Bladder cancer

Bladder Cancer

The Bladder

‍
The bladder is a hollow organ in the lower abdomen where urine is stored. It is part of the urinary system, which also includes the kidneys, ureters, and urethra. The bladder’s walls have four layers:

1. The urothelium (inner layer),
2. The lamina propria,
3. The detrusor muscle (muscle layer), and
4. The fatty connective tissue (outermost layer).

Bladder cancer typically starts in the urothelium and can grow into other layers and spread to nearby organs.

‍

Risk Factors

‍
Several factors increase the risk of bladder cancer:

1. Smoking: Smoking is the leading risk factor, increasing the likelihood of developing bladder cancer 4 to 7 times more than non-smokers.
2. Age: The risk increases with age, with most cases occurring in people over 65 years.
3. Gender: Men are four times more likely to develop bladder cancer than women.
4. Chemical Exposure: Working with certain chemicals (such as benzidine, beta-naphthylamine, and arsenic) used in industries like textiles, rubber, leather, paint, and printing increases risk.
5. Chronic Bladder Issues: Long-term urinary infections, kidney stones, or continuous use of catheters can lead to bladder cancer.
6. Personal History: Those who have had bladder cancer before are at a higher risk of recurrence.

Symptoms

‍
Not all patients experience symptoms, but some of the common ones include:

• Blood in the urine
• Pain or burning during urination
• Frequent urination or feeling the need to urinate often, even at night
• Pain in the lower back on one side

Diagnosis

1. Urine Test: A urine test can check for cancer cells in the urine (cytology).
2. Cystoscopy: A thin tube with a camera is used to examine the inside of the bladder.
3. Biopsy: During cystoscopy, if any abnormal growths are seen, a small piece of tissue is removed for microscopic examination (TURBT - Transurethral Resection of Bladder Tumor).
4. Imaging Tests: CT scans, MRI, PET scans, bone scans, or ultrasounds can help determine the extent of cancer spread.

Bladder Cancer Staging

‍
Bladder cancer is staged using the TNM system:

• T (Tumor): Describes how far the cancer has spread in the bladder wall.
• T1: Spread to the lamina propria (the next layer) but not into the muscle layer.
• T2a/b: Spread to the muscle layer (partially or fully).
• T3a/b: Spread to the fat layer surrounding the bladder.
• T4a/b: Spread to nearby organs or structures like the prostate or uterus.
• N (Node): Indicates whether cancer has spread to nearby lymph nodes.
• N0: No lymph node involvement.
• N1-3: Spread to one or multiple pelvic lymph nodes.
• M (Metastasis): Describes whether the cancer has spread to other body parts.
• M0: No distant metastasis.
• M1a/b: Spread to distant lymph nodes or other organs.

Treatment

‍
Common treatments for bladder cancer include:

1. Surgery:
• TURBT (Transurethral Resection): Used for early-stage cancer confined to the inner layers.
• Radical Cystectomy: Removal of the entire bladder and nearby lymph nodes. In some cases, other organs, like the prostate or uterus, may also need to be removed.
• Urinary Diversion: If the bladder is removed, a new path is created for urine to leave the body.
2. Chemotherapy:
• Intravesical Chemotherapy: Medication delivered directly into the bladder through a catheter.
• Systemic Chemotherapy: Medications (like Cisplatin, Gemcitabine) given intravenously to treat cancer that has spread beyond the bladder.
3. Immunotherapy:
• Local Immunotherapy (BCG): A bacteria called BCG is introduced into the bladder to trigger an immune response.
• Systemic Immunotherapy: Medications like Avelumab, Nivolumab, or Pembrolizumab are used to stimulate the immune system to fight cancer.
4. Targeted Therapy:
This treatment targets specific genes or proteins that allow cancer to grow and spread. Examples include drugs like Enfortumab vedotin and Sacituzumab govitecan.
5. Radiation Therapy:
High-energy radiation is used to destroy cancer cells, often used in combination with chemotherapy.

Follow-Up Care
After treatment, regular follow-up tests are essential to monitor for recurrence and manage side effects. This includes physical exams, blood tests, and imaging tests.

‍