side Effects of Targeted Therapy
Targeted therapy is a newer treatment approach for bladder cancer and can have certain side effects, such as:
Targeted therapy drugs can cause fatigue or general tiredness.
Some patients may develop a rash or experience skin reactions, such as dryness, itching, or redness.
Targeted therapy drugs can cause gastrointestinal side effects, including diarrhoea, nausea, vomiting, or loss of appetite.
Certain targeted therapy drugs may lead to an increase in blood pressure.
Some targeted therapy drugs can affect the liver and lead to liver function abnormalities.
In rare cases, targeted therapy drugs can increase the risk of blood clot formation, leading to serious complications.
Although rare, allergic reactions to targeted therapy drugs can occur. Symptoms may include difficulty breathing, swelling, rash, or severe itching.
Some targeted therapy drugs may impact the heart, leading to changes in heart rhythm or function. Regular cardiac monitoring may be required.
Side Effects of Immunotherapy
Similarly, immunotherapy can cause side effects like:
Immunotherapy drugs can cause fatigue or a general feeling of tiredness.
Some patients may develop a rash or experience skin reactions, such as itching, redness, or dryness.
Immunotherapy can cause flu-like symptoms, including fever, chills, body aches, or headache.
Some patients may experience diarrhoea, nausea, vomiting, or loss of appetite due to immunotherapy treatment.
Immunotherapy drugs occasionally affect the endocrine system, leading to hormonal imbalances.
Immunotherapy stimulates the immune system, which can occasionally lead to immune-related side effects known as immune-related adverse events (irAEs). These can affect various organs and systems in the body, such as the lungs (pneumonitis), liver (hepatitis), intestines (colitis), or endocrine glands (hypophysitis).
In rare cases, immunotherapy can trigger autoimmune reactions, where the immune system mistakenly attacks healthy cells or organs. This can lead to conditions such as autoimmune hepatitis, thyroiditis, or type 1 diabetes.
Managing Side Effects in Bladder Cancer Treatment
It is important to recognise that early detection of bladder cancer significantly improves management outcomes. If you notice any changes in your bladder health or have concerns, promptly consult a healthcare professional for evaluation.
If you or your loved one suspects bladder cancer, obtaining timely support and diagnosis is essential for effective treatment.
Regardless of the disease stage, scheduling an appointment with a specialist is advised. Advances in bladder cancer research continue to introduce new and innovative treatment options, which your oncologist can explore to optimise your care.
What is Bladder Cancer?
Bladder cancer is a type of cancer that originates in the cells of the bladder, a hollow organ in the lower abdomen that stores urine. The most common type of bladder cancer is urothelial carcinoma, also known as transitional cell carcinoma, which begins in the urothelial cells lining the inside of the bladder.
Bladder cancer is a significant global health concern. It ranks as the 10th most common cancer worldwide, accounting for around 3.2% of all new cancer cases. The disease primarily affects older individuals, with most cases occurring in people over the age of 55. The global mortality rate is estimated to be approximately 2.8%.
These statistics provide a general overview of bladder cancer’s prevalence and impact both worldwide and in Singapore, emphasising the need for continued research, early detection, and effective treatment strategies to combat this disease.
What Are the Signs and Symptoms of Bladder Cancer?
The signs and symptoms of bladder cancer can vary, and some individuals may not experience any symptoms in the early stages.
The most common symptoms include:
The most noticeable symptom of bladder cancer is blood in the urine, also known as hematuria. Blood may appear either grossly (visible to the naked eye) or microscopically (detected only during urine testing) and is typically painless.
Bladder cancer can cause an increased urge to urinate frequently, often accompanied by a sense of urgency or discomfort during urination.
Some individuals may experience pain or a burning sensation during urination, often resulting from irritation or inflammation caused by the tumour.
Advanced bladder cancer may cause persistent pain in the lower back or pelvis, which may worsen over time.
Bladder cancer can lead to changes in urinary habits, such as increased frequency, urgency, or difficulty emptying the bladder completely.
In some cases, bladder cancer may cause fatigue and unexplained weight loss, symptoms more commonly associated with advanced stages of the disease.
It’s important to note that other non-cancerous conditions, such as urinary tract infections or bladder stones, can also cause these symptoms. However, if any of these symptoms persist or cause concern, consulting a healthcare professional for a proper evaluation and diagnosis is crucial.
Screening for Bladder Cancer
Unlike some other cancers, there are no standard screening tests recommended for the general population to detect bladder cancer in its early stages. This is because there is currently insufficient evidence to support the effectiveness of routine screening for this disease in individuals without specific risk factors or symptoms.
However, for certain high-risk individuals, such as those with a history of bladder cancer or exposure to certain occupational hazards, regular screening or surveillance may be recommended. The specific strategies may vary based on individual risk factors and medical history.
In general, if you have symptoms suggestive of bladder cancer, such as blood in the urine (hematuria), frequent urination, or persistent urinary tract infections, it is essential to consult a healthcare professional for proper evaluation. They may perform tests such as urine analysis, imaging studies (like ultrasound or CT scan), or cystoscopy (a procedure to examine the bladder using a thin tube with a camera) to help diagnose or rule it out.
Additionally, it’s worth noting that reducing exposure to known risk factors for bladder cancer, such as quitting smoking and minimising occupational exposure to certain chemicals, can help lower the risk of developing the disease.
How Bladder Cancer Is Diagnosed
Bladder cancer is typically diagnosed through a combination of medical history evaluation, physical examination, and diagnostic tests. The process may involve the following steps:
The doctor will begin by taking a detailed medical history, including any symptoms you may be experiencing and any risk factors you may have. They will also perform a physical examination to assess your overall health and look for signs or abnormalities.
A urine sample will be collected and analysed for the presence of blood, cancer cells, or other abnormalities. This test, known as urine cytology, can help detect cancerous cells in the urine.
Imaging tests such as ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be performed to visualise the bladder and surrounding structures. These tests can help identify the presence, size, and location of any tumours or abnormalities.
Cystoscopy is a procedure in which a thin, flexible tube with a camera on the end, called a cystoscope, is inserted through the urethra and into the bladder. This allows the doctor to visualise the bladder directly and examine its lining for abnormalities, such as tumours. During cystoscopy, a biopsy may be taken, where small tissue samples are collected for further examination under a microscope.
If suspicious areas or tumours are detected during cystoscopy, a biopsy may be performed to confirm the presence of cancer cells. The collected tissue samples are sent to a laboratory where a pathologist examines them under a microscope to determine if they are cancerous and to determine the specific type and grade of bladder cancer.
Once a diagnosis of bladder cancer is confirmed, further tests may be conducted to determine the stage of the cancer and whether it has spread to other part.
What Are the Causes and Risk Factors of Bladder Cancer?
The exact causes of bladder cancer are not fully understood, but it is believed to develop due to a combination of genetic and environmental factors. Several risk factors have been identified that can increase the likelihood of developing bladder cancer. These include:
Smoking: Smoking tobacco is the most significant risk factor for bladder cancer. Chemicals in tobacco smoke are absorbed into the bloodstream and excreted in the urine, directly exposing the bladder lining to carcinogens.
Occupational Exposure: Certain occupations involving exposure to chemicals such as aromatic amines, benzidine, and certain dyes and industries such as rubber, paint, and metalworking have been linked to an increased risk of bladder cancer.
Age and Gender: Bladder cancer occurs more frequently in older adults, with the risk increasing with age. Men are more likely to develop it compared to women.
Previous Cancer Treatment: Individuals who have received certain cancer treatments, such as radiation therapy or certain chemotherapy drugs, particularly cyclophosphamide, have an increased risk of developing bladder cancer.
Chronic Bladder Inflammation: Chronic urinary tract infections, bladder stones, and long-term use of urinary catheters can cause chronic irritation and inflammation of the bladder, which may increase the risk of developing bladder cancer.
Family History: Bladder cancer has been observed to occur more frequently in some families, suggesting a genetic predisposition.
Diet and Lifestyle Factors: A diet low in fruits and vegetables and high in processed meats, as well as obesity, have been suggested as potential risk factors for bladder cancer.
It’s important to note that having one or more of these risk factors does not necessarily mean that an individual will develop bladder cancer. Conversely, some individuals with the disease may not have any known risk factors. Understanding the risk factors can help individuals make informed lifestyle choices and undergo appropriate screening or preventive measures when necessary.
What Are the Types of Bladder Cancer?
Bladder cancer can be classified into different types based on the specific cells that are affected. The main types include:
This is the most common, accounting for the majority of cases. It develops in the urothelial cells that line the inside of the bladder and can also occur in the lining of the ureters and urethra.
This type arises from squamous cells that form in response to chronic irritation or inflammation of the bladder, such as from long-term urinary tract infections or bladder stones. Squamous cell carcinoma is less common than transitional cell carcinoma and is often associated with advanced disease.
Adenocarcinoma of the bladder is a rare type of cancer that develops in the glandular cells of the bladder. It is more similar to cancers found in other organs like the colon or prostate than to typical bladder cells.
Less common types include small cell carcinoma, sarcoma, and lymphoma, and they account for a small percentage of bladder cancer cases.
The type of bladder cancer and its stage play a crucial role in determining the treatment approach and prognosis. A proper diagnosis is essential to guide appropriate treatment decisions, and healthcare professionals use various diagnostic tests, including biopsies and imaging, to determine the specific type and stage of bladder cancer in each case.
What Are the Stages of Bladder Cancer?
Bladder cancer staging refers to the process of determining the extent and spread of the cancer within the bladder and to nearby organs or lymph nodes. The stages are typically classified using the TNM system, which stands for Tumour, Nodes, and Metastasis. It ranges from non-invasive (limited to the inner lining of the bladder) to invasive (spreading into deeper layers of the bladder or beyond). Here is a general overview of the stages of bladder cancer:
The cancer is confined to the innermost layer of the bladder lining and has not invaded the bladder muscle or spread to nearby lymph nodes or distant sites.
The cancer has grown into the connective tissue layer beneath the bladder lining but has not reached the muscle layer or beyond. It has not spread to lymph nodes or distant sites.
The cancer has invaded the muscle layer of the bladder but has not spread beyond the bladder walls. It has not reached lymph nodes or distant sites.
The cancer has grown through the bladder muscle and may have spread to the surrounding fatty tissue. It may involve nearby organs or lymph nodes but has not spread to distant sites.
This is the most advanced stage and indicates that the cancer has spread beyond the bladder to nearby organs, lymph nodes, or distant sites, such as the bones, liver, or lungs.
Staging plays a crucial role in determining the appropriate treatment options and predicting the prognosis for bladder cancer patients. Various diagnostic tests, such as imaging, biopsies, and sometimes surgical exploration, are done to accurately determine the stage of bladder cancer in each individual case.
