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Bladder Cancer Basics II: Diagnosis, Treatment, and Prevention

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Bladder Cancer Awareness Month happens in May every year, and it is a time to raise awareness of symptoms and share crucial information about prevention and treatment. According to the World Cancer Research Fund, bladder cancer is the tenth most common cancer worldwide. In 2020, the number of deaths stemming from this cancer was over 90,000 in Asia. 

Bladder cancer can happen to anyone, including you or your loved ones. In the previous article, we look at the causes, symptoms and stages of bladder cancers. In this second part of the 2-part series, we take a look at the diagnosis, treatment and prevention of this cancer.

How to diagnose bladder cancer?

Cystoscopy 

This is the gold standard to evaluate the bladder and urinary system. Cystoscope is a small tube with a camera, which is inserted through the urethra into the bladder. It surveys for any abnormalities in the lining of the bladder and urethra. 

Urinalysis or Urine Cytology

Your doctor may order for this test to check for cancer cells in your urine. This is a non-invasive and quick procedure. However, absence of cancer cells does not rule out a diagnosis of cancer.

Biopsy

If abnormal tissue is seen during a cystocopy or urine cytology, the urologist may remove tissue samples from your bladder. The sample, known as a biopsy, will be examined under a microscope for cancerous cells.

Computed Tomographic (CT) Urography

This is a radiological imaging test which involves injecting a contrast dye into a vein. As the contrast dye moves through the ureters, kidneys, and bladder, x-rays are taken to check for blockages. The CT urography images the entire abdomen and pelvis area. This allows a radiologist to identify signs of spread beyond the bladder.

How to treat bladder cancer? 

Treatment of cancer will depend on the stage and grade of the tumour. Early detection of symptoms is key to increasing success of treatments. 

Treatment for non muscle invasive bladder cancer (i.e. tumour has not yet invaded the muscle layer)

Transurethral resection of bladder tumour (TURBT) surgery 

This is done during a cystoscopy. There are no external cuts to the body. The cystoscope is passed through the urethra and into the bladder. The surgeon may use a wire loop on the cystoscope to remove the tumour. Repeated TURBT may be required for more aggressive tumours.

Immunotherapy 

Immunotherapy is a type of cancer treatment that uses vaccines and drugs to utilise the immune system’s natural ability to fight cancer.

Bacillus Calmette-Guerin (BCG) is the most common immunotherapy for treating early-stage bladder cancer. It prevents the cancer from growing or recurring. BCG is a germ related to the one causing tuberculosis, but it is not disease-causing. A catheter delivers the BCG into the bladder, so that it contacts with the cancer cells. This subsequently switches on the immune system. The immune system cells proceed to attack the bladder cancer cells. 

Approximately 70% of bladder cancer patients go into remission after BCG treatment. 

Intravesical chemotherapy 

Chemotherapy refers to the use of medications to stop the growth of cancer cells, without damaging healthy cells. Intravesical refers to the use of a catheter inserted through the urethra to access the bladder. The catheter delivers medications into the bladder, and the medications are left on the bladder walls for a period of time. Each treatment is known as an instillation. 

Treatment for muscle invasive bladder cancer (i.e. tumour has invaded the muscle layer)

Radical cystectomy

This involves the removal of the whole bladder, nearby lymph nodes, and even nearby organs if needed. After radical cystectomy is completed, bladder reconstruction surgery is needed to store urine in an alternative way. 

Radiation therapy

High energy x-rays are used to kill the cancer cells. This is often combined with chemotherapy, and done over several weeks. 

Systemic chemotherapy 

Systemic chemotherapy involves giving medications in either pill or injection form to kill cancer cells. These medications are given over a certain period of time, usually every few weeks for a number of months.

Immunotherapy

For advanced bladder cancer patients, there are investigational immunotherapies which “train” the immune system to recognise bladder cancer cells. Cancer cells create barriers called checkpoints. These checkpoints prevent immune system from attacking them. These therapies, known as checkpoint inhibitors, block these checkpoints and make cancer cells visible to the immune system. The immune system can now recognise and destroy the cancer cells. 

How to prevent bladder cancer? 

There is no sure way to prevent bladder cancer, but there are steps you can take to lower your risk: 

  • Do not smoke 
  • Stay away from certain chemicals in the workplace
  • Drink plenty of liquids 
  • Eat lots of natural fruit and vegetables. However, do take note that this does not include vitamins or supplements. In fact, studies have shown that beta-carotene supplements increase risk of bladder cancer.

Summary of Part II

In the first part of this 2-parts series, we learn more about the basics of the bladder, and the symptoms and stages of the cancer. The second part of this series rounds off with the diagnosis and treatment available. Find out more about this disease from your urologist, especially if you have similar symptoms as discussed before.

Article is written in conjunction with Bladder Cancer Awareness Month 2021.

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