Every year over 2,400 people in Australia are diagnosed with bladder cancer. Bladder cancer occurs when abnormal cells in the lining of the bladder multiply faster than normal, causing a tumour or tumours. Most of these arise from the inner-most lining of the bladder and are called Transitional Cell Carcinomas (TCC).
Sometimes these stay localised to the surface layers of the bladder (Superficial Bladder Cancer) and sometimes they can grow more deeply through the wall of the bladder into the muscle layers and beyond (Muscle-Invasive Bladder Cancer). These cancerous cells, as well as growing into and through the bladder wall can also travel to sites outside the bladder, including the bones, liver, lungs and lymph nodes. These secondary tumours are called Metastases.
Superficial and muscle-invasive bladder cancers require different treatments and have different likely outcomes (prognosis). Some superficial bladder cancers can turn into muscle-invasive ones. If bladder cancer spreads outside the bladder and local lymph nodes it is treatable, however ‘cure’ is usually not possible. In this case most treatments are aimed at slowing down the growth of the cancer and reducing the symptoms (Palliation).
What Are the Causes of Bladder Cancer?
There are lifestyle factors such as cigarette smoking, and exposure to certain toxic dyes that increase the incidence of bladder cancer. Bladder cancer is very uncommon before the age of 60 and is more common in men than in women.
In some parts of the world, exposure to schistosomiasis, a type of infection that occurs especially in Egypt, other parts of the Middle East and Africa, can cause a certain type of bladder cancer called Squamous Cell Carcinoma. Sometimes these can be mixed with TCC in the same cancer.
What Are the Symptoms of Bladder Cancer?
Common symptoms include bleeding in the urine and irritation in passing urine including going more frequently and getting up more at night to pass urine.
There may be stinging or burning but not necessarily.
These problems can also occur (much more frequently) with bladder infections. If antibiotics are given for a bladder or urinary tract ‘infection’ but symptoms keep recurring, and/ or if bleeding in the urine is not associated with any pain, bladder cancer needs to be considered.
Symptoms of advanced bladder cancer may include pain in the bones or abdomen/pelvis or weight loss caused by the spread of the cancer. It would be very unusual that these symptoms would occur without there having been any bleeding noted in the urine at an earlier stage.
What Are the Treatments for Bladder Cancer?
The available treatments for bladder cancer depend on the stage at which the cancer has been diagnosed, especially the extent to which the cancer has grown into the wall of the bladder, the amount of cancer in the bladder, the symptoms caused by the cancer and the bladder function as well as the general health of the individual.
If the cancer is diagnosed when the cancer is very superficial (on the surface of the bladder wall) then local surgical removal plus or minus chemotherapy or other agents being put into the bladder afterwards will likely be the treatment. If the cancer goes more deeply into the muscle wall (muscle invasive bladder cancer) then complete removal of the bladder, called cystectomy, is one option for treatment.
Chemotherapy (drug therapy) in the vein may be recommended before and/or after this procedure. This will also involve the urine from the kidneys being diverted into a bag on the skin through the abdominal wall or less commonly, a ‘new’ or neobladder being made out of piece of bowel that will store the urine once the bladder has gone. Sometimes only part of the bladder can be removed leaving a smaller bladder, though this may not be possible in larger cancers or where the bladder has already been scarred by previous treatments.
A less invasive treatment for muscle invasive bladder cancer in suitable patients is radiation therapy to the bladder with or without chemotherapy often given as a once-weekly dose. This is called organ-conserving treatment as the bladder remains and ideally is functioning well after treatment. This is why only patients who have reasonably good bladder function are suitable for this kind of treatment.
The quality of life is often better in these patients who do not have to have the bladder completely removed. There are other features that are required to make someone an ideal candidate for bladder conservation. After this approach patients are required to have regular ‘check’ cystoscopies (checks inside the bladder) so that if the cancer comes back, it can still be removed if need be. This is called salvage cystectomy.
Some people who have more advanced cancers at diagnosis including those that might have spread to other parts of the body and that are not possible to try to cure still might benefit from radiation therapy. Bleeding in the urine can often be reduced or stopped, and pain in the bladder or other places such as the bones, can be reduced or delayed with short courses of palliative radiation therapy.
What Are the Side Effects of Radiation Therapy?
The side effects of radiation therapy for bladder cancer can be divided into the following.
Side effects during/soon after treatment (Early or ‘acute’ side effects)
General – tiredness is not uncommon during radiation therapy and may be worse if you are having chemotherapy (drug treatment) at the same time. This will improve a few weeks to a few months after the treatment is over.
Local – most people will get some increased frequency of urination and stinging or burning when passing urine in the second half of their treatment. With the extra fluid given along with chemotherapy, this may be worse on some days than others through the treatment course.
The treatment lasts anything from 2 to 7 weeks (radiation therapy is usually given on all working days) depending on the goal of treatment and other factors. Keeping the urine dilute (drinking plenty of water) and using urine alkylising agents, e.g. Ural, can help reduce stinging.
The bowels may also be affected temporarily with windiness and/or diarrhoea or just some mild increase in needing to pass motions. This is because some of the bowel may be in the field getting radiation. Again, these early side effects will almost certainly settle back to normal a few weeks after treatment is completed.
Keeping well hydrated and using medication to slow the bowels (if prescribed by your doctor) can help this. Sometimes your diet might need to be modified.
Side effects well after treatment (Late or long-term side effects)
The bladder sometimes become smaