Bladder Cancer: Unmasking The Silent Threat

Did you know that bladder cancer, though rare in India, claims 11,000 lives annually? It affects males more than females, and its incidence varies nationwide. According to the GLOBOCAN 2020 database, it ranks as India's 17th most common malignancy, highlighting its presence in the country's medical landscape.

 

This silent killer, lurking around the corners of society, needs attention. Physicians such as yourself should be aware of the many influencing factors and screening procedures to be able to reduce the prevalence of Bladder Carcinoma.

 

With proper awareness, patient education, and early screenings, Bladder Carcinoma prevalence rates can be reduced. As a physician, it’s your mission to stay current with the latest treatment procedures and advances in screening to be able to function as a public health officer.

 

In this blog, we provide a brief overview of Bladder Cancer and also discuss ways in which you can upskill in order to tackle the demons of such health concerns.

 

What is Bladder Carcinoma?

Bladder cancer develops when abnormal, malignant cells proliferate uncontrollably in the lining of the bladder, a hollow organ in the lower abdomen that holds urine. These malignant cells begin to disrupt bladder function and can spread to neighboring organs. The bladder's benign and malignant neoplasms, such as von Brunn's nests and urothelial carcinoma, are among the most common histological diseases of the genitourinary tract. Urothelial carcinomas are the most common type of bladder cancer and are classified according to the depth of invasion into the bladder wall. At the time of the initial diagnosis, 75%-85% of urothelial carcinomas are superficial, while 15%-25% are invasive and metastatic.

 

Types of Bladder Cancer:

Depending on the layer of the bladder that gets affected by the neoplastic cells, Bladder Carcinoma can be differentiated into four major types, which are:

 

Urothelial or Transitional Cell Carcinoma:

• Urothelial carcinoma (also known as transitional cell carcinoma) is a type of cancer that starts in the urothelial cells that border the urethra, bladder, ureters, renal pelvis, and other organs.
• Urothelial carcinomas account for nearly all bladder malignancies.
• In this type of cancer, abnormal cells spread from the inner lining to deeper layers of your bladder or through your bladder wall into the fatty tissues that surround it.

 

Squamous Cell Carcinoma:

• Squamous cells are thin, flat cells found inside the bladder.
• This type of bladder cancer accounts for around 5% of all bladder malignancies.
• This type of cancer can develop as a result of long-term irritation or infection with schistosomiasis, a tropical parasite that is common in Africa and the Middle East.
• When there is a continuous irritation, the transitional cells that line the bladder can gradually transform into squamous cells.

 

Adenocarcinoma:

• Adenocarcinoma is a type of cancer that develops in glandular cells located in the bladder lining.
• The bladder's glandular cells produce mucus and other chemicals.
• Adenocarcinomas account for just around 1% of bladder cancers.

 

Small Cell Carcinoma:

• Small cell carcinoma of the bladder is a type of cancer that starts in neuroendocrine cells (nerve-like cells that release hormones into the blood in response to a nervous system signal).

Transitional Cell Carcinoma, followed by Squamous Cell Carcinoma, are common types of bladder carcinomas. Bladder carcinomas affect men more often than women, with a ratio of 4:1.

 

Risk Factors of Bladder Carcinoma

Bladder cancer is a complex disease with various risk factors that can increase the likelihood of its development. Some of the risk factors for Bladder Cancer include:

• Smoking: Smoking tobacco, whether it's cigarettes, cigars, or pipes, can introduce harmful chemicals into the urine. These chemicals can damage the bladder's lining, thereby increasing the risk of bladder cancer.
• Increasing age: Bladder cancer is more commonly diagnosed in older individuals. While it can occur at any age, the risk increases with advancing age, and most cases are found in people over 55 years.
• Gender: Men are more likely to develop bladder cancer compared to women. The reasons for this gender difference are not yet fully understood.
• Exposure to certain chemicals: Occupational exposure to certain chemicals has been linked to an increased risk of bladder cancer. These chemicals include substances like arsenic and those used in the production of dyes, rubber, leather, textiles, and paints.
• Previous cancer treatment: Individuals who have received previous cancer treatment, specifically with the anti-cancer drug cyclophosphamide or radiation therapy targeting the pelvic region, may have a higher risk of developing bladder cancer.
• Chronic bladder inflammation: Chronic or recurrent bladder infections or inflammations, such as those associated with long-term urinary catheter use, may increase the risk of a specific type of bladder cancer called squamous cell carcinoma. In some parts of the world, chronic bladder inflammation caused by the parasitic infection schistosomiasis is also linked to an increased risk of squamous cell carcinoma.
• Personal or family history of cancer: Individuals who have previously had bladder cancer are at a higher risk of developing it again. While bladder cancer typically doesn't run in families, having a first-degree relative (parent, sibling, or child) with bladder cancer may slightly increase the risk. Additionally, certain genetic conditions like Lynch syndrome (hereditary nonpolyposis colorectal cancer) can raise the risk of bladder cancer along with cancers in other organs.

 

Signs and Symptoms of Bladder Carcinoma

Bladder cancer symptoms can vary among individuals. The most frequent sign is hematuria, which is the presence of blood in the urine. Hematuria often appears as a slightly rusty to bright red color. Blood in the urine may be intermittent, with periods of seeing it followed by periods without. Sometimes, only a medical test can detect small amounts of blood.

 

Other common symptoms of bladder cancer include:

• Frequent urination
• Pain or burning sensation during urination
• The urgency to urinate even when the bladder is not full
• Nocturia (frequent urination during the night)

 

When bladder cancer has advanced or spread to other parts of the body, additional symptoms may arise, such as:

• Inability to urinate
• Lower back pain on one side
• Abdominal pain
• Bone pain or tenderness
• Unintentional weight loss and loss of appetite
• Swelling in the feet
• Fatigue

Screening for Bladder Cancer:

Screening for bladder cancer involves detecting the disease before symptoms appear, making treatment easier. While there is no established standard screening test for bladder cancer in the general population, specific tests can be used for individuals at higher risk or with a history of bladder cancer.

1. Hematuria Test:

The hematuria test examines urine samples for the presence of red blood cells, which can indicate cancer or other conditions. It can be done by observing the urine under a microscope or using a special test strip. The test may be repeated over time.

2. Urine Cytology:

Urine cytology involves examining a urine sample under a microscope to identify abnormal cells that could be indicative of bladder cancer.

3. Urine Tumor Marker Tests:

Urine tumor marker tests analyze urine samples in the lab to detect substances produced by bladder cancer cells or as a response to the disease. These tests can aid in diagnosing specific types of bladder cancer.

4. Cystoscopy:

Cystoscopy is a procedure that utilizes a thin, illuminated tube called a cystoscope to visually examine the bladder and urethra for any abnormal areas. Biopsy samples may be taken during this procedure.

 

4 Treatments for Bladder Cancer:

With advanced modern medical facilities and ongoing research in the field, there is a wide range of treatment options available for Bladder Carcinoma.

Some of the treatments for Bladder Cancer include:

 

1. Surgery:

Transurethral resection (TUR) with fulguration: This procedure involves the insertion of a cystoscope into the bladder through the urethra. A small wire loop removes or burns the tumor using high-energy electricity. Partial cystectomy: In cases where the tumor has invaded the bladder wall but is limited to one area, a partial cystectomy may be performed. This surgery removes only a part of the bladder, allowing normal urination after recovery. Radical cystectomy with a urinary diversion: This extensive surgery involves the removal of the bladder, nearby lymph nodes, and sometimes adjacent organs. For men, the prostate and seminal vesicles may be removed, while for women, the uterus, ovaries, and part of the vagina may be removed. Urinary diversion procedures are also performed to create alternative ways for urine storage and elimination.

 

2. Radiation therapy:

External beam radiation therapy: High-energy X-rays or other types of radiation are used to kill cancer cells or prevent their growth. This treatment may be administered alone or in combination with other therapies like chemotherapy.

Chemotherapy:

• 1. Systemic chemotherapy: Anti-cancer drugs are injected into a vein, allowing them to circulate throughout the body via the bloodstream. This approach is used to treat bladder cancer and may involve medications such as carboplatin, cisplatin, fluorouracil (5-FU), gemcitabine, and more.
  2. Intravesical chemotherapy: Chemotherapy drugs are delivered directly into the bladder through a catheter, reducing the risk of cancer recurrence after surgery.

Immunotherapy:

• 1. Systemic immunotherapy: Certain drugs stimulate the body's immune system to target and fight cancer cells. Immunotherapy options for urothelial cancer (a type of bladder cancer) include nivolumab, pembrolizumab, and atezolizumab.
  2. Intravesical immunotherapy: Bacillus Calmette-Guérin (BCG) is a type of immunotherapy drug that is instilled into the bladder through a catheter. It helps destroy any remaining cancer cells after surgery and lowers the chances of cancer recurrence.

3. Targeted therapy:

Targeted therapy drugs are designed to block specific molecules, enzymes, or proteins involved in the growth and spread of cancer cells. Biomarker testing may be conducted to determine the suitability of targeted therapy drugs such as enfortumab vedotin, erdafitinib, ramucirumab, and sacituzumab govitecan-hziy.

 

4. Clinical trials:

Participating in clinical trials can provide access to innovative treatments and approaches still being evaluated for bladder cancer. It allows patients to contribute to the advancement of medical knowledge and potentially receive cutting-edge therapies.

 

Bladder Cancer Screening and Survival Rates

Bladder cancer prognosis depends on various factors, including cancer stage, type, grade, and the patient's age and general health. Non-muscle-invasive bladder cancer can often be cured, while the prognosis for muscle-invasive bladder cancer is influenced by the presence of carcinoma in situ.

• Survival rates help provide insight into bladder cancer prognosis. The 5-year relative survival rate, a commonly used statistic, indicates the percentage of individuals who survive at least 5 years after diagnosis.
• For bladder cancer, the overall 5-year relative survival rate is around 77%. However, it's important to note that survival rates can vary depending on the stage and grade of cancer, among other factors.
• By raising awareness, promoting regular check-ups, and encouraging early screening, healthcare professionals such as yourself, can contribute to detecting bladder carcinoma in its early stages, leading to better treatment outcomes and improved patient survival rates.

 

Staying updated for improved Bladder Carcinoma Management

 

As a physician, it is crucial to stay updated with the latest developments in bladder carcinoma management to provide the best possible care for your patients. Here are some ways to upskill in this area:

• Continuing Medical Education (CME) Programs: Attend conferences, seminars, and workshops focused on urology and oncology to learn about the latest advancements in bladder carcinoma management. CME programs provide opportunities to interact with experts in the field and gain knowledge through lectures, case discussions, and hands-on training.
• Medical Journals and Publications: Stay abreast of current research and clinical guidelines by reading medical journals and publications dedicated to urology and oncology. Regularly review articles and studies related to bladder carcinoma to understand emerging treatment options and diagnostic techniques.
• Online Resources and Courses: Take advantage of online resources and courses offered by reputable organizations and institutions. These can provide comprehensive information on bladder carcinoma, including diagnosis, treatment, and management strategies. Online platforms often offer self-paced learning, allowing you to fit education into your busy schedule.
• Collaborate with Specialists: Foster collaboration with urologists and oncologists who specialize in bladder cancer. Discuss challenging cases, seek their expertise, and learn from their experiences. This interdisciplinary approach can enhance your understanding of bladder carcinoma management and contribute to better patient outcomes.

Remember, staying up to date with advancements in bladder carcinoma management allows you to offer the best care to your patients and contribute to reducing the burden of this disease.

 

Upskilling for improved patient outcomes in Bladder Carcinoma

In addition to staying updated, upskilling in specialized areas of medicine can greatly enhance your ability to tackle health concerns like bladder carcinoma.

• Medvarsity is one such platform that can aid you in all your upskilling requirements as a physician.
• The online and blended learning courses are designed by expert faculty members aimed at helping physicians upskill while continuing their medical practice.
• The peer-reviewed content is designed in such a way that it makes the learning more interactive as opposed to regular classroom learning.

Let's explore a couple of relevant courses that can contribute to your professional development:

1. Fellowship in Nephrology:

The Fellowship in Nephrology provides comprehensive training in the field of nephrology, covering kidney diseases, renal replacement therapies, and dialysis management. By participating in this program you can:

• Enhance your clinical skills,
• Learn advanced diagnostic techniques,
• Develop a multidisciplinary approach to providing comprehensive care for patients with kidney diseases.

Hear from our Course Faculty and an experienced Nephrologist Dr. Ravi Andrews on the career scope after the Fellowship in Nephrology.

 

2. Fellowship in Clinical Oncology:

The Fellowship in Clinical Oncology is designed to provide specialized training in clinical oncology. Through this program, you will:

• Gain expertise in diagnosing, treating, and managing various types of cancer.
• Learn about different treatment modalities, collaborate with multidisciplinary teams
• Gain insights into research and clinical trials.

This fellowship equips you with the skills needed to provide holistic care for cancer patients. By pursuing these specialized courses, you can upskill yourself in the field of medicine and enhance your ability to tackle diseases like bladder carcinoma. While raising awareness and early screenings are crucial, staying updated and expanding your knowledge through targeted training programs will enable you to make a greater impact in the field of healthcare. Remember, early screening and treatment are key to improving the chances of survival among patients affected by bladder carcinoma. Therefore, it’s important to diagnose and screen for bladder cancer while it’s still in the initial phase.