Bladder Cancer

Bladder cancer

Bladder cancer is a cancer that forms in tissues of the bladder – an organ which function is to store urine. The most frequent type of bladder cancers begins in cells that normally form the inner lining of the bladder and it is called transitional cell carcinoma. Other types include squamous cell carcinoma – a bladder cancer that begins in thin, flat cells in the lining of the bladder, and adenocarcinoma – a type of cancer that begins in cells from the bladder lining that release mucus.

Bladder cancer frequency

what are the Risk factors for bladder cancer?

A risk factor is something that increases the risk of developing cancer. It could be a behavior, substance or condition. Most cancers are the result of many risk factors. Smoking is the most important risk factor for bladder cancer.

The risk of developing bladder cancer increases with age. It usually occurs in people older than 65 years of age. Bladder cancer is most common in Caucasians, and men develop this disease more often than women.

Risk factors are generally listed in order from most to least important. But in most cases, it is impossible to rank them with absolute certainty.

 Risk factors

  • Smoking
  • Arsenic
  • Occupational exposure to chemicals
  • Cyclophosphamide
  • Exposure to radiation
  • Chronic bladder irritation
  • Personal history of cancer in the urinary tract
  • Bladder birth defects
  • Aristolochic acids
  • Chlorine by-products
  • Working as a hairdresser
  • Family history
  • Outdoor air pollution
  • Pesticides
  • Certain medicines

 

What are the Symptoms of bladder cancer?

Bladder cancer may not cause any signs or symptoms in its early stages. Symptoms appear once the tumor grows larger or into the deeper layers of the bladder wall. Other health conditions can cause the same symptoms as bladder cancer.

The most common symptom of bladder cancer is blood in the urine (called hematuria). Bloody urine may vary from pale yellow-red to bright or rusty red. Blood may always be in the urine, or it may come and go. Sometimes the blood can only be seen with a microscope or found with other urine tests.

Other symptoms of bladder cancer include:

  • the need to urinate often (called urinary frequency)
  • an intense need to urinate (called urinary urgency)
  • trouble urinating
  • a burning sensation or pain during urination

Late signs and symptoms develop as the cancer grows larger or spreads to other parts of the body, including other organs. Late symptoms of bladder cancer include:

  • loss of appetite
  • weight loss
  • anemia
  • fever
  • change in bowel habits
  • pain in the rectum, anus, pelvis, flank (the side of the body) above the pubic bone or in bones
  • a lump in the pelvis
  • swelling in the legs, scrotum (the pouch of skin below the penis that contains the testicles) or vulva (the outer female sex organs)

 

How is bladder cancer Diagnosed?

Diagnostic tests Staging and other tests

  • Health history and physical exam
  • Cystoscopy
  • Biopsy
  • Intravenous pyelogram (IVP)
  • Urine tests
  • Cytology
  • Tumour marker tests
  • Complete blood count (CBC)
  • Blood chemistry tests
  • Cystoscopy
  • Biopsy
  • Intravenous pyelogram (IVP)
  • Blood chemistry tests
  • Chest x-ray
  • CT scan
  • MRI
  • Ultrasound
  • Bone scan

 

 

What are the Treatments for bladder cancer?

If you have bladder cancer, your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for bladder cancer, your healthcare team will consider:

Stage of  tumor

The grade of the tumor

The grade is a description of the differentiation of the cancer cells. Differentiation is how the cancer cells look and behave compared to normal cells.

Low grade means that the cancer cells are well differentiated. They look and act much like normal cells. Lower grade cancer cells tend to be slow growing and are less likely to spread. Grade 1 is well differentiated and grade 2 is moderately well differentiated.

High grade means that the cancer cells are poorly differentiated, or undifferentiated. They look and act less normal, or more abnormal. Higher grade cancer cells tend to grow more quickly and are more likely to spread. Grade 3 is poorly differentiated and grade 4 is undifferentiated.

location of the tumor

your overall health

You may be offered the following treatments for bladder cancer.

Surgery

Most people will have surgery to treat bladder cancer. The type of surgery you have will depend on the type of tumor and the stage of the cancer.

Transurethral resection (TUR) is most often used to remove tumors that are only in the lining of the bladder and have not grown into the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer). It is also the first step in diagnosing and treating more advanced tumors.

