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.
