Bladder Cancer

Bladder cancer

 Introduction

Urinary bladder, commonly known as bladder, is located inside your pelvic cavity, in the lower region of your abdomen. It serves the purpose of collecting urine via ureters from kidneys and stores it. After receiving micturation reflex it discharges the liquid waste, urine to outside through your urethra.

The organ is the seat of abnormal overgrowth of cells inside lining of your urinary bladder. The mechanism that set cancer growth lies in the change in your bladder lining cells DNA structure. The result is the development of tumor, which spread within your balloon shaped organ. Although it is a cancer that is diagnosed at early stages as compared to cancers of other parts ,but keep it in mind that, it has greater tendency for recurrences . Like any other cancer or malignant growth, your bladder cancer too, spreads to adjacent organs and via blood circulation to distant parts like liver, lungs, bones.

The different types of cells lining your bladder can develop into cancerous growth. The types of bladder cancer encountered are broadly grouped into  following two sub types depending upon their invasive nature;

1)                Superficial or non-invasive bladder cancer  :  This bladder cancer variety remains confined within the inner lining of mucosa and lamina, and does not go deep into muscular lining wall. According to cell type these commonly are called, urothelial or transitional cell carcinoma. This type of bladder cancer comprises of more then 90% of bladder malignancies across the globe. The statistics reveal this variety to be the most commonly  occurring cancer of bladder in US. On rough estimates 7 out of 10 bladder carcinomas are of this variety and they are generally of less serious nature. Deaths rarely occur with this type of bladder cancer.

2)                 Deep seated or invasive  bladder cancer         :  When your bladder cancer has invaded or penetrated the surrounding muscular lining of your bladder they may become severe in symptoms and lethal at times. They are least common type of bladder carcinomas, but they have tendency to spread to neighboring structures and distant locations of your body. The invasive types are subdivide into;

Ÿ                       Squamous cell carcinoma of bladder   :  Sometimes constant irritation or inflammation as it happens in bladder stones or certain parasite infection, may result in formation of  squamous cells growth and development of bladder cancer over a period of months or years. About 4-8% of bladder cancers are of squamous cell type.

                      Adenocarcinomas of bladder               : This cancerous growth is in mucous secreting glands of your bladder wall. Like the squamous cell variant, it also develops into abnormal cell growth because of long standing inflammation/irritation in your bladder wall. Metaplasia of bladder cell takes place, which spreads into deeper muscular lining of your bladder wall. These account for 2% of bladder malignancy.

       

 Signs and symptoms of bladder cancer         

Ÿ                               Blood in urine               :       The first and most common symptom of your bladder cancer is macroscopic( visible to naked eye) hematuria(blood in urine). Although ,sometimes it becomes necessary to analyze your urine under microscope to confirm for hematuria.

                      

Ÿ                            Frequency of urination       :              Unlike normal period of interval in passing urine ,you may feel going for urination after very short interval. You pass very small amount each time.

Ÿ                             Pain during passing urine    :        formation of blood clots in passage of your urine may cause pain when you urinate. There may be sense of burning during passing urine(dysuria).

Ÿ                            Urgency of urination                   :   You feel you may soil your cloth, as the intense desire to void or empty the cancerous bladder gets beyond your control. But you will feel the output does not match the desire you felt, hence this cycle may be repeated.

Ÿ                             Incontinence of urine              :  It is one extreme of urgency ,when you are unable to control or hold urine from leaking out of your urethra. Either it keeps leaking from time to time or there is complete emptying of your cancerous organ, without warning.

Ÿ                          Weight loss                                  :    loss of appetite and consequent loss of your weight is one of features of your bladder cancer. Sometimes you will find it hard to cope with ,even you are eating well you are loosing weight. This may warrant seeing your doctor for evaluation.

Ÿ                          Pelvic pain                                        :  Although it is rare , but the pain in your pelvic region may be a symptom of bladder cancer, due to tumor growth and nerve stretching in bladder lining.

Ÿ                              Legs swelling                                    : In some of you with bladder cancer, legs become swollen as result of pressure of growth on venous drainage or spread of tumor to other parts of urinary system.

2.0 Causes and Risk factors

The definitive etiology of your bladder cancer is still not brought to light. The uncontrolled or abnormal growth which takes place during development of you tumor has been attributed to following significant factors ;

Ÿ          Cigarette smoking :  The most common variety of bladder cancers, urolethial carcinoma is caused by cigarette smoking. Half of bladder cancers in men and nearly thirty percent in women are caused by years of smoking. The risk with smoking and your developing a bladder carcinoma increases with frequency and duration of your smoking. Even if you are a passive or second hand smoker, you may develop bladder cancer over years of exposure. It is believed and proved in studies that, cigarette smoke has carcinogens( cancer causing substances),getting expose to smoke results in your bladder cancer. The carcinogen travel through blood and cause cell damage of bladder wall.

Ÿ           Herbal substance :   A herb used in Chinese medicine supplement for loosing weight, called Aristolochia fangchi has been implicated for causing your bladder cancer. This herb has certain chemical that starts process of abnormal cell growth leading to your bladder cancer.

Ÿ            Chemical exposure:  Aromatic amines have great association of bladder cancer growth. If you are involved in plastic industry, detergent manufacturing,  pharmaceutical chemicals, leather, dye, rubber and paint manufacturing. You may develop bladder cancer, as these all involve aromatic phenol amines exposure .

Ÿ            Schistosomia parasite: There has been proved link between your bladder cancer and Schistosomiasis, a parasitic infection of urinary bladder. This is because of production of cancer causing substance by Schistosomia parasite inside your bladder wall excites cancer cell growth. This has been attributed to production of N- nitrosamines by Schistosomia parasite inside your bladder. This chemical is a strong carcinogen. Another mode given is , the damage caused by schistosomia larvae to your bladder wall lining,resulting in met plastic(cancer) changes.

Risk factors      :There are a number of risk factors which may increase your chances of developing bladder cancer like;

Ÿ            Aging                 : With some other associated factors your advancing age makes you more susceptible for developing bladder cancer. It is found more after the 65 years, commonly in male  population.

Ÿ          Occupational  hazard :  Working in certain occupation like in chemical industries dealing in textile dyes, rubber, plastic, crude oil and pharmaceuticals will increase your risk of bladder cancer .

   

Ÿ         Sex                               :  If you are a male, then you have three times at more risk of developing bladder cancer ,compared to your female counterpart in same age group. A female under 40 years rarely develops bladder cancer.

Ÿ          Agricultural farmers        :  The parasite Schistosomia is a water habitat. It infects and travels via blood circulation to reach your bladder. It is a common source of chronic irritation and inflammation in your bladder. Particularly  so if you are living in some African country and engaged in agricultural farming.

Ÿ            Race                           :  White colored individual are more prone to have bladder cancer than other colored races.

Ÿ              Exposure to radiotherapy   : If you have been treated in past with radiotherapy for prostatic cancer or (in case female) for cervical cancer, you are exposed to much greater risk of developing bladder cancer in future. Even   chemotherapy,(cyclophosphamide) has been found to increase risk for bladder cancer development.

Ÿ              Long term catheterization    :  If there is paralysis effecting bladder control, you may be catheterized for long duration which can be a constant irritation to your bladder and source of infection. This itself increases your chances of developing bladder cancer.

Ÿ             Genetic predisposition            : Having any family member with bladder cancer puts you at more risk of bladder cancer growth compared to normal population.

            

Ÿ               Viral infection                        :  Human papilloma, herpes simplex group and polyomaviruses have been found in non-invasive urothelial bladder cancer . Human papilloma virus is more associated with  urothelial or transitional cell bladder cancer. Their link with bladder cancer is more marked in smokers( or passive smokers) than non-smokers.