General information about bladder cancer
What is bladder cancer?
The bladder is an empty muscle bag containing urine. It is located in the pelvis and is part of the urinary system.
Bladder cancer is the abnormal growth and multiplication of cells in the urinary bladder, which has been broken from the normal mechanisms that help control cell growth.
As many cancer cells grow, they form a tumor and over time can invade metastasize to other body parts, including the lungs, bones and liver.
Treatment for bladder cancer depends on how fast the tumor cells are growing and how far the cancer has spread in the bladder layers.
Most bladder cancers begin in urothelium or transitional epithelium. This is the inner lining of the bladder. Transitional cell cancer is a cancer that forms in the cells of urothelium.
Bladder cancer gets worse as it develops into or through other layers of the bladder wall.
Over time, cancer can develop outside the bladder into nearby tissues. Bladder cancer can spread to nearby lymph nodes and others farther away. Cancer can reach the bone, lung or liver and other parts of the body. With NMIBC, the tumor will not spread beyond the bladder.
Types of bladder cancer
The type of bladder cancer depends on how the tumor cells look under a microscope. The three main types of bladder cancer are:
Urothelial carcinoma (transitional cell carcinoma)
- The most common type of urinary cell found in the urinary tract, and accounts for 90% -95% of all bladder cancers and is strongly linked to smoking
- There are two types of cancer: papillary carcinoma (growing like a finger on the bladder) and flat carcinoma that does not produce a finger-like projection.
- This type accounts for about 2% of all bladder cancers and develops from glandular cells. Nearly all glandular cells of the bladder are invasive.
Squamous cell carcinoma
- Squamous cells grow in the lining of the bladder in response to irritation and inflammation. Over time, these cells can become cancerous.
- This type of cancer accounts for 1% -2% of bladder cancer and is also associated with prolonged infection, inflammation and irritation as associated with permanent stones in the bladder.
- This is the predominant form of bladder cancer and is associated with a chronic infection caused by the Schistosoma worm (fluke, which causes schistosomiasis, also known as malaria).
Other rare bladder cancers include : small cell cancer, pheochromocytoma and sarcoma. Sarcoma begins in the fat layers or muscles of the bladder. Small cell anaplastic cancer is a rare type of bladder cancer that has the ability to spread to other parts of the body.
The exact cause of bladder cancer is still unknown. It occurs when abnormal cells grow and multiply quickly and out of control, and invade other tissues.
Some key factors causing bladder cancer:
- Smoking is the most important cause of bladder cancer. Smoking causes about half of bladder cancers in both men and women.
- Smokers are 3 times more likely to get bladder cancer than non-smokers.
Age and gender
- The risk of developing bladder cancer is directly proportional to age. Up to 9 in 10 cases of bladder cancer are found in older adults, especially between 55 and 75 years of age.
- Men are 3-4 times more likely to get bladder cancer than women
Genetics or Personal history
- A small number of bladder cancers are linked to a genetic gene.
- If you’ve ever had bladder cancer, it’s likely that the cancer will recur.
- Contact with chemicals used to produce plastics, paints, textiles, leather and rubber can cause bladder cancer.
- Chemicals called thomine amines such as benzidine and beta-naphthylamine, used in the dyeing industry, can cause bladder cancer.
Some medications or herbal supplements
- The use of diabetes medications like pioglitazone has been associated with an increased risk of bladder cancer. The risk seems to be higher with higher doses.
- Aristolochic acid diets have been linked to an increased risk of urinary tract cancer, including bladder cancer.
Chronic bladder irritation and infection
- Urinary tract infections, kidney stones and bladder, bladder catheter left in place for a long time and the causes of chronic bladder irritation are linked to bladder cancer.
- Radiation therapy (such as for prostate or cervical cancer) and chemotherapy with cyclophosphamide increases the risk of developing bladder cancer.
Symptoms of bladder cancer
Sometimes bladder cancer doesn’t have many symptoms and is found when a urine test is done for another reason. However, people with bladder cancer often experience symptoms, including:
- blood in the urine but no pain when urinating.
- painful urination
- frequent urination
- Urinary urgency
- urinary incontinence
- pain in the abdomen
- low back pain
There are several symptoms that can indicate bladder cancer such as fatigue, weight loss and bone pain, and these symptoms may indicate more advanced disease.
Never ignore the blood symptom in your urine. Even if you notice blood in the urine only once and it’s painless, see your doctor as soon as you notice symptoms.
Other less common symptoms:
- Pain in the lower abdomen
Not everyone who has these symptoms has bladder cancer. These changes may also indicate bladder irritation or infection. Blood in the urine can also be caused by kidney stones or bladder, and prostatic hypertrophy in men.
Stages of bladder cancer
- Stage 0 : does not spread through the lining of the bladder.
- Stage 1 : Has spread through the bladder mucosa, but it did not reach the muscular layer in the bladder.
- Stage 2 : has spread to the muscular layer in the bladder.
- Stage 3 : Has spread to the tissue surrounding the bladder.
- Stage 4 : Has spread through the bladder to adjacent areas of the body.
Depending on the stage of cancer and other factors, you may receive one or more treatments, and treatment options for people with bladder cancer may include:
Surgery is part of the treatment for most bladder cancers. The type of surgery done depends on the stage of the cancer.
- Surgery to remove bladder tumor (TURBT) or thyroid resection (TUR) is often used to find out if someone has bladder cancer, whether the cancer has invaded the muscle layer of the wall of the bladder. optical. TURBT is also the most common treatment for early-stage bladder cancer
- Cystectomy: When bladder cancer invades, all or part of the bladder may need to be removed. Chemotherapy is given before bladder resection is performed.
