Pramod Mann (35), a chain smoker from Rajasthan who was previously diagnosed with bladder stones, noticed some blood in his urine in mid-2020. As he did not experience any pain, he ignored it thinking it was an isolated incident. However, he was diagnosed with second-stage bladder cancer after a couple of months when he went to a hospital after experiencing severe bleeding during urination.
Doctors treating this young father found that the malignant cells had penetrated the muscle walls of his bladder and the only way to prevent further spread was to remove the organ through a surgery. “He got a new lease of life through a procedure where a duplicate bladder (neo-bladder) was created from the end of the bowel to facilitate normal passing of urine,” says Dr Vipul Tilva, consultant uro-oncologist and robotic surgeon, HCG Cancer Centre, Ahmedabad, who treated Pramod.
Pramod has been cancer-free for three years now and living a happy life. However, many cases of bladder cancer do not end on a happy note and require careful diagnosis and treatment.
READ MORE :
Hematuria: Why blood in urine must not be ignored
Smoking: The path to bladder and kidney cancer
Urinary catheters may cause infection, anxiety
How to manage pelvic organ prolapse
“Cancer of the bladder is not common —but it can rapidly encompass the inner lining of the bladder and subsequently the bladder muscles, spreading rapidly to other organs if not detected early. Men and elderly people are more at risk for this type of cancer compared to women. However, this form of cancer is often more aggressive in women. Women are also likely to present with advanced stages as they may ignore blood in urine, connecting it to menstruation. Regular monitoring is important as this type of cancer has a high recurrence rate. Early detection and timely intervention are necessary to successfully manage this form of cancer,” says Dr Tilva.
What is bladder cancer?
According to the American Cancer Society (ACS), bladder cancer develops when cells in the lining of the bladder start multiplying abnormally, giving rise to malignancy. ACS lists the different types of cancers that affect the bladder:
- Urothelial cancer: This form of cancer develops in the urothelium (cells present in the inner lining of the bladder). Urothelial cancer constitutes almost 90 percent of all bladder cancer cases.
- Squamous cell carcinoma: This develops in the squamous cells (flat cells located in the inner surface of the bladder).
- Other forms: Other types of cancer that are quite rare include sarcoma, small cell carcinoma and adenocarcinoma of the bladder.
Symptoms of bladder cancer
According to the Centres for Disease Control and Prevention (CDC), symptoms of bladder cancer include:
- Visible blood in urine, often without pain.
- Blood in urine, seen in a pathology lab not visible to the naked eye.
- Pain in the lower abdomen and back.
- Difficulty in passing urine.
- Constant urge to urinate.
- Burning sensation while passing urine.
Risk factors
The primary risk factors for bladder cancer include:
- Smoking: According to the National Cancer Institute (NCI), almost 50 percent of the patients who present with bladder cancer have a history of smoking.
- Genetic predisposition: The International Agency for Research on Cancer (IARC) and World Health Organization (WHO) together released an Evidence Summery Brief in 2022 which states that a simple urine test can detect mutations in the telomerase reverse transcriptase (TERT) gene, which are the most common mutations in bladder cancer.
- Occupational hazards: “It has been documented that individuals working in the mining sector and industries that produce poly-aromatic hydrocarbons (like petroleum, rubber, leather or paint industry) are at a high risk of developing bladder cancer,” says Dr Tilva.
- Chronic bladder irritation: Chronic bladder infections, repeated catheterisations, multiple previous surgeries and repeated bladder stones are all risk factors for bladder cancer, adds Dr Tilva.
Diagnosis of bladder cancer
If blood is detected in the urine
“When an individual reports blood in urine, the doctor may ask for an ultrasound, urine analysis, cytology (to check for cancer cells) or cystoscopy (a procedure where an urologist examines the lining of the bladder and urethra with a tube-like device called cystoscope which has a light and a camera at the end) to diagnose the problem,” says Dr Ananthakrishnan Sivaraman, consultant urologist, laparoscopic and robotic surgeon, Chennai Urology and Robotics Institute, Chennai.
If test results show malignancy
“If the tests results show malignancy in the bladder, other investigations such as computed tomography (CT) scan and magnetic resonance imaging (MRI) may be recommended to detect the type of cancer, how aggressive it is, if it is superficial or has penetrated deeper into the muscle walls, etc. Around 75 percent of all bladder cancers are superficial, while 25 percent are invasive. This means that the malignant cells invade the glands, muscles and nearby lymph nodes, spreading to other organs later,” Dr Sivaraman added.
Treatment
Bladder cancer can be treated in the following ways:
- Transurethral resection of bladder tumour (TURBT): In this procedure, a superficial tumour is removed and sent to the lab for testing. Once the tumour is resected, the surgeon will use laser or electric current in the affected area to destroy any remaining cancer cells, says Dr Tilva.
- Chemotherapy: Here, the individual is administered chemotherapy directly into the bladder (to target cancer cells) through a tube inserted into the urethra, he adds.
- Cystectomy: This procedure involves surgery where the bladder is removed.
- Neo-bladder: This is an advanced procedure where a segment of the small bowel (part of the intestine called the ileum) is used to make a duplicate bladder that is connected to the urethra.
- Immunotherapy: This treatment method that boosts the immune system to fight against cancer cells.
Prevention of bladder cancer
The CDC and NCI recommend the following ways to prevent bladder cancer:
- Avoiding smoking.
- Consuming a healthy and balanced diet.
- Using protective gear while working in hazardous environments.
- Making occupational changes if necessary.
- Ensuring regular check-ups if there are occupational hazards.
- Consulting a doctor immediately if blood is noticed in urine.
Takeaways
- Bladder cancer develops when cells in the lining of the bladder start to multiply abnormally, giving rise to malignancy.
- Risk factors for this form of cancer include smoking, genetic predisposition, occupational hazards and chronic bladder irritation.
- Consuming a balanced diet, avoiding smoking and using protective gear while working in hazardous environments are some of the precautions that can be taken to prevent bladder cancer.
