Bladder Cancer (Part Two)

Staging of bladder cancer

After the diagnosis of bladder cancer, the patient undergoes several additional examinations to determine the stage (spread) of the cancer. For this, the following are recommended:

• Scanner
• Magnetic resonance imaging
• Bone scan using radioactive material
• Chest X-ray

The stages of bladder cancer are:

• Stage I. At this stage, the cancer develops only in the inner layer of the bladder (mucosa), without affecting its muscular layer.
• Stage II. At this stage, the cancer has invaded the bladder wall but is still confined to the bladder.
• Stage III. Cancerous cells have spread beyond the bladder wall, into the surrounding tissues.
• Stage IV. At this stage, cancerous cells can spread to lymph nodes and other organs such as; bones, liver, or lungs.

Treatment

The treatment of bladder cancer depends on a series of factors including the type and stage of cancer, the overall health condition, and the patient's preference.

Treatments for early stage

If the cancer is very small and has not invaded the bladder wall, the following may be recommended:

• Endoscopic removal of only the tumor. Transurethral resection (TURBT) is usually used to remove cancer that is confined to the inner layers of the bladder.
• Surgical removal of the tumor and a small part of the bladder. (partial cystectomy). Only the part of the bladder that has cancerous cells is removed.
• Biological therapy (immunotherapy). Biological therapy works by stimulating the immune system to help fight cancer cells. This consists of directly inserting a medication into the bladder through a catheter.

A common biological medication used is the BCG vaccine, which is also used in the disease of tuberculosis. Another is the synthetic version of interferon, which is a protein produced by the immune system to fight infections.

Surgery for invasive bladder cancer

If the cancer has involved all layers of the bladder, it is recommended:

• Surgery to remove the entire bladder. This operation is called radical cystectomy and consists of removing the entire bladder, and the lymph nodes that surround it.

• Surgery to create a new way to excrete urine. Immediately after the bladder is removed, a new way to excrete urine is created. There are several methods:

  • Creating a tube with a piece of intestine where on one end the ureters that bring urine from the kidneys are inserted, and the other end is brought out through the skin of the abdomen where the urine is continuously emptied into a plastic bag (urostomy bag) which the patient empties themselves.
  • Creating a small reservoir inside the body with an intestine to collect urine. For emptying the urine, the patient uses a small catheter that is inserted through a small hole in the skin into the reservoir. This procedure is repeated several times a day.
  • In special cases, a reservoir inside the body with a piece of intestine can be created. This reservoir (new bladder) is connected to the urethra and the patient urinates normally.

Chemotherapy

Chemotherapy is a procedure based on the use of medications to fight cancer cells. Usually, a combination of two or more medications is used. These can be given intravenously (intravenous therapy), or inserted directly into the bladder through a catheter (intravesical therapy).

Chemotherapy can also be used to fight cancer cells that may have remained after surgical intervention. It can also be applied before surgery with the aim of reducing the tumor mass to assist the surgeon in performing a less invasive intervention. In some cases, when surgery cannot be performed, chemotherapy is combined with radiotherapy.

Radiotherapy

This treatment consists of using high-energy rays focusing on the cancer mass to destroy cancer cells. Radiotherapy for bladder cancer is also applied after surgery to kill all remaining cancer cells. In some cases, when surgery cannot be performed, radiotherapy is combined with chemotherapy.

Prevention

Although there is no sure way to prevent bladder cancer, some tips are recommended to reduce the risk:

• Do not smoke. This means that the chemicals that cause cancer do not accumulate in the bladder.
• Avoid chemical substances. If you work in environments with chemical substances, follow recommendations to avoid exposure to them.
• Drink water throughout the day. Theoretically, drinking fluids especially water, can dilute the concentration of toxic substances in urine and helps in their faster elimination from the body.
• Use fruits and vegetables. Fruits and vegetables are rich in antioxidants which help in reducing the risk of cancer.