diease

Bladder Cancer


OVERVIEW OF Bladder Cancer :

When a bladder cells grows out of control it is defined as the bladder cancer. It is also called as the transitional cell carcinoma.


STRUCTURE of Bladder Cancer :

The bladder is an hollow organ and it has flexible, muscular walls that can be stretched  to hold urine and squeeze to send it out of the body. The bladder's main job is to store urine. Urine is liquid waste made by the 2 kidneys and then carried to the bladder through 2 tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra.

 

Types of bladder cancer:

Types of bladder cancer include:

  • Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well. Urothelial carcinoma is the most common type of bladder cancer in the United States.
  • Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder — for instance, from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the United States. It's more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections.
  • Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is very rare


EPIDEMIOLOGY :

It occurs in the old indivduals. the urinary incontinence and urinary tract infections can incresase the chances of bladder cancer.


CAUSES :

  • Mutations that ocuurs in the cells
  • Genetics
  • Previous UTI
  • Voiding dysfunction
  • Smoking
  • Alcohol consumption
  • Being exposure to certain chemicals such as arsenic, leather and latex and paint products


PATHOPHYSIOLOGY :

The urothelial stem cells has some regenerating capacity and they rejuvenate many times. And this rejuvenating capacity of the cells leads to the development of the bladder cancer.

The hyperplastic urothelium tends to divides in the lumen of the bladder resulting in the cancer cells.

Cancers alter their microenvironment by recruiting and activating stromal cells, adipocytes, fibroblasts, inflammatory cells, as well as mesenchymal and endothelial progenitors

Epithelial plasticity, the ability of cells to switch between phenotypic states, plays an important role in the transformation of healthy urothelial tissue into malignant neoplasm.

This results in the urothelium to dive spontaneously, invasive, immune to apoptopic triggers, and resistant to therapy.


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • burning with urination
  • increased frequency of urination without passing much urine
  • increased urgency of urination
  • lethargy
  • bloody urine
  • cloudy urine
  • urine that looks like cola or tea
  • urine that has a strong odour
  • pelvic pain in women
  • rectal pain in men

          


DIAGNOSTIC :

Tests and procedures used to diagnose bladder cancer may include:

  • Cystoscopy:

It is the small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens and also it emits light and what happens in the inside of your urethra and bladder, to examine these structures for signs of disease.

Biopsy:

It is the procedure of removing the tissue from the bladder

In cystoscopic procedure , it has some specialized  tool through which the scope and into your bladder to collect a cell sample (biopsy) . This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer.

  • Examining a urine sample (urine cytology). A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
  • Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, are used to reveal the structures in the urinary tract.

During a CT urogram, a contrast dye is injected intravenously by the hand and eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract

Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. The threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

Determining the extent of the cancer:

After determining  the above mentioned test the doctor might suggest the following diagnostic test:

Tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan
  • Chest X-ray

Bladder cancer grade

Bladder cancers are further classified based on how the cancer cells appear when viewed through a microscope. This is known as the grade, and your doctor may describe bladder cancer as either low grade or high grade:

  • Low-grade bladder cancer. This type of cancer has cells that are closer in appearance and organization to normal cells (well differentiated). A low-grade tumor usually grows more slowly and is less likely to invade the muscular wall of the bladder than is a high-grade tumor.
  • High-grade bladder cancer. This type of cancer has cells that are abnormal-looking and that lack any resemblance to normal-appearing tissues (poorly differentiated). A high-grade tumor tends to grow more aggressively than a low-grade tumor and may be more likely to spread to the muscular wall of the bladder and other tissues and organs.

Stages in the bladder cancer:

Stage 0:

The cancer is not spread but has potential development of the cancer in the future which is termed as carcinoma insitu.

Stage 1:

The cancer cells are consider to the localized area. This is also called the early stage cancer

Stage 2 and Stage 3:

It indicates that the cancer cell has spread to the nearby lymphnodes or tissues.

Type 4 :

It indicates that the cancer has spread to other parts of the body and also it easily gets metastasis. This is also called an advanced type of cancer.

 


TREATMENT AND PROGNOSIS :

Transurethral bladder tumour resection:

a cystoscope  is inserted through the urethra into the bladder. The surgeon then removes the tumor using a tool with a small wire loop, a laser, or fulguration (high-energy electricity). The patient is given an anesthetic, medication to block the awareness of pain, before the procedure begins.

 

Radical neck dissection and Lymph node dissection:

 A radical cystectomy is the term used to removal of the whole bladder and possibly nearby tissues and organs. In men, the prostate and part of the urethra are removed. In women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. For all patients, lymph nodes in the pelvis are removed. This is called a pelvic lymph node dissection.

 

Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

 

Chemotherapy:

A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously

  • Cisplatin and gemcitabine
  • Carboplatin (available as a generic drug) and gemcitabine
  • MVAC, which combines 4 drugs: methotrexate, vinblastine, doxorubicin, and cisplatin
  • paclitaxel

 

Radiation therapy:

It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.

Immunotherapy

it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.

Bacillus calmette Guerin

Interferon

Drugs:

Nevulomab

Avelumab- used to treat advances stages of cancer.


PROGNOSIS :

The prognosis of cancer is good in its  first and second stages. But as the stages advance the prognosis is very bad. It might cause fatality of the patient.


PREVENTION :

Take healthy diet

Drink lots of water

Avoid chronic exposure to chemicals

Be hygienic while voiding urine and during sexual practices

Avoid smoking

Avoid consumption of alcohol

Take lots of fiber containing fruits and vegetables

Don’t get stress.

 


Recovery Period :

It might takes 6 weeks to recover from the cancer after surgery.

 


Medicines used in the Treatment :

Cisplatin and gemcitabine

Carboplatin (available as a generic drug) and gemcitabine

MVAC, which combines 4 drugs: methotrexate, vinblastine, doxorubicin, and cisplatin

paclitaxel

Nevulomab

Avelumab