Bladder Cancer

Bladder cancer is a common cancer in Hong Kong. There are about 400 new cases in a year, with obviously more male patients than female patients. The ratio is 3:1 and it is common among people aged between 55 and 70. If bladder cancer is diagnosed at an early stage, the prognosis is good, but bladder cancer is particularly easy to recur. For this reason, those who have recovered need to go for follow-up checks regularly.

(Special thanks to Dr. HC CHENG, Associate Consultant, Department of Clinical Oncology, Queen Elizabeth Hospital for reviewing the information of this page.)

 

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The bladder is a hollow organ in the lower abdomen that stores urine. When the process of cell growth inside the lining of the bladder goes wrong, bladder cancer may be caused.

Most of the bladder tumours are like small mushrooms, appearing first in the innermost layer of the bladder, called nipple tumours. After some period, they will spread to the muscular wall of the bladder and other parts of the body.

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  • Smoking
    The chance of smokers getting bladder cancer is 2 to 3 times higher than that of non-smokers.
  • People having frequent contact with chemicals
    People who work in the rubber, chemical, dyeing, paints, leather & printing industries are at risk.People who often use hair dyes also fall in this category.
  • People with frequent cystitis
    People with bladder problems or cystitis stand a higher chance of getting bladder cancer.
  • Family history
    People with family members who have a bladder cancer are more likely to get the disease.
  • Gender
    Males
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  • Quit smoking and avoid second-hand smoking
  • To eat fresh food rather than preserved food or food with preservatives
  • To drink more water
  • To eat more fruit and green vegetables
  • To avoid contacting dyes and organic solutions
  • Preventive measures for whom working in textile, dyeing, leather, chemical, agricultural and printing industries, such as wearing gloves, masks and reain shoes, etc.
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There are no known causes for bladder cancer, but it is found that absorbing cancer causing materials for a long time is one of the causes. Materials include chemicals in cigarettes.After those materials undergo metabolism inside the body, some will be excreted through the urine. and the bladder membrane will be in contact with them, which cause abnormal cell growth inside the bladder.

Furthermore, in places where Schistosomiasis (a kind of parasite causing cystitis) prevails, the cases of bladder cancer are more.Frequent consumption of preserved food or food with nitrite enhaces the risk of getting bladder cancer.

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相片 Some of the symptoms of bladder cancer are identical to those of cystitis, bladder stone or kidney stone, and the commonest symptoms are haematuria. This may not cause pain and in the early stage, it may occur every now and then. When the situation worsens, there may be blood clods in the urine, making one feel pain when one urinates or causing one unable to urinate. Should the tumour erode the neck of the bladder, the patient will develop urinary frequency and have difficulty in urinating or will feel the urinating being blocked.

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相片

If you suspect that you have got bladder cancer, a urine test is suggested.  For men, rectal examination will be performed.. For women, rectal examination and vaginal examination should be performed. The urine sample is sent to the laboratory to check if there are cancer cells. If necessary, a urologist will conduct a further examination including:

i.  Cystocope and Biopsy

This examination may need local or general anesthesia. The doctor inserts a thin, lighted tube to look directly into the bladder to examine the lining of the bladder.Samples of tissue can be removed with the cystocope for further examination and pathological analysis.

ii. Intravenous pyelogram

This can identify abnormal conditions of the kidney, bladder and the urinary system. The doctor injects dye which is excreted in the urine, enabling the doctor to see conditions in the kidney, the urethra and the bladder on X-rays.

The dye may cause the the patient a short period of burning feeling, blushing but it rarely causes death.
If it is confirmed that the patient has got bladder cancer, the patient has to go through blood tests, thoracic X-ray examination and the following examinations. They are for identifying the stages of the cancer growth, which is thus used to decide on the treatment plans.

iii. Computer Scan

To scan the abdomen and pelvis from different angles, locating precisely where the tumor is and its size. The patient needs to drink a special dye.  The process takes more than 10 minutes. 

iv. Radioistopes Bone Scan

This is to check if the cancer cells have spread to the skeletons. During the examination, the medical staff will inject a small dose of radioisotopes into the blood vessel of the patient’s arm. They will then measure the small amount of radioactive index inside the body. The cancer affected skeleton will show a large amount of radioactivity and the doctor is to judge if the cancer has spread. The injected dose of radioisotopes is so small that it will not cause the patient to carry radiation.

v. Ultra-sonic Abdomen and Pelvic Scan

This is to synthesize the image of the abdomen and the pelvis. The patient has to drink a large quantity of liquid to blow up the bladder. This test needs a few minutes and the patient has to stop eating or drinking 4 hours prior to examination.

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 相片 If the bladder cancer is at its early stage, which means the cancer tumor has not yet eroded the muscule of the bladder, the cystocope may be used to scrub off the cancer cells.  The doctor can also consider filling the bladder directly with anti-cancer drygs, or using B.C.G. immunotherapy:

1. Transurethral Removal of Bladder Tumour – TURBT
The doctor uses the cystocope to remove the bladder tumor inside the inner lining of the bladder, and uses a small amount of electricity to cauterize the wound to stop the bleedings. For a few days after the surgery, the patient may experience hae-maturia.

2. Intravesical Chemotherapy
With a soft tube, the doctor inserts anti-cancer drugs into the inner lining of the bladder via the urethra. The drugs may cause the inner lining to inflame, thus making the patient feel pain or have urinary frequency.