Partial, or segmental, cystectomy removes the tumor and part of the bladder.

Radical cystectomy removes all of the bladder along with the surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed.

Urinary diversion to create a urinary path is needed after the bladder is removed with a radical cystectomy.

 

Immunotherapy

Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. Biological therapy uses natural or artificial substances that act like (mimic) or block natural cell responses to kill, control or change the behavior of cancer cells.

Immunotherapy is most often used to treat tumors that are only in the lining of the bladder but have a higher risk for growing into deeper layers (especially high-grade and T1 tumors).

The immunotherapy treatment used most often is the vaccine bacillus Calmette-Guérin (BCG). BCG is passed into the bladder through a urinary catheter, or tube (called intravesical immunotherapy).

Immunotherapy may be offered for locally advanced or metastatic bladder cancer as a second-line therapy if the cancer is still growing during or just after finishing chemotherapy with cisplatin or if the cancer recurs within 12 months after finishing chemotherapy with cisplatin. The immunotherapy drug that is used for advanced bladder cancer is pembrolizumab (Keytruda). Recently, here are a number of ongoing trials in advanced urothelial carcinoma both using durvalumab monotherapy and in combination with other targeted therapies. In addition, durvalumab is being investigated in the non-muscle-invasive urothelial carcinoma, which is centered around intravenous formulations. These exciting developments have added a significant number of therapies in a previously limited treatment landscape. Durvalumab antibody blocks PD-1 and PD-L1 interaction, which prevents a SHP2-mediated co-inhibitory signal, allowing the neoepitope expressed by MHC-i to act as signal in stimulating an immune response, leading to the release of perforins and granzymes, theoretically leading to the destruction of the tumor cell

 

Atezolizumab (Tecentriq) authorization for locally advanced or metastatic urothelial carcinoma as a monotherapy after patients have undergone treatment with a platinum-containing chemotherapy or are ineligible for cisplatin chemotherapy, regardless of PD-L1 status. The results from both the Phase II IMvigor210 and the Phase III IMvigor211 studies were the basis for approval in this indication.

The Phase II study demonstrated that Tecentriq achieved a median overall survival of 15.9 months in a specific cohort. The Phase III study did not increase overall survival compared to patients undergoing chemotherapy. However, the median duration of response, which was the secondary endpoint, was 21.7 months in the Tecentriq cohort compared to 7.4 months in chemotherapy cohort. Additionally, 63% of patients continuously responded to Tecentriq treatment compared to only 21% of chemotherapy patients.

Tecentriq is an antibody that was developed to bind PD-L1, a protein that is present on tumor cells. By binding to PD-L1, the antibody blocks interaction with PD-1 and B7.1 receptors, which in turn enable the activation of cancer-destroying T-cells. In the U.S., it is approved for treatment of metastatic NSCLC as well as for locally advanced or metastatic urothelial carcinoma for patients.

“The totality of the data for Tecentriq across all indications including long-term responses in advanced bladder cancer and the overall survival advantage observed in our phase III advanced lung cancer study means that we are able to extend the benefits of Tecentriq to people living with these types of cancer regardless of their levels of PD-L1 expression

 

Chemotherapy

Intravesical chemotherapy or systemic chemotherapy may be used to treat bladder cancer.

During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter. Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG. Mitomycin (Mutamycin) is the drug most often used in intravesical chemotherapy. A dose of mitomycin is usually put into the bladder after surgery to remove the bladder tumor. Intravesical chemotherapy with mitomycin reduces the risk of bladder cancer recurring (coming back) in people with tumors that are only in the lining of the bladder and have not grown into the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer).

During systemic chemotherapy, the drugs are given through a needle into a vein (intravenously) and circulate throughout the body. Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder (called locally advanced cancer) and bladder cancer that has spread to other parts of the body (called metastatic cancer). Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.

 

Radiation therapy

External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.

Some people with cancer that has grown into the muscle layer of the bladder wall (called muscle-invasive bladder cancer) will have a transurethral resection (TUR) to completely remove all the cancer that the surgeon can see. This surgery is followed by both radiation therapy and chemotherapy.

Radiation therapy may be the main treatment for people who can’t have surgery. It may also be given to relieve symptoms caused by advanced bladder

 

 

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center

 

 

© Copyright 2018 - Hematology Oncology Care. Digital Marketing by MD Digitas