Bladder cancer is one of the more common types of cancer, but it often gets confused with an easily treatable infection. The cancer is far from easy to treat and, if caught in the most advanced stages, could even lead to removal of the bladder.
Dr. Jenny J. Kim, a medical oncologist who recently left the Alvin & Lois Lapidus Cancer Institute at LifeBridge Health to take a job in California, talks about the symptoms and treatments for bladder cancer.
What are the symptoms of bladder cancer?
Symptoms of bladder cancer include painless hematuria, or blood in the urine, which is macroscopic (grossly visible) or microscopic. Hematuria can be associated with irritative voiding symptoms such as pain, increased frequency and urgency. At times, due to the similarity of symptoms, bladder cancer can be initially misdiagnosed as a urinary tract infection, which can unfortunately delay the [correct] diagnosis. Other symptoms can include pain in the lower abdomen related to tumor growth and infiltration into adjacent organs or the pelvic wall. In advanced [stages], weight loss, anorexia, fatigue and night sweats can be symptoms of bladder cancer.
Bladder cancer is the ninth-most-common malignancy worldwide, with approximately 430,000 new cases diagnosed each year. There are several different subtypes of bladder cancer, with urothelial (transitional) cancer being the most common type, making up more than 90 percent of all cases in the U.S. and Western Europe. Environmental exposure accounts for most cases of bladder cancer, with cigarette smoking responsible for the majority. Industrial chemical exposure also has been associated with bladder cancer development. Median age of diagnosis is 70,with 4-to-1 male predominance. Racial and ethnic variations also exist, with white males having the highest risk, twice the incidence of nonwhite males. Other risk factors include chronic inflammation or trauma of the urinary tract as well as certain types of infection.
How is bladder cancer detected?
Initial studies in patients with unexplained hematuria include urinalysis. The gold standard for detecting bladder tumors in patients with hematuria or suspicion of bladder cancer is cystoscopy. During cystoscopy, a scope is inserted into the bladder through the urethra for direction examination of the bladder by the urologist. Any abnormalities or tumors detected are then biopsied and diagnosis is made. In patients diagnosed with bladder cancer, further [tests] such as [a] CT scan or MRI will be necessary to establish the extent of the disease.
Is it associated with other diseases?
Bladder cancer can be associated with schistosomiasis infection, a disease caused by parasitic worms. Schistosomiasis is most prevalent in East Africa and [the] Middle East, where it has been the cause of high incidence of bladder cancer — [the] most common cancer in men and second to breast cancer in women. Schistosomiasis infection is also responsible for bladder cancer in these regions at a significantly lower median age (40s). In the Western world, on the other hand, due to the fact that the majority of bladder cancer cases [are] caused by cigarette smoking, many patients who present with bladder cancer have other [health problems], such as cardiovascular disease, also caused by smoking.
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How is it treated, and are there any new treatment options?
Bladder cancer is subdivided into two different types: nonmuscle-invasive (superficial) and muscle-invasive bladder cancer. Nonmuscle-invasive disease is mainly treated with [surgical removal] of the tumor and intravesical (inside bladder) instillation of chemotherapy with agents such as Bacillus Calmette-Guerin (BCG) or mitomycin which have been associated with reduction in the recurrence of superficial tumors. In muscle-invasive disease however, the standard treatment is removal of the bladder, with chemotherapy given prior to the surgery. For patients in whom the risk of surgery is too high, [a] combination of chemotherapy and radiation therapy is also used. In patients who have Stage 4 disease, where bladder cancer has already spread to other sites of the body, chemotherapy remains the mainstay of the treatment. Most recently, manipulating the immune system for anticancer therapy has met with significant success in many different tumor types, including bladder cancer. .
How can you live without a bladder?
Patients can have a live very active lifestyle without [a] bladder with one of the following urinary diversions — ileal conduits, where a segment of small bowel is used to divert urine from the kidney to an exterior bag, or orthotopic bladder, where a segment of the small bowel [is] used to reconstruct a new bladder, which is then connected to the native urethra.