3. BCG Intravesicle Immunotherapy
The vaccine may cause reaction in the bladder, stimulating the immune system to reduce the number of cancer cells. The treatment is carried out in 6 weeks, with weekly instillation. During the treatment, the medical staff use a catheter to insert liquid vaccine directly into a bladder. In due course, there may appear some side effects, namely heamaturia, coughing, fever, chills, vigor, nausea, urinary frequency, feeling pain on urinating and skin rash, etc., but these will disappear gradually.                                                        

4. Cystectomy
Should cancer cells have eroded the bladder muscle, the doctor will consider removing parts of the bladder or the whole of it. It is then necessary to create a stoma at the paitient’s abdomen to let the urine pass through. Some patients may create an artificial bladder out of their intestines. At present, this operation can be performed in the form of minimal invasive surgery, replacing a big wound with a few small holes.

If it is decided that the whole bladder to be removed, the male patient has to have his prostate gland, part of the urethra and the lymphatic glands near the bladder removed. The female patient may have her uterus, cervix, the nearby lymphatic and part of the urehtra removed.

5. RadiationTherapy
It is to kill the cancer cells with highenergy radiation. Should a patient be found out not suitable to undergo surgery, he/she may be recommended to have radiotherapy alone or both radiotherapy and chemotherapy at the same time to replace an operation as a radical treatment.

6. Palliative treatment
If the cancer has spread widely, the priority is to reduce the signs and symptoms and to maintain the patient’s quality of the life. The systemic chemotherapy can soothe the signs and symptoms and improve life quality. Radiation therapy can also reduce urinary frequency and haematuria.

7. Artificial Storing of Urine
After the removal of the bladder, the doctor will at once try to create a place for storing urine. Depending on the conditions of the patient, the following methods can be considered:

  • Stoma
    The commonest way is to create an artificial uninary outlet by cutting a part of the intestine and using one of its end to connect the two urethras and the other end protruding out of the abdomen wall. The outlet on the abdomen wall is called a stoma, where a waterproof plastic bag will be fixed with some special glue for collecting urine. The stoma will not form an obstacle to the patient’s normal life, but will affect the patient’s look.
  • bladder reconstruction surgery
    Another method is to make an artificial bladder by cutting a certain length of the intestine. The doctor then reshapes the intestine part into a ball shape bag. He then sews it to the top of the urethra. Thus a new bladder is created and connected to the ureter. The patient can urinate through the urethra as usual, without having to use urine bag.

As the nerves of the patient’s bladder are no longer functioning, he/she may suffer a slight urinary incontinence, especially when he/she is sleeping. After the operation, the male patient may become impotent while the female patient may experience differently during sexual intercourse.

  • Urinary Catheter Operation
    This is similar to that of the stoma. A length of the patient’s intestine is used to make a urine bag which is then placed inside the abdomen. It is connected to a small plastic catheter which passes throguh the stoma, thus allowing the urine to emit. Urine can be relieved 4 to 5 times daily. The patient has to emit the urine manually, but he will not have to carry a urine bag.
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After receiving chemotherapy or radiation therapy, the patient may suffer different side effects, including:

  • Annal sore
  • Intestines being stimulated, resulting in diarrhoea
  • Cystitis causing urinary frequency and pains on urinating
  • Narrowing of the vagina, making sexual intercourse difficult or uncomfortable
  • Male impotence
  • Fatigue
  • The skin where radiation therapy has applied may cause pains and there is hair loss
  • Nauseating and vomiting
  • Hearing weakens
  • Limb pains and numbness

The above side effects can be soothed with drugs, and they will gradually disappear after the treatments. However, radiation therapy may also cause permanent damages to the intestine and bladder, such as increasing the movement of the intestine, continuous diarrhoea or urinary frequency. After the radiation therapy, the intestine and the blood vessels inside the bladder may become fragile, resulting in haematuria and blood in stool. This phenomenon may occur a few months or years after the radiation therapy and the patient should notify the doctor for examination and treatment. If the pelvis radiation is necessary, there may be permanent effects on the patient’s sexual life or reproduction.

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1. Regular consultation and follow-up tests
As bladder cancer is easy to recur, the patient should have regular checks at hospital. It is recommended that during the 2 years after treatment, the patient should go for the cystocope examination and then an examination every year. The patient should take care of his/her body conditions and should not hesitate to discuss with or notify the doctor should any change or new signs and symptoms occur.

2. Learn to use the stoma
After the removal of the bladder, the patient has to use the stoma to emit urine. At the beginning, the patient may not adapt to it easily. Actually, most patients with a stoma can have a normal life. Besides carrying on with their work, they can also take part in various activities, including swimming.

The patient should allow himself/herself more time to get used to it. In hospitals, there are usually specially trained nurses called “Stoma nurses”. They are responsible for teaching patients the stoma care and cleaning, and how to tackle problems arising from the use of the stoma. Regarding how to change the urine bags and to clean the stoma, it is advisable for the patient to invite a relative to learn together so that after returning home, the relative can offer help when necessary.

3. Sharing with family members and other patients
The patient may develop depression when he/she has to undergo bladder cancer treatment and the subsequent the side effects. He/she should try to talk more with family members about his/her feelings, which helps ease his/her emotions and pressure of suffering. Furthermore, the patient can participate in some activities organized by patient groups. This will not only enhance his/her understanding of the disease and treatments, but he/she will also come across patients suffering from similar diseases, which enables him/her to share experiences and feelings. Psychologically, he/she gets supports and encouragement.

4. Consulting Specialists
If the patient’s sexual functions and reproduction ability have been affected by treatments, he/she should discuss the situation with the medical staff. If necessary, they will transfer him/her to the specialists concerned or counsellors for professional guidance and support.

5. Caring for health
The patient must quit smoking, eat more fresh fruit and vegetables, avoid high fat and preserved foods, do more exercises and keep fit physically and mentally.

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