Bladder Cancer: An Unmerciful Killer

 

“Cancer is the disruption of the orderly and regulated cycle of cell replication and division under the control of our genes” (Handout).  There are more than one hundred different forms of cancer that can attack almost any part of the body. One form of cancer that affects more people than most are aware of is bladder cancer.  It is the “growth of abnormal cells in the lining of the bladder” (WebMD).  The bladder is the pouch in the urinary tract where urine collects until emptied during urination.

 

There are many types and subtypes of bladder cancer.  Urothelial Carcinoma (TCC) is the most common.  More than ninety per cent of all bladder cancers a subtype of TCC.  Dependent on whether they are flat or papillary and whether they are noninvasive or invasive is how they are categorized.  Invasive means whether or not it has spread beyond the innermost layer(s).  Papillary tumours have fingerlike projections that extend into the bladder.  “Invasion of the thick, deep muscle layer of the bladder is much more serious than an invasion that is limited to the superficial connective tissue layer or the superficial, thin, muscle layer” (American Cancer Society).

 

A mere two per cent of all bladder cancers in the United States are classified as squamous cell carcinomas.  Under a microscope, these tumours highly resemble skin cancer cells.  These types are almost always invasive.  Adenocarcinomas make up around one to two per cent of all bladder cancers.  Having gland forming cells similar to those of intestinal cancers, all adenocarcinomas of the bladder are invasive.  The determination of the type of bladder cancer is important in deciding treatment since each form responds differently.

 

Establishing the stage of the cancer is the most important factor in choosing treatment options since it aids in generating a prognosis for the patient. The staging system employed by the American Joint Committee on Cancer (AJCC) is known as the TNM system. The letter “T” followed by a number from one to four represents the degree of the tumour’s invasion into the bladder wall and surrounding tissues (ACS).  The higher the T number, the more extensive the invasion.  Similarly, the letter “N” followed by a numerical ranging from zero to three designates if cancer has reached beyond the bladder to the nearby lymph nodes (ACS). The numbers zero or one preceded by the letter “M” specifies if cancer’s coverage has extended to distant organs and lymph nodes (ACS).  This compilation of information leads to the determination of a patient’s disease stage, and in turn the treatment that must be utilized.

 

A multitude of symptoms exist that indicate the presence of bladder cancer in one’s body (WebMD):

 

Frequently urinating in small amounts

 

An occurrence of the following symptoms may indicate types of advanced bladder cancer:

 

However, one must realize that these symptoms could signal any number of other ailments, such as a common bladder infection.

 

Although the exact cause of bladder cancer is unknown, habitual smokers are two to four times as likely to develop this form of cancer (WebMD). Similarly, experts have come to the conclusion that smoking triggers up to fifty per cent of male bladder cancer (WebMD).  Bladder cancer may also result from occupational exposure to carcinogens, or cancer-causing chemicals, “such as phenacetin and aniline dyes, used in leather, wood, rubber, and apparel industries” (WebMD). According to The American Cancer Society normal bladder cells, due to DNA mutation, can mature abnormally and form cancers.  The DNA mutation can activate oncogenes, genes that promote mitosis or inactivate tumour suppressor genes that slow down cell division (ACS).  Though the actual mutation is not inherited, “some people seem to inherit a reduced ability to detoxify (break down) certain types of cancer-causing chemicals” (ACS).  Furthermore, alterations in DNA related to bladder cancer arise throughout one’s life (ACS). Another possible cause of bladder cancer is schistosomiasis, an infection that occurs typically in developing countries (WebMD).

 

According to The American Cancer Society, about 57,400 new cases of bladder cancer will be diagnosed across the United States in 2003; of these, 42,200 will occur in men. Likewise, approximately 12,500 Americans (about 8,600 men and 3,900 women) will die from bladder cancer this year (ACS). Consequently, bladder cancer occurs more often in men than in women, making it the fourth most common cancer in men and the tenth most common in women (ACS). Although Caucasian Americans are diagnosed with bladder cancer more frequently, they sometimes have a better prognosis since African Americans are usually diagnosed with more advanced cancer (ACS).

 

Sometimes, bladder cancer can be detected in an early stage, improving the patient’s chances of recovery (ACS).  The initial step involves a physical exam and a detailed medical history to identify any risk factors or symptoms.  If bladder cancer is suspected, a cystoscopy must be performed.  This procedure allows the physician to observe the interior of the bladder, and a sample of tissue can be extracted, a process known as a biopsy if any suspicious regions are noticed (ACS).  Of the many possible laboratory tests to diagnose bladder cancer, the urine culture rules out an infection which causes mistaken symptoms similar to those of cancer (ACS). Furthermore, bladder cancers are graded on a scale from one to four based on their appearance in a microscopic view (ACS).  Low-grade (1) cancers resemble normal bladder tissue, usually have a hopeful prognosis, and are called well-differentiated (ACS).  Grade 2 cancers are known as moderately differentiated and high-grade (3-4) cancers are referred to as either poorly differentiated or undifferentiated (ACS).  Some characteristics of high-grade cancers are (ACS):

 

Does not resemble normal bladder tissue

 

More probable to infest the bladder wall

 

Generates a less desirable prognosis

 

Additional cancers often arise in other areas of the urinary system in people who currently have bladder cancer (ACS). As a result, a surgeon will possibly remove several samples of the bladder lining (ACS).

 

Due to advances in medical technology, there are many treatment options for each patient, including surgery, radiation therapy, immunotherapy, and chemotherapy (ACS). A cystoscopy involves slicing through the bladder wall in order to remove the diseased section of tissue (ACS). A partial cystoscopy can sometimes be done when the cancer is not large and only part of the bladder must be removed (ACS). When the cancer is advanced or large, a radical cystoscopy must be performed. This procedure involves the removal of the whole bladder and surrounding lymph nodes (ACS). When performed on men, the prostate must also be severed. When concerning women, this course of action involves cutting out the uterus, ovaries, a section of the vagina, and fallopian tubes (ACS). Complications may arise, including but not limited to excessive bleeding, urinary tract infections, urine leakage, and the obstruction of the urine stream. Following this course of action, there are a variety of reconstructive surgeries that will be essential to pass urine. There are sexual consequences to this procedure. Men may become impotent, though this may subside with time. The younger the man, the sooner he will regain his sexual abilities. When the patient is able to become fully erect again, he will have a “dry” orgasm due to the lack of a prostate (ACS).

 

By definition, immunotherapy is a treatment that utilizes the body’s immune system to attack bladder cancer (ACS).  Bacillus Calmette-Guerin, or BCG, is a bacterium like the one used to vaccinate against tuberculosis (ACS). Another effective treatment, chemotherapy, destroys the cancer cells using anti-cancer medications and may shrink an advanced tumour for removal by surgery (ACS). Also, chemotherapy can be administered to ensure that the growth of stray cells remaining in the body does not occur (ACS). Similar to chemotherapy, radiation therapy kills cancer cells with high-energy radiation (ACS). Pre-surgery, radiation may ease surgery by shrinking the tumour (ACS). Post-surgery, radiation kills small amounts of cancer cells that could have been overlooked during surgery (ACS). Finally, the pains of advanced bladder cancer, such as urine blockage, bleeding, and discomfort may be alleviated with the aid of radiation (ACS).

 

Prognosis and treatment depend on the stage of cancer when diagnosed. Every patient is different and treatment alternatives vary for each individual. “Based on the stage of cancer, one type or a combination of types of treatment may be recommended” (ACS).

 

There are a number of new alternatives to the cancer treatment choices, such as a Spiral CT Scan, Chemoprevention, Urine tumour marker tests, and Photodynamic Therapy. Not unlike the traditional CT Scan, the Spiral CT Scan is designed to take pictures in thinner portions and in a shorter period of time (ACS). Chemoprevention is a therapy that involves taking particular vitamins and drugs that may prevent new cancers from developing (ACS). Urine tumour marker tests attempt to detect the presence of specified proteins that are found only in cancer cells (ACS). These will be used for recovering cancer patients to detect new cancerous growths. Photodynamic therapy involves an injection of chemicals that accumulate in the tumour (ACS). After a few days, a laser alters the injected chemicals forming a new substance that can kill cancerous cells while not affecting normal cells (ACS).  These new remedies could severely change the way cancer is treated.

 

Following the cancer treatments, lifestyle changes must happen, along with many frequent visits to the doctor. “A typical follow-up plan includes cystoscopy, urine cytology, a general physical exam, x-ray studies and routine blood tests” (ACS). The patient’s body necesitates plenty of rest and good nutrition (ACS). Smoking is not an option for recovering cancer patients. It is also recommended that these patients attend a local support group (ACS).

 

Many factors that increase the risk of getting bladder cancer or from having it recur are (ACS):

 

Race – Caucasians more likely to have recurring         cancers

 

The avoidance of certain things in one’s lifestyle can greatly reduce the risk of contracting cancer.

 

Bladder cancer can severely affect the lives of the patient and their family and friends.  Early symptoms can alert one that cancer is present, and if diagnosed soon enough, can be treated more simply. One should be careful not to overlook or excuse the symptoms, so that an existing problem may not worsen. After all, symptoms are the body’s way of communicating a problem and consequently should not be ignored.

 

 

 

 


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