BLADDER CANCER

Causes and Risk Factors

Cancer-causing agents (carcinogens) in the urine may lead to the development of bladder cancer. Cigarette smoking contributes to more than 50% of cases, and smoking cigars or pipes also increases the risk. Other risk factors include the following:

• Age
• Chronic bladder inflammation (recurrent urinary tract infections, urinary stones)
• Consumption of Aristolochia fangchi (herb used in some weight-loss formulas)
• Diet high in saturated fat
• Exposure to second-hand smoke
• External beam radiation
• Family history of bladder cancer (several genetic risk factors identified)
• Gender (male)
• Infection with Schistosoma haematobium (parasite found in many developing countries)
• Personal history of bladder cancer
• Race (Caucasian)
• Treatment with certain drugs (e.g., cyclophosfamide—used to treat cancer)

Exposure to carcinogens in the workplace also increases the risk for bladder cancer. Medical workers exposed during the preparation, storage, administration, or disposal of antineoplastic drugs (used in chemotherapy) are at increased risk. Occupational risk factors include recurrent and early exposure to hair dye, and exposure to dye containing aniline, a chemical used in medical and industrial dyes. Workers at increased risk include the following:

• Hairdressers
• Machinists
• Printers
• Painters
• Truck drivers
• Workers in rubber, chemical, textile, metal, and leather industries

Signs and Symptoms

The primary symptom of bladder cancer is blood in the urine (hematuria). Hematuria may be visible to the naked eye (gross) or visible only under a microscope (microscopic) . Hematuria is usually painless. Other symptoms include frequent urination and pain upon urination (dysuria).

Diagnosis

A complete medical history is used to identify potential risk factors (e.g., smoking, exposure to dyes).

Laboratory tests may include the following:

• Urinalysis (to detect or confirm microscopic hematuria)
• Urine culture (to rule out Urinary Tract Infection)
• Urine cytology (to detect cancer cells by examining cells flushed from the bladder during urination)

Cystoscopy remains the gold standard investigation to establish the cause of hematuria. Under cystoscopic examination, the bladder cancer appears like underwater corals. Local anesthesia is administered and a cystoscope (thin, telescope-like tube with a tiny camera attached) is inserted into the bladder through the urethra to allow the physician to detect abnormalities. If tumour is detected, the patient goes for transurethral resection of bladder tumour (TURBT). Other than resecting the tumour, the base of the tumour is taken separately. If the tumour is superficial, the tumour has a high chance of recurrence. If it is deeply invasive, the bladder will have to be taken out and a new bladder reconstructed

IVU or intravenous urography is a series of X-rays taken of the kidney, ureter and bladder after injection of a dye into the bloodstream. The aim is to diagnose tumours that may arise from the internal mucosal lining of the whole urinary tract. This is time consuming and labour intensive and seldom done nowadays.

CT Urography is a series of CT scan X-rays of the kidney, ureter and bladder taken after injection of a dye into the bloodstream. This very detailed study not only allows tumours arising from the internal mucosal lining to be diagnosed, it can also detect solid tumours in the kidney and bladder. The scan is done within a few minutes and the report is printed within 2 hours. Other organ systems like the liver, spleen, pancreas and colon can also be visualized. Occasional other disease or tumours may be found incidentally.