Risk Factors for Bladder Cancer (BC)

 

Bladder cancer takes a long time to develop, that is why it might be observed in the longer time after exposure to some of the risk factors takes place

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Smoking

The strongest risk factor for bladder cancer worldwide is cigarette smoking. Incidence is strongly positively corelated with the increase of the number of cigarettes smoked daily and duration of smoking

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Occupational exposure to chemicals

The second most important risk factor for BC is work related exposure to chemicals. The most often occurs in dyes, rubbers, textiles, paints, lather related industries. Also exposure to aromatic amines

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Radiotherapy 

External – beam and brachytherapy radiotherapies a a treatment of the gynecological cancers or prostate cancer is a risk factor for the bladder cancer

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Bladder schistosomiasis and chronic urinary tract infections

Bladder schistosomiasis is the second most common parasitic infection after. Good treatment of this disease will decrease the risk of BC. Other risk factor are untreated chronic infections of the urinary tract or bladder stones.

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Genetic factors

Studies showed first and second line relatives affected as a risk factor, but this can be also a common wealth of environmental, not necessarily genetic factor

 

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Prevention of the bladder cancer

 

Quit smoking

Studies show immediate decrease in the risk of BC has been observed among those, who stopped smoking. The longer period free of cigarettes, the higher risk reduction. Find out more about smoking cessation programs.

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Consume flavonoids and ligans

Studies show negative correlation between consumption of flavonoids and ligans and BC

 

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Possible symptoms of bladder cancer

 

• blood in the urine – haematuria 

• urgency to urinate

• dysuria 

• increased frequency of urination

• pelvic pain

• urinary tract obstruction

 

 

Diagnosis

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• physical examination

• CT scan

• MRI

• cystoscopy

• biopsy mapping

• urinary cytology (important to know, that does not indicate undoubtfully bladder cancer, if positive – might originate from the tumor located in the urinary tract)

 

 

Treatment of Bladder Cancer

 

TURBT (Transurethral Resection of a Bladder Tumor)

Is a surgical, but incisionless procedure, performed as both – diagnostic and treatment. Procedure is done under general anesthesia. Surgeon introduces a resectoscope – device similar to cystoscope through the urethra into the bladder. Using this instrument surgeon can visualize and remove those tumors, that are suitable for resection. All the removed specimen will be send to histopathological examination. This exam should confirm type of tumor, its stage and depth of invasion into the bladder wall. This data combined with the results of imaging diagnosis will determine the further treatment options. In some cases a second resection is necessary. Procedure is minimally invasive and relatively safe for the patient

 

Surgical Treatment – Radical Cystectomy

If the tumor has invaded the muscle wall or if the BCG therapy doesn’t bring the expected results or tumor comes back after BCG, patients may be suggested to undergo the Radical Cystectomy surgery. During this procedure surgeon will remove the bladder itself and the most often:

 

in male patients he will also remove prostate, seminal vesicles, distal ureters, and regional Lymph Nodes (LN) to avoid metastasis of the cancer. Prostate sparing cystectomyis possible for the carefully selected patients. In the case if prostate and prostatic urethra are disease free. Unfortunately statistics show, that in 21-50 % of the male patients undergoing cystectomy for the BC, prostate cancer is also found

 

in the female patients the bladder, distal ureters, entire urethra, uterus, adjacent part of vagina and regional Lymph Nodes will also have to be removed

 

After this first part of the surgical procedure, surgeon will create the neoblader – pouch, where urine will be stocked and relieved from the body. Neobladder will be created from the portion of the small intestine. Neobladder will be connected to the urethra, so patient will be able urinate normally, using the specially trained abdominal muscles. Due to its complexity this operation lasts usually 6-8h and needs to be performed by extremely experienced and skillful surgeon to ensure that results are safe oncologically and great functionally. Dr Corona recommends a robotic approach to ensure precision as for example sparing a prostatic nerve bundles (sexual functions in men) and keep concentration of the operating surgeon maximally high (robotic assistance is much more physically comfortable for the surgeon than laparascopic approach during this long procedure). Also due to the length of procedure overall physical condition and nutrition of the patient should be rather strong

 

RC is recommended to be performed asap, not longer than 90 days after full diagnosis, further delay may have a negative impact on the life expectancy of the patient

 

Chemotherapy & Immunotherapy

The therapies used to support initial TURBT, prepare for Radical cystectomy or as an organ sparing therapy. In this method the pharmacological material is placed through the urethra directly in bladder and effects bladder lining

 

Bacille Calmette-Guerin (BCG)

Immunotherapy, weak tuberculosis bacteria “irritates” – brings the allergic reaction the bladder lining and this kills a cancer cells. It does not enter the blood system. Used for non- muscle invasive bladder tumor patients. Placed in the bladder through catheter in the liquid form and stays there for about two hours. Usually recommended once a week for several weeks

 

disadvantages

• prolonged bladder irritation

• fever

• bleeding

 

advantages

 

 

Mitomycin C

drug, introduced same way as BCG, effective after TURBT 

 

disadvantages

• lining irritation, felt like a urinary tract infection

• pain while urinating

 

advantages

• reduces number of tumor recurrences by about 50%

• not easily absorbed by lining to the blood – less side effects than chemotherapy taken intravenously