Did you know that bladder cancer is the fourth most common cancer among men?
Your bladder is an important organ in your body, located in your lower abdominal area. It is hollow and stores urine. Once it is filled, you will naturally feel the urge to head to the loo. Your bladder has a lining that is made out of transitional cells. This lining is special as it can protect the rest of your body from the toxins in your urine and it stops urine from being absorbed back into your body
However, just like any cell in your body, there is the probability that this lining can go from healthy to carcinogenic and if it does, cancer will develop. Bladder cancer is affects everyone but men are more susceptible than women. Urologist at Sunway Medical Centre, Dr. Badrulhisham Bahadzor reveals the ins and outs of bladder cancer.
It’s in your bladder
“The most common type of bladder cancer is transitional cell carcinoma,” begins Dr. Badrulhisham. “In this case, the cancer starts at the urothelial cells (transitional cells) that line the inside of the bladder.” This type of cancer is also called urothelial carcinoma and makes up about 90 percent of bladder cancers.
Dr. Badrulhisham explains that there are other types of bladder cancer including:
- Squamous cell bladder cancer which begins in the squamous cells, which are thin, flat cells that may form in the bladder after a long term infection or irritation. This cancer is not as common as urothelial carcinoma but may be more aggressive.
- Adenocarcinoma develops in the inner lining of the bladder as a result of chronic irritation and inflammation.
How does it develop?
“Most cases of bladder cancer appear to be caused by exposure to harmful substances,” says Dr. Badrulhisham. Once your cells are exposed to such substances, it can lead to abnormal changes in your bladder cells, over the years.
One of the most dangerous things you can do, which will greatly damage your bladder cells, is to smoke. “Smoking is a common cause of bladder cancer. It’s estimated that half of all bladder cancer cases are caused by smoking,” says Dr. Badrulhisham. “If you’re currently a smoker, your risk of having bladder cancer is four times higher than a person who doesn’t smoke.”
Chemicals play a role too. “Being in contact with certain chemicals used in manufacturing is also known to cause bladder cancer. The good news is, many of these substances are now banned in most countries.” These harmful chemicals include aniline dyes and benzidine.
Other things you may inadvertently be doing to increase your risk factor of bladder cancer include:
- Using hair dye
- Eating a high fat diet
- Being overweight
- Having a sedentary lifestyle
A risk at birth
If your bladder was not well-developed at birth and you have a condition called bladder extrophy, you may be at risk of bladder cancer as well, according to Dr. Badrulhisham.
“Bladder extrophy occurs when the bladder and urethra do not form properly and are exposed outside the body. Hence, the bladder is not protected by a layer of skin and is susceptible to infections. This can eventually lead to adenocarcinoma of the bladder.”
Spot the signs
Dr. Badrulhisham explains that blood found in the urine is a common symptom of bladder cancer. “Four out of five people with bladder cancer have some traces of blood in their urine,” he says.
In some cases, blood in the urine will be clearly visible. “It usually looks bright red and in some rare cases, dark brown. This symptom is not accompanied by pain,” explains Dr. Badrulhisham. On the other hand, there are some cases where blood is present in the urine but not visible. Either way, a urine test will provide conclusive evidence of the presence of blood.
“There are other symptoms of bladder cancer as well but these are relatively general and at times, it could be symptoms of another medical condition. Other symptoms include the need to pass urine frequently and urgently as well as pain while urinating.”
Test and diagnosis
As some of the symptoms may be linked to other medical conditions, Dr. Badrulhisham stresses that, “Most of the time, a diagnosis cannot be made based on the symptoms alone. If a patient presents himself with symptoms associated with bladder cancer, we will advise the patient to undergo a series of tests.”
There are three important tests that can identify bladder cancer:
- A urine analysis
- An ultrasound of the bladder
- A cystoscopy. This procedure involves examining the inside of a bladder using a tube with a camera and light called a cystoscope.
Non-invasive and invasive
“Once a cancerous growth has been identified in the bladder via diagnostic tests, the patient will undergo a procedure known as Tran Urethreal Resection of Bladder Tumour (TURBT),” says Dr. Badrulhisham. “A camera is inserted into the bladder and the tumour is resected from the bladder. The tumour is then analysed and the surgeon will be able to know the severity of the cancer.”
If it is early-stage cancer (known as superficial non-invasive cancer), only surgery will be required and possibly chemotherapy or radiation. The patient will need to go for follow-ups diligently and consistently to ensure that if the cancer reoccurs, it can be detected early.
Then there is invasive cancer where the cancer cells have spread beyond the inner lining of the bladder and into the muscle layers. “At this stage, there is a risk that the cancer could spread to other parts of the body. In this case, the whole bladder is usually removed,” says Dr. Badrulhisham.
‘Replacing’ the bladder
If the patient’s bladder has been surgically removed, the patient will not have an organ to store his urine any longer. Hence, there are two options to ‘replace’ his bladder. “The first option would be to use a segment of the small bowel and construct it to become a hollow organ which can store urine. This option is usually for younger patients who would like to regain their quality of life as much as they can,” explains Dr. Badrulhisham. “The second option is to have a section of the small bowel as a stoma (an opening which connects a part of the body to the outside) which is linked to a bag externally. This bag will store the patient’s urine.”
There are some possible lifestyle adjustments a person has to make such as quitting smoking and exercising regularly. If he has had his bladder removed, the patient will need to change the urine drainage bag regularly. “My advice to patients with bladder cancer is to take control of your life and keep going. Do not think about your fears as they will become more intense,” says Dr. Badrulhisham.
It could be a parasite…
According to Dr. Badrulhisham, parasitic infection is the main cause of bladder cancer in the developing world. The waterbourne parasite which is known as bilarzia or schistosomiasis is widespread in many countries and increases the risk of squamous cell bladder cancer.