The urinary tract is made up of the kidneys, ureters, bladder and urethra. The bladder is lined with a layer of cells called the urothelium, which is separated from the bladder wall muscles by a thin, fibrous band called the lamina propria.

Bladder Cancer Treatment In Malaysia



 

Types of bladder cancer

The 3 main types of bladder cancer are:

Urothelial carcinoma

accounts for about 90% of all bladder cancers and is also called transitional cell carcinoma.

Squamous cell carcinoma

accounts for about 4% of all bladder cancers.

Adenocarcinoma

accounts for about 2% of all bladder cancers and develops from glandular cells.

Sarcoma and small cell

bladder cancer are much less common types of bladder cancer.

Bladder cancer may be described as non-muscle-invasive, or muscle-invasive.
Non-muscle-invasive

Non-muscle-invasive bladder cancer typically has grown only into the lamina propria and not into muscle, also called stage I.

Muscle-invasive

Muscle-invasive bladder cancer has grown into the bladder's wall muscle and into the surrounding tissue outside the bladder.

Risk Factors

The following factors may raise a person’s risk of developing bladder cancer.

Tobacco use
Smokers are 4 to 7 times more likely to develop bladder cancer than nonsmokers.
Age
More than 70% of people with bladder cancer are older than 65.
Gender
Men are 4 times more likely to develop bladder cancer than women.
Chemicals
Used in the textile, rubber, leather, dye, paint, and print industries can increase the risk of bladder cancer.
Chronic bladder problems
Such as bladder stones and infections may increase the risk of bladder cancer.
Schistosomiasis
People who have some forms of this parasitic disease are more likely to develop squamous cell bladder cancer.
Lynch syndrome
Is an inherited condition, associated with DNA mismatch repair defect. People with Lynch syndrome have an increased risk of developing bladder cancer.
Arsenic
When found in drinking water has been associated with an increased risk of bladder cancer.

 

Symptoms and signs of bladder cancer

  • Blood or blood clots in the urine
  • Pain or burning sensation during urination
  • Frequent urination
  • Feeling the need to urinate many times throughout the night
  • Feeling the need to urinate, but not being able to pass urine
  • Lower back pain
  • Unexplained appetite loss, and weight loss

 

Diagnosis of bladder cancer

Cystoscopy can detect growths in the bladder and determine the need for a biopsy or surgery.

Biopsy, If abnormal tissue is found during a cystoscopy, a biopsy will be carried out

Transurethral resection of bladder tumor (TURBT) allows the removal of the tumor and a sample of the bladder muscle near the tumor. TURBT is used to diagnose bladder cancer and find out the type of tumor, how deeply it has grown into the layers of the bladder, and identify any additional microscopic cancerous changes, called carcinoma in situ.

 

Stages of prostate cancer

 
Stage I

The cancer has grown through the inner lining of the bladder and only into the lamina propria.

 
Stage II

The cancer has spread into the thick muscle wall of the bladder. It is also called muscle-invasive cancer.

 
Stage III

The cancer has spread through the muscle wall into the tissues around the bladder.

 

  • Stage IIIA: The tumor has grown into the perivesical tissue or has spread into the prostate, uterus, or vagina.
  • Stage IIIB: The cancer has spread into 2 or more regional lymph nodes.

 

Stage IV

The tumor has spread into the pelvic wall or abdominal wall, or to lymph nodes outside of the pelvis or to other parts of the body.

 

Treatment overview

Talk to our Oncologists at Onco Life Centre about your treatment options. The main treatments for bladder cancer are surgery, chemotherapy, targeted therapy, immunotherapy and radiation therapy. Often the best approach uses 2 or more of these treatment methods. It is important that you understand the goal of your treatment. If a cure is not possible, treatment is aimed at relieving symptoms such as pain.

 

Surgery

Transurethral bladder tumor resection may be able to eliminate non-muscle-invasive bladder cancer.

Radical cystectomy and lymph node dissection is the removal of the whole bladder. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. For all patients, lymph nodes in the pelvis are removed, called pelvic lymph node dissection. If the bladder is removed, a section of the small intestine or colon will be used to divert urine to a stoma on the outside of the body.

Systemic therapies

The types of systemic therapies used for bladder cancer include Chemotherapy, Immunotherapy and Targeted therapy.

Chemotherapy can be intravesical or systemic. During intravesical chemotherapy, drugs are delivered into the bladder through a catheter that has been inserted through the urethra to destroy superficial tumor cells that come in contact with the chemotherapy solution. In systemic chemotherapy, a combination of drugs works better than 1 drug alone.

Immunotherapy is designed to boost the body’s natural defenses to fight the cancer. Immune checkpoint inhibitors block a protein called PD-1. PD-1 is found on the surface of T cells and keeps the immune system from destroying cancer cells. Thus, stopping PD-1 from working allows the immune system to better eliminate the cancer. Multiple Immune checkpoint inhibitors have been approved by the US-FDA for bladder cancer treatment.

Targeted therapy targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival to block the growth and spread of cancer cells while limiting damage to healthy cells. A targeted therapy for patients with metastatic urothelial carcinoma with FGFR3 or FGFR2 genetic mutations has been approved for use after receiving platinum chemotherapy.

Radiation therapy

The most common type of radiation treatment is called external-beam radiation therapy. Combined radiation therapy and chemotherapy may be used to treat cancer that is located only in the bladder to destroy any cancer cells that may remain after TURBT, to relieve symptoms caused by a tumor, such as pain, bleeding, or blockage, to treat brain or bone metastasis.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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