Bladder cancer 101

Afflicted: One of the biggest risk factors for bladder cancer is smoking. — AFP

Afflicted: One of the biggest risk factors for bladder cancer is smoking. — AFP

Bladder cancer is not an uncommon cancer, and it usually affects men more than women.

BLADDER cancer is the sixth most common cancer among males in Malaysia, with an estimated incidence of 4.7%.

One of the biggest risk factors for bladder cancer is smoking. The risk is about four times higher in smokers compared to non-smokers.

The risk increases with the number of cigarettes smoked, and the duration one has been smoking.

Chemicals that can cause cancer are present in cigarette smoke. Some of these chemicals are absorbed into the blood and end up in the urine after being filtered by the kidneys.

The chemicals can damage the cells that line the bladder, and over many years, this may cause cancer.

Besides that, the older the person is, the higher the risk of bladder cancer. In Malaysia, the average age of a bladder cancer patient is 65 years old. If you are a male, the risk is also greater.

In a study carried out in a hospital in Malaysia, the male-to-female ratio was 9.4 to 1.

Radiotherapy is a treatment option for bladder cancer, especially if the patient has multiple medical illnesses and is not fit for surgery. - Filepic
Radiotherapy is a treatment option for bladder cancer, especially if the patient has multiple medical illnesses and is not fit for surgery. — Filepic

Exposure to certain chemicals like aromatic amines used in dye factories, rubber, leather, textiles, printing, gasworks, plastics, paints, and in other chemical industries also increases the risk.

Other risk factors include repeated urinary infections, untreated bladder stones, radiotherapy to the pelvis, cyclophosphamide (a type of chemotherapy) and family history of bladder cancer.

The most common presenting complaint of bladder cancer is blood in the urine (haematuria). This is usually visible to the naked eye (macroscopic haematuria), and is usually painless.

Sometimes, the blood is not visible and can only be detected by urine tests (microscopic haematuria).

There may also be urinary symptoms like increased frequency of going to the toilet as well as urgency (a sudden urgent desire to pass urine and not being able to put off going to the toilet).

If bladder cancer is suspected in an individual, a urine test will usually be performed to look for blood as well as cancer cells.

A flexible cystoscope (a thin tube with a camera and light on the end) will then be used to directly view the bladder. A jelly containing anaesthetic will be squeezed into the opening of your urethra to make the procedure less uncomfortable.

The doctor gently passes the cystoscope through your urethra and into the bladder and examines the whole lining of the bladder. The whole test takes a few minutes and you can usually go home after it is finished.

If bladder tumour is seen, the next step is to get the same procedure done under general anaesthesia in the operating theatre, either to take a small piece of tissue (biopsy) or to remove the tumour (transurethral resection of bladder tumour/TURBT).

The tissue specimen will then be sent to the laboratory to be examined under the microscope to look for cancer cells.

If it is proven to be cancer, it will then need to be staged to determine the extent of the cancer, i.e. whether it is localised (confined to the bladder) or advanced/metastatic (spread beyond the bladder into surrounding tissues or distant organs like the liver, lung or bone).

This would entail having radiological imaging like computerised tomography (CT) scan or magnetic resonance imaging (MRI).

Treatment will then be determined by the extent of spread.

Most of the time (about 70% of cases), the cancer is superficial. After complete resection of the tumour with a cystocope, chemotherapy drugs like mitomycin or a vaccine known as BCG (Bacillus Calmette–Guérin) will be introduced into the bladder.

If the cancer is found to be invasive but has not spread to distant organs, then either surgery (radical cystectomy) or radiotherapy is needed.

Radical cystectomy entails removing the bladder with the surrounding lymph nodes. This can be done either through open surgery, or laparoscopic/robotic surgery. In men, the prostate is removed as well.

To replace the bladder, either a urostomy (ileal conduit), continent cutaneous urinary diversion or a new bladder (neobladder) is formed.

In urostomy, the ureters are connected to a section of the small bowel, which will then divert the urine out through an opening in the abdomen.

In continent cutaneous urinary diversion, a pouch is made from the bowel to replace the bladder. The ureters are again connected to this pouch and urine is emptied by inserting a catheter (small tube) into this pouch through an opening in the abdomen.

In a neobladder, this pouch is connected to the remaining urethra instead of an opening in the abdomen.

Radiotherapy is another option, especially if one has multiple medical illnesses and is not fit for surgery.

This involves high energy rays to kill off the cancer cells. Each treatment takes about 10-15 minutes, and they are usually given Monday-Friday, with a rest at the weekend. A course of radiotherapy for bladder cancer may last four to seven weeks.

Chemotherapy may be given in combination with surgery or radiotherapy.

If the cancer has spread to other sites or organs, then treatment will not be curative. It will depend on the symptoms involved and may require a combination of radiotherapy, chemotherapy, or rarely, surgery.

Bladder cancer is notorious for recurrences, even when it is superficial. Therefore, careful and regular follow up is essential.

Cystoscopes and urine examination are needed during clinic appointments, and sometimes CT scans are also required.

Most superficial cancers do well after proper treatment. Those who have poor survival are usually diagnosed late and have advanced cancer that has spread beyond the bladder.

Therefore, early diagnosis and prompt treatment is mandatory. Do not procrastinate. See your doctor if you have any of the symptoms described above.

This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist.

For more information, e-mail The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.

The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

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