The urinary bladder, or the bladder, is a hollow organ in the pelvis. Most of it lies behind the pubic bone of the pelvis, but when full of urine, it can extend up into the lower part of the abdomen. Its primary function is to store urine that drains into it from the kidney through tube-like structures called the ureters.
Bladder cancer is an uncontrolled abnormal growth and multiplication of cells in the urinary bladder, which have broken free from the normal mechanisms that keep uncontrolled cell growth in check. Invasive bladder cancer has the ability to spread (metastasize) to other body parts, including the lungs, bones, and liver.
Burden. Bladder cancer is among the top 10 list of cancers, with an estimate of 81,190 new cases occurring in 2017 within the U.S. Bladder cancer is three to four times more likely to be diagnosed in men than in women, and about two times higher in white men than in African-American men. Bladder cancer killed approximately 17,240 people in the U.S. in 2017. In the U.S., the risk for bladder cancer in men is about 1 in 26, and for women about 1 in 90.
Types. Bladder cancer is classified based on the appearance of its cells under the microscope. The more common types of bladder cancer are as follows:
- Urothelial carcinoma: is the most common type and comprises 90%-95% of all bladder cancers. Urothelial carcinoma (transitional cell carcinoma) is strongly associated with cigarette smoking.
- Adenocarcinoma of the bladder comprises about 1%-2% of all bladder cancers and is associated with prolonged inflammation and irritation. Most adenocarcinomas of the bladder are invasive.
- Squamous cell carcinoma comprises 1%-2% of bladder cancers and is also associated with prolonged infection, inflammation, and irritation such as that associated with longstanding stones in the bladder. In certain parts of the Middle East and Africa (for example, Egypt), this is the predominant form of bladder cancer.
Risk factors and causes of bladder cancer.
- Cigarette smoking.
- Age and family history are other risk factors as is male sex
- Exposure to toxic chemicals
- Radiation therapy and
- Long-term chronic infections.
Signs and symptoms.
The most common symptom of bladder cancer is bleeding in the urine (hematuria). Most often the bleeding is “gross” (visible to the naked eye), episodic (occurs in episodes), and is not associated with pain (painless hematuria). However, sometimes the bleeding may only be visible under a microscope (microscopic hematuria) or may be associated with pain due to the blockage of urine by formation of blood clots. Some types of bladder cancer may cause irritative symptoms of the bladder with little or no bleeding. The patient may have the desire to urinate small amounts in short intervals (increased urinary frequency), an inability to hold the urine for any length of time after the initial desire to void (urgency), or a burning sensation while passing urine (dysuria).
Diagnosis. Bladder cancer is most frequently diagnosed by investigating the cause of bleeding in the urine that a patient has noticed. The following are investigations or tests that come in handy in such circumstances:
- Urine cytology
- CT scan/MRI
- Cystoscopy and biopsy
- Newer biomarkers like NMP 22 and fluorescent in-situ hybridization (FISH) are currently in use to detect bladder cancer cells by a simple urine test.
In addition to all these, the best way to prevent bladder cancer is to avoid exposure to agents that cause the disease. People who don’t smoke are three to four times less likely to get bladder cancer as compared to smokers. Continuing to smoke after the diagnosis of bladder cancer portends a poorer outcome and increases the chance of the disease coming back after treatment. Avoidance of occupational exposure to cancer-causing chemicals such as aniline dyes may also be important.
Conclusively, a number of online resources are available for bladder cancer patients to gain more insight into this disease and its management. Bladder Cancer Advocacy Network (http://www.bcan.org) is one such resource that provides a downloadable patient information handbook and links to patient support groups.
The National Cancer Institute (http://www.cancer.gov) also provides bladder cancer information.
The European Organization for Research and Treatment of Cancer (http://www.eortc.be/tools/
bladdercalculator) features a calculator that predicts the chances of recurrence and progression of superficial bladder cancer after initial treatment based on certain tumor characteristics.
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