What is bladder cancer?
The bladder is the hollow organ in the lower abdomen that stores urine. Bladder cancer is an abnormal growth that starts in the inside lining of the bladder wall. It may remain confined to the bladder initially, but later grow into surrounding organs and spread to other parts of the body.
Who is at higher risk of developing bladder cancer?
It is more common in men and adults above the age of 50. Cigarette smokers have an increased risk of developing it by 2 to 4 times over never-smokers. Prolonged exposure to certain industrial chemicals, like ‘azo’ compounds found in dyes, can also increase the risk. Family history of bladder cancer plays a role. Chronic bladder infection by a parasitic worm (Schistosomiasis) as a cause is rare in Singapore but a major risk factor in Egypt and the Middle East.
What are the symptoms and how is it diagnosed?
The early symptoms may be intermittent and mistaken for other conditions like urinary tract infection, enlarged prostate and urinary stone. These include blood in the urine, frequent and urgent urination and less commonly pain on urination. Late symptoms include weight loss, fatigue and pain in the pelvis and flanks. Visible blood in the urine, once confirmed with a urine test, requires a complete check of the urinary tract. This usually involves a CT scan of the urinary tract and a cystoscopy, whereby a urologist uses a scope inserted into the bladder via the urine pipe to directly visualise the bladder lining. Abnormal tissue is biopsied and sent for evaluation under the microscope.
What are the treatment options for bladder cancer?
Bladder cancer limited to the inner lining, and not invading the outer muscle layer of the bladder wall, is known as superficial bladder cancer. Such cancers can be removed from the inside by a transurethral resection of bladder tumour (TURBT) via a cystoscopy. A single dose of chemotherapy instilled into the bladder is usually advised to further reduce the risk of the tumour coming back. Higher risk superficial cancers may require instillations of BCG, a bacteria that stimulates the body’s immune system to work against any residual cancer cells.
Bladder cancer that has invaded into or beyond the muscle layer is treated by surgical removal of the bladder (cystectomy). Intravenous chemotherapy can be given to shrink the tumour before surgery. After removal of the bladder, the intestinal tissues would be used to create a diversion of urine to an opening in the abdomen or in some cases reconstruction of a new bladder. An alternative treatment, for patients who are not fit for cystectomy, or want to attempt to preserve their bladder, is to have a combination of chemotherapy and radiation therapy to eliminate the cancer, following TURBT.
Bladder cancer that has spread to other parts of the body is usually treated with chemotherapy, and more recently, immunotherapy and targeted drug therapy. These drugs can shrink the bladder tumours, relieving symptoms and prolonging life in the process.
What is the prognosis for bladder cancer patients?
The prognosis varies depending on the stage and grade of the cancer, as well as other factors such as the patient’s overall health and response to treatment. Early-stage bladder cancer often has a good prognosis, with high survival rates. However, advanced-stage bladder cancer may have a poorer prognosis, with a higher risk of recurrence and metastasis. Hence, bladder symptoms should be highlighted early to medical professionals as detection and treatment at an earlier stage leads to a markedly better prognosis.
This article is contributed by Dr Jonathan Teh Yi Hui, Medical Director (Centre for Stereotactic Radiosurgery) & Senior Consultant Radiation Oncologist at Asian Alliance Radiation & Oncology (AARO).