With intravenous therapy, the doctor will put a liquid medicine into your bladder instead of giving it by mouth or injecting it into the blood. The medication is inserted through a soft catheter that enters the bladder through your urethra and stays in your bladder for up to 2 hours.
In this way, the drug can affect the cells lining your bladder without having a great effect on other parts of the body.
Intravenous therapy is used: after surgery to remove bladder tumors, treatment of non-invasive bladder cancer, treatment of invasive bladder cancer at a higher stage.
Types of intravenous therapy: Immunotherapy and Chemotherapy
Chemotherapy is the use of drugs to treat cancer. Chemotherapy for bladder cancer can be given in 2 different ways:
- Internal chemotherapy : chemotherapy drugs are immediately inserted into the bladder. The chemicals act to kill harmful cells. This type of chemotherapy is used for bladder cancer only in the lining of the bladder.
- Systemic chemotherapy : When chemotherapy is given as a pill or injected into a vein (IV) or muscle (IM), it enters the bloodstream and travels throughout the body. Systemic chemotherapy can affect cancer cells anywhere in the body. It can kill cancer cells that may have spread outside the bladder.
Chemotherapy used: Before surgery, after surgery, in people receiving radiation therapy,
Radiation therapy uses high-energy radiation to kill cancer cells.
The type of radiation commonly used to treat bladder cancer is called external beam radiotherapy. It concentrates radiation from an outside source into the cancer ..
Radiotherapy may be used:
- As part of treating some early-stage bladder cancer, surgery doesn’t remove the entire bladder after surgery
- It is the main treatment for people with early cancer who cannot undergo surgery or chemotherapy
- To try to avoid bladder cutting
- As part of treatment for advanced bladder cancer
- To help prevent or treat the symptoms caused by advanced bladder cancer
- Radiation therapy is often given along with chemotherapy to help the radiation work better, called chemoradiation.
Immunotherapy is the use of drugs to help the immune system recognize and kill cancer cells. Immunotherapy is sometimes used to treat bladder cancer.
- Intravascular BCG : is a bacteria associated with the bacteria that causes tuberculosis, which helps trigger the immune response. BCG can be taken immediately into the bladder as a liquid, activating immune system cells in the bladder, and then attacking bladder cancer cells.
- Immune control point inhibitors (for advanced cancer): An important part of the immune system is its ability to keep itself from attacking normal cells in the body. These drugs are used to treat bladder cancer that has spread to other parts of the body: Atezolizumab, durvalumab and avelumab, Nivolumab and pembrolizumab .
Targeted treatment drug
Drugs that target activity differ from other types of treatment, such as chemotherapy
- FGFR inhibitors: Drugs targeting FGFR-altered cells (called FGFR inhibitors) may help treat some people with bladder cancer.
- Erdafitinib (Balversa): used to treat metastatic or locally advanced bladder cancer with certain changes in the FGFR2 or FGFR3 genes, and is still growing despite chemotherapy. It is taken orally in tablet form, once a day.
Your doctor will talk to you to decide which treatment will be based on the type and stage of bladder cancer, your symptoms and overall health.
There is no sure way to prevent bladder cancer. Certain risk factors, such as age, gender, race and family history, cannot be controlled.
Simple lifestyle changes you can control can reduce your risk of developing bladder cancer:
- Smoking cessation: Smoking is a major cause of bladder cancer, stopping smoking can significantly reduce the likelihood of cancer.
- Drink plenty of water: men who drink at least 1.44 L of water (about 6 cups) per day may be able to significantly reduce the incidence of bladder cancer when compared to those who drink less
- Eat more fruits and vegetables: fruits and vegetables may reduce the risk of bladder cancer in moderation.
- Exercise: get regular physical activity and keep a healthy weight
After treatment, people who already have bladder cancer are at a higher risk of recurrent bladder cancer, so it is important to attend all scheduled appointments.
The schedule of your tests and tests will depend on the stage and level of the cancer, the treatments you have done and other factors. Be sure to follow your doctor’s advice about follow-up tests.
Check back every 3 to 6 months for those who have no signs of cancer after treatment
Tell your doctor about any new symptoms, such as pain when urinating, blood in the urine, frequent urination, or need to urinate immediately. These symptoms may be a sign that the cancer is back or a sign of another medical condition.
If you use any kind of nutritional supplement, talk to your doctor. They can help you decide which ones you can safely use and avoid things that can be harmful.
Source of Reference Bladder cancer:
Assoc.Prof.Dr. Tran Ngoc Anh is currently Hanoi Medical University Hospital, Associate Professor, Department of Internal Medicine, Gastroenterology and Head of Department of General-Uematology of Hanoi Medical University. Consulting doctor at ThuocLP Vietnamese health.
Professional qualifications, Academic degrees – Education:
Graduated from General Practitioner System, Hanoi Medical University
Graduated with a Master degree in Internal Medicine, Hanoi Medical University
Graduated from the training program specialized in Gastrointestinal, Henri Mondor Institute Center, University of Paris 6, French Republic 1996-1997; 1999
Graduated from the training program specialized in Gastrointestinal, North Royal Sydney Hospital, Australia; 2002
Graduated from a training program specialized in chronic liver diseases, Pizza, Italy 2009
Graduated with a PhD in Gastrointestinal, Hanoi Medical University
Associate Professor, Gastroenterology, Hanoi Medical University
Training and Scientific Research:
Published more than 200 articles in domestic and international specialized journals
Editor of many monographs and participates in compiling 2 textbooks.
Guide many students and graduate students of Hanoi Medical University
Manager of many grassroots research projects
Certificate of Good Clinical Practice (GCP: 2012, 2015), Ministry of Health
Specialized certificates: General gastrointestinal endoscopy, Interventional gastrointestinal endoscopy, General gastrointestinal ultrasound, Interventional gastrointestinal ultrasound (Bach Mai BV), Chronic liver disease.