By Dr Pankaj N. Maheshwari, Senior Consultant and Chief Urologist, Fortis Hospitals, Mulund~
Cancer has been one of the leading causes of disease-related death for a long time. Among all kinds of cancers, Bladder Cancer is the ninth most common malignancy worldwide, affecting nearly 430,000 people every year. India alone had 18,921 new cases of bladder cancer in 2020, with an incidence rate of 2.4 in males and 0.7 in females per lakh population until 2020. The mortality rate being 1.3 in males and 0.3 in females.
The urinary bladder, a vital organ, is involved in collecting and storing urine from the Kidneys before disposal. The bladder is a hollow, muscular and distensible (or elastic) organ. This cancer begins when the bladder’s lining (Urothelial Cells) cells start to grow abnormally and out of control. The cells multiply with time, and cancer may eventually go deep in the bladder muscle or spread to different body parts. Urothelial cells are also present in the inner lining of the kidney and ureters. Different types of Bladder Cancer are:
- Urothelial Carcinoma – This type of cancer is also called Transitional cell carcinoma. This is the most common variety of bladder cancer; tumours can also develop in the kidney and ureter as they also share the urothelial lining.
- Squamous Cell Carcinoma arises when there is a chronic infection or irritation to the bladder like a long-term urinary catheter or neglected stones. This is relatively common in places where Schistosomiasis, a parasitic infection, is a cause of bladder infections
- Adenocarcinoma is another rare form of bladder cancer that arises from the mucus-secreting glands cell in the organ
SYMPTOMS OF BLADDER CANCER:
- Hematuria (blood in urine): this is a standard mode of presentation. It is essential not to neglect visible or microscopic blood in urine after the age of 40 years.
- Frequent and painful urination
- Abdominal, lower back pain
- Urinary incontinency
HIGH-RISK FACTORS:
The significant risk factors for bladder cancer include tobacco smoking, industrial exposure to potential carcinogens such as aromatic amines and carbon black dust, long-term drinking of arsenic-contaminated or chlorinated water, and family history of Prostate, Endometrial and Bladder Cancers.
Smoking – Smoking is not just responsible for oral and lung cancer. Smoking cigarettes, cigars and even pipes can also cause bladder cancer, as certain harmful chemicals excrete out of the body through urine. This, in turn, damages and deteriorates the bladder lining, thus increasing cancer chances
Gender – Men are more likely to develop this cancer in their lifetime than women.
Exposure to chemicals – Kidneys play a primary role in filtering harmful substances from our bodies and bloodstream. Thus, exposure to arsenic, aromatic amines, chemicals used to manufacture dyes, rubber, leather, etc., is detrimental to health.
Personal or family history of bladder cancer is another highly probable risk factor for the disease.
Urinary Tract infections or bladder problems – Frequent bladder inflammation or infections and bladder stones may go on to cause bladder cancer
Evaluation and management:
Apart from basic pathology evaluation, CT scan and endoscopic examination (Cystoscopy) are the mainstays for the diagnosis. Treatment depends on the stage of the disease. Early and superficial tumours may be managed endoscopically, but once it grows inside the bladder wall, removal; of the bladder becomes necessary.
PRECAUTIONS TO BE TAKEN:
Many risk factors can be modified by lifestyle measures and environmental protective initiatives, implying a solid prospect for intervention. To initiate lifestyle changes, one must avoid or, better yet, quit smoking. Drink lots of fluids because when a person urinates, they get rid of the harmful chemicals that initiate and cause Cancer growth. If your job requires you to be around chemicals, take necessary precautions to protect yourself. Lastly, include plenty of colourful fruits and vegetables, rich in antioxidants, macro and micronutrients, in your diet. Finally, being observant of the colour of urine and symptoms can be instrumental in saving lives.
