Bladder cancer is a condition when cells inside the bladder grow abnormally and uncontrollably, thus forming cancer cells. If cancer cells continue to grow, cancer cells can spread to tissue around the bladder or spread to other organs further away such as liver, bone and lung. The bladder is the organ that serves to hold the urine before it is removed from the body. Urine is produced by the kidneys and carried to the bladder through a connective tube called the ureter. During the process of urination, the muscles in the bladder contract and push the urine out through a channel called the urethra.
The type and treatment of bladder cancer is determined by the cells in which the cancer grows. The following is a type of bladder cancer that is differentiated based on the type of cells where the cancer grows.
- Urothelial carcinoma . This type is the most common in bladder cancer. This cancer grows in the urothelial cells, the layer of cells in the bladder.
- Squamous cell carcinoma . Squamous cell c arsinoma or squamous cell carcinoma (KSS) is a type of bladder cancer that also grows in squamous urothelial cells. Bladder KSS is associated with persistent bladder irritation, for example because of the use of long-term urine catheters or bladder infections
- Adenocarcinoma . This type of cancer grows on cells that make the mucus-producing glands in the bladder. Cancer cells are formed after the bladder often develops inflammation.
Causes of Bladder Cancer
Bladder cancer occurs because there is a change in the structure of DNA (mutation) in cells in the bladder. These mutations make the cells in the bladder grow abnormally and form cancer cells. However, it is unknown what causes the cells in the bladder to change.
Experts suspect that cell changes in the bladder are associated with exposure to certain chemicals, such as carcinogenic substances in cigarettes. The bladder of a person who smokes, will be exposed to carcinogenic substances continuously. Such exposure can trigger a mutation in bladder cells, thus causing the risk of bladder cancer. It is important to know, people who smoke 4 times more at risk of bladder cancer than people who do not smoke.
In addition to cigarettes, bladder cancer is also suspected triggered by exposure to industrial chemicals such as 4-Aminobiphenyl, Benzidine, Xenylamine, O-toluidine, Aniline dyes, and 2-Naphthylamine used in leather, rubber, textile, and paint manufacturing industries. Another suspected chemical that can trigger the growth of bladder cancer cells is arsenic.
In addition to cigarettes and industrial chemicals, other risk factors that are thought to trigger bladder cancer are:
- Male sex.
- Women who experience menopause are too early (under 40 years).
- Have undergone radiotherapy of the pelvic area or near the bladder, for example for the treatment of colon cancer.
- Never undergo chemotherapy with cisplatin or cyclophosphamide.
- Suffered from urinary tract infections and chronic bladder stones.
- Use long-term urine catheter.
- Suffered untreated cystosomiasis .
- Ever had prostate surgery.
- Have type 2 diabetes .
- There is a history of cancer in the family.
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Symptoms of bladder cancer
Generally, a person suffering from bladder cancer has problems during urination, such as the presence of blood in the urine ( hematuria ), frequent urination (BAK), sudden craving for BAK, and BAK pain.
Bladder cancer can develop and spread to other parts of the body. At this stage, the symptoms are:
- Pelvic pain .
- Loss of appetite and weight loss.
- Swelling of the legs.
- Bone pain.
Diagnosis of Bladder Cancer
After inquiring about the patient's symptoms and performing a physical examination, including a rectal examination or a vaginal plug (for women) to feel for a lump, the doctor may suggest some investigations to diagnose bladder cancer, such as:
- Urine test e . Urine of patient will be checked to know the condition of health.
- Imaging. Photo examination Urinary tract contamination with contrast agent (BNO-IVP), or urinary tract scan (urography) can be performed to see bladder images.
- Cystoscopy. This procedure includes a small hose equipped with a camera to see the condition inside the bladder.
- Biopsy. The doctor will take a tissue sample from the bladder to see if there is a cell change to cancer.
- Stage 0 . Cancer has not spread beyond the bladder layer.
- Stage I. The cancer has spread through the bladder layer, but has not yet reached the muscle layer in the bladder.
- Stage II . The cancer has spread to the muscle layer in the bladder.
- Stage III . Cancer has spread to the tissues around the bladder.
- Stage IV . cancer has spread to other organs other than the bladder.
Treatment of Bladder Cancer
Treatment in bladder cancer patients depends on the type of cancer, stage, age, and general health condition of the patient.
Transurethral resection of bladder tumor (TURBT)
TURBT is a common surgical procedure performed to deal with early-stage bladder cancer. This procedure incorporates an instrument called a resectoscope into the bladder through the urinary tract (urethra). Resectoscope is equipped with special wire to remove tumor cells. If cancerous tissue is still present in the patient's bladder after the tumor is removed, the doctor will use a laser to destroy the cancer.
This procedure is done by first giving the anesthetic to the patient, either with local anesthesia or general anesthesia. After the TURBT procedure is complete, the doctor will insert chemotherapy drugs into the patient's bladder to destroy the remaining cancer cells and prevent the tumor from growing again.
Cystectomy is surgery to remove part or all of the bladder. In a partial cystectomy, the doctor only removes a portion of the bladder containing a cancer cell. Partial cystectomy is performed if the cancer is present in only part of the bladder which can be removed without jeopardizing the function of the bladder.
In a radical cystectomy, the doctor will remove the entire bladder, a portion of the ureter, and surrounding lymph nodes. In male patients, radical cystectomy involves removal of the prostate and seminal vesicles, whereas in female patients involves removal of the uterus, ovaries, and part of the vagina. This procedure is performed by incision on the lower abdominal wall. Radical cystectomy procedures can lead to erectile dysfunction in men, as well as early menopause and infertility (infertility) in women. Radical cystectomy procedures may also be at risk of infection and bleeding.
In patients undergoing radical cystectomy, the doctor will make a new bladder by taking tissue in the intestine. Generally, the new bladder allows the patient to urinate normally. In some cases, patients with new bladders have difficulty emptying urine and may need to use catheters periodically to remove all urine from the new bladder.
This therapy is commonly applied to early-stage cancer. The doctor will enter the drug directly into the bladder. The drugs included are:
- Immunotherapy . Doctors will lure body cells against cancer in the bladder by inserting Bacillus Calmette-Guerin (BCG) bacteria into the bladder through a catheter. This therapy can begin several weeks after the patient undergoes TURBT.
- Intravesical chemotherapy. This procedure is carried out by incorporating medications to fight cancer cells in the bladder through a catheter. Chemotherapy can also be done by injection of blood vessels for a further stage, when cancer cells have spread out from the bladder.
Patients may undergo radiotherapy 5 days a week for several weeks. This therapy is usually recommended in some conditions, such as:
- Early-stage bladder cancer.
- Patients with early-stage bladder cancer who can not undergo surgical procedures.
- Advanced therapy after TURBT or partial cystectomy.
- As a prevention or treatment of advanced stage bladder cancer symptoms.
Prevention of Bladder Cancer
Although there is no proven way to prevent bladder cancer, but the risk factors of this disease can be reduced by living a healthy lifestyle such as:
- Quit smoking. Consult a doctor and live all the methods to stop smoking, so carcinogenic substances do not accumulate in the body.
- Avoid chemical exposure. Follow safety procedures and use personal protective equipment to avoid exposure to chemicals in the work environment.
- Eat lots of fruits and vegetables. The content of antioxidants in fruits and vegetables can reduce the risk of cancer.