Urothelial carcinoma is known as the most common type of bladder cancer.
Squamous cell carcinoma, small cell carcinoma, and adenocarcinoma are often less common types.
Urothelial carcinoma also developed in the ureters, that bring urine from the kidney to the bladder, and responsible for spreading to the kidneys. Bladder cancer can also be described as the non-muscle-invasive or the muscle-invasive.
Symptoms of Bladder Cancer
In bladder cancer, sometimes doesn’t have many signs or symptoms and is detected when a urine test is performed. Apart from this, most patients with bladder cancer do have some signs and symptoms.
These symptoms can include:
- Blood in the haematuria
- Changes in the bladder habits
- Pain in one side of a lower abdomen or back.
What are the risk factors?
Studies represent that the people with certain risk factors have higher chances to develop bladder cancer. These factors include:
- Smoking
- Older age
- Being male
- Chemical exposure at work
- Chronic infections
- Long-term catheter use
- Previous cancer treatments
- Diabetes treatment
- Personal or family history
How Does Bladder Cancer Start And Spread: Inside the lining of a bladder is the urothelium, which is made of urothelial cells (also called transitional cells). If urothelial cells make the excess copies of themselves and grow out of control, this is a bladder cancer.
After forming in urothelium, the tumors generally grow into the bladder wall. Then cancerous cells travel through lymph or blood in order to form new tumors in other parts of the body. This is known as metastasis.
PHASES OF BLADDER CANCER:
Patients with bladder cancer are grouped into 3 main categories, depending on the stage of cancer. Treatment goals as well as management of these groups are different.
Non-muscle invasive bladder cancer: Stages 0 and 1 belong to the non–muscle-invasive. It is known as the early bladder cancer. In this, the tumor has not spread to the thick layer of the muscle in the bladder wall. The purpose of treatment for non-muscle-invasive cancer are to:
- Decrease the risk of cancer coming back after it is being treated successfully.
- Resist the cancer from progressing to an advanced stage.
Muscle-invasive bladder cancer: Basically stages 2, 3, and early stage 4 are the muscle-invasive. Local control therapy such as radiation or surgery, combined with the chemotherapy, is required in order to prevent the spread of cancerous cells away from the bladder. The purpose of the treatment for muscle-invasive cancer are to:
- Cancer's stage in order to confirm that it is muscle-invasive, but has not metastasized.
- Determine the best local treatment options.
Metastatic bladder cancer: In this, the cancer has spread to organs and lymph nodes far from the bladder. These cancers are difficult in order to cure. The major purpose of care for metastatic bladder cancer is to assist you live as comfortably as possible.
Diagnosing of Bladder Cancer:
Diagnosis is performed with the help of several existing ways:
General Tests: General tests may include:
- blood and urine tests
- an internal examination: in this the healthcare provider slides a gloved finger into the rectum or vagina in order to know for anything unusual.
Main Tests: In order to diagnose the bladder cancer, your doctor may arrange:
- an ultrasound: a scan that uses soundwaves to create pictures of your organs.
- a cystoscopy: the doctor inserts a tube with a light and camera through the urethra to view the bladder; a flexible cystoscopy can be done with local anaesthetic, while a rigid cystoscopy is done under general anaesthetic in hospital and may include a biopsy.
- MRI and CT scans: these basically involve an injection of dye into the body.
Further Tests: In order to check if cancer has spread to other parts of the body, you may have:
- a radioisotope bone scan
- x-rays
- an FDG-PET scan
Treatment Options For Non-muscle Invasive Bladder Cancer:
Once tumor found after close examination of the bladder, your doctor may choose to perform a transurethral resection of bladder tumor (TURBT) as a first step in your treatment.
TURBT: It is generally the initial treatment for non-muscle invasive bladder cancer. It is basically a procedure which is used both for diagnosis as well as treatment. By using this procedure doctors remove the tumor which is generally reserved for the non-aggressive cancer.
Patients with the non-muscle invasive cancer located only in the bladder can be recommended in order to receive immunotherapy or chemotherapy drugs after a TURBT via intravesical therapy. There are numerous intravesical therapy bladder cancer treatment options:
Bacille Calmette-Guerin (BCG): This vaccine is an immunotherapy drug. This therapy is used in order to boost the body’s natural defenses to fight cancer. The onco-BCG is a first-line treatment for carcinoma that has not spread outside the bladder. It is effective in order to prevent bladder cancer recurrences following TURBT.
Mitomycin C: Mitomycin is basically a chemotherapeutic agent used to kill cancer cells. It is mainly given to patients at doctor’s offices, outpatient clinics or hospitals.
The mitomycin injection is easily absorbed into the bladder and has helped with preventing tumor recurrence.
The mitomycin 40 mg has been used more often immediately after TURBT or sometimes within 24 hours after the initial TURBT treatment.
Thiotepa (Tepadina): Thiotepa is used as intravesical chemotherapy in bladder cancer. The thiotepa is recommended to be used prophylactically in order to prevent seeding of the tumor cells at the cystoscopic biopsy; as a therapeutic agent in order to prevent recurrence after cystoscopic resection of the bladder tumor (transurethral resection of bladder tumor) or as an adjunctive agent at the time of biopsy.
Cisplatin: The cisplatin 50 mg specifically belongs to the platinum-based antineoplastic family of medications. It works in part by binding to the DNA and inhibiting its replication.
Intercalating Agents (Doxorubicin, Valrubicin and Epirubicin): These agents are known for good absorption into the bladder, and systemic toxicity is very rare. Doses can vary from 3 times a week to once in a month.
Gemcitabine: This is used for more advanced bladder cancer. In patients who received previous therapy without cure, gemcitabine therapy may be helpful.
Atezolizumab: This medication is used for the locally advanced or metastatic urothelial carcinoma after the failure of cisplatin-based chemotherapy.
The use of atezolizumab is considered as a first-line treatment for the metastatic bladder cancer in patients who can not receive cisplatin-based chemotherapy and have high levels of PD-L1.
Laser-Ablation Therapy: This involves using a laser in order to burn cancer cells. Patients for this type of therapy have low-grade papillary tumors as well as a history of the low-grade, low-stage tumors.
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