Bladder Cancer

Bladder Cancer

Bladder cancer is cancer that begins in the bladder due to the growth of abnormal cells . Bladder cancer is often characterized by the presence of blood in the urine.

The bladder is an organ located in the middle of the lower abdomen. This organ functions to collect urine before it is excreted from the body through a channel called the urethra.

Bladder cancer occurs when cells in the bladder grow uncontrollably and form  cancer cells . If they continue to grow, the cancer cells can spread to the tissues around the bladder, or to other organs that are more distant, such as the liver, bones, and lungs.

Types of Bladder Cancer

Bladder cancer is divided into several types based on where the cancer cells grow, namely:

Urothelial carcinoma

Urothelial carcinoma  is the most common type of bladder cancer. Urothelial carcinoma  begins in the  urothelial cells , which are cells that line the inside of the bladder.

Squamous cell carcinoma

Squamous cell carcinoma begins as thin, flat squamous cells that grow in the lining of the bladder. This type of bladder cancer occurs when the bladder is continuously irritated, for example from long-term use of a urinary catheter or repeated bladder infections  .

Adenocarcinoma

Adenocarcinomas  grow in glandular cells, which are cells in the mucus-producing glands in the bladder. Adenocarcinoma  occurs when the bladder becomes inflamed in the long term.

Causes of Bladder Cancer

Bladder cancer is caused by changes (mutations) in the cells in the bladder. Mutations cause these cells to grow uncontrollably and form cancer cells that can spread (metastasize) to other organs of the body.

It is not known what causes these cells to mutate into cancer cells. However, there are several factors that can increase a person's risk of developing bladder cancer, namely:

  • Male gender
  • Over the age of 55 years
  • Have a smoking habit
  • Have a history of cancer, both in yourself and in your family
  • Exposure to chemicals, such as arsenic or chemicals used in the leather, rubber, textile, and paint industries, such as  aniline dyes , benzidine , xenylamine  o-toluidine  4-aminobiphenyl , and  2-naphthylamine
  • Have had radiotherapy to treat cancer near the bladder, such as colon cancer
  • Have had  chemotherapy with cisplatin or cyclophosphamide
  • Experiencing  menopause too early, i.e. under the age of 45 years
  • Using a urinary catheter in the long term
  • Suffering from urinary tract infections and chronic bladder stones
  • Suffering  from untreated schistosomiasis
  • Suffering  from type 2 diabetes

Symptoms of Bladder Cancer

The most common symptom in patients with bladder cancer is the presence of blood in the urine ( hematuria ) so that the color of the urine becomes reddish or brown.

Other symptoms that can be experienced by bladder cancer sufferers are:

  • Frequent urination at night
  • Increased frequency of urination
  • Difficulty holding urine ( urinary incontinence )
  • Pain or burning sensation when urinating
  • Frequent urge to urinate suddenly

If bladder cancer continues to grow and spread to other parts of the body, symptoms can vary, including:

  • Pelvic pain
  • Body tired easily
  • Loss of appetite
  • Weight loss
  • Swelling in the legs
  • Bone pain

When to go to the doctor

Immediately see a doctor if you experience any of the above symptoms, especially if you suspect blood in your urine.

Please note, the presence of blood in the urine does not always mean bladder cancer, but it can also be due to  cystitis , kidney infection, kidney  stones , enlarged prostate gland, or urethritis (inflammation of the urethra).

Therefore, it is important to see a doctor if you find blood in your urine. The goal is that the exact cause can be identified and treated appropriately.

Bladder Cancer Diagnosis

The doctor will ask the patient's symptoms, the patient's and family's medical history, and whether the patient has ever been exposed to chemicals that can increase the risk of developing bladder cancer.

After that, the doctor will perform a digital rectal examination to detect the presence of lumps that may indicate cancer.

If there is a suspicion of bladder cancer, the doctor will perform additional tests, such as:

  • Urine cytology test, to detect the presence of cancer cells in the patient's urine sample
  • Scans with MRI, CT scan, or X-rays with contrast material, to see the condition of the bladder
  • Cystoscopy, to see the condition of the bladder through a small tube with a camera
  • Tissue sampling ( biopsy ) from the bladder, to detect cancer cells in the sample of tissue taken

After the patient is confirmed to have bladder cancer, the doctor will determine the stage or severity of the condition. This determination will help the doctor in determining the appropriate treatment method.

Bladder cancer is divided into 5 stages, from stage 0 to stage 4. The following is an explanation:

  • Stage 0 The
    cancer has not spread beyond the lining of the bladder.
  • Stage I The
    cancer has passed through the lining of the bladder, but has not yet reached the muscle lining of the bladder.
  • Stage II The
    cancer has spread to the muscle lining of the bladder.
  • Stage III The
    cancer has spread to the tissues around the bladder.
  • Stage IV
    Cancer has spread to other organs around the bladder, such as the lymph nodes, bones, liver, and lungs.

Bladder Cancer Treatment

Treatment for bladder cancer depends on the type of cancer, stage, age, and the patient's overall health condition. Some of the methods of treatment that can be done by doctors are:

1. Immunotherapy

Immunotherapy is the administration of drugs or vaccines to help the immune system fight cancer cells. Immunotherapy can be done by injecting the vaccine directly into the bladder (intravesical).

The vaccine used in bladder cancer immunotherapy is the BCG vaccine which is used to prevent tuberculosis (TB). This vaccine will attract immune cells to the bladder to fight cancer cells.

2. Chemotherapy

Chemotherapy is the administration of two or more drugs to kill cancer cells. Just like immunotherapy, chemotherapy drugs can be injected directly into the bladder or injected through a vein.

The drug that is often used in bladder cancer chemotherapy is a combination of cisplatin with methotrexate or vinblastine.

3. Radiotherapy

Radiotherapy  or radiation therapy aims to kill cancer cells with the help of high levels of radiation, such as X-rays and protons. In some cases, radiotherapy can be combined with chemotherapy or done after surgery to remove cancer cells.

4. Operation

Types of surgery that can be performed to treat bladder cancer include:

  • Transurethral resection of bladder tumor (TURBT), which is the removal of the cancer using a special wire or  resectoscope
  • Partial cystectomy , which is the removal of part of the bladder that is affected by cancer cells
  • Radical cystectomy, which is the removal of the entire bladder and some of the surrounding organs

Bladder Cancer Complications

Bladder cancer can spread ( metastasize ) to other nearby organs, such as lymph nodes in the pelvis, liver, lungs, and bones. Other complications that can occur are:

  • Lack of blood (anaemia)
  • Erectile dysfunction in men
  • Sexual dysfunction in women
  • Uncontrolled urination (urinary incontinence)
  • Swelling of the kidneys and ureters ( hydronephrosis )
  • Narrowing of the urethra ( urethral stricture )

Bladder Cancer Prevention

As explained above, it is not yet known what causes bladder cancer. Therefore, it is difficult to prevent this disease.

However, the risk of developing bladder cancer can be reduced by living a healthy lifestyle, such as:

  • Quit smoking and stay away from exposure to secondhand smoke.
  • Avoid chemical exposure, by using personal protective equipment and following safety procedures in the work environment.
  • Avoid drinking and bathing with river or lake water, to avoid schistosomiasis which can develop into bladder cancer.
  • Sufficient drinking water
  • Increase consumption of fruits and vegetables rich in antioxidants.
  • Do regular exercise to maintain a healthy body.
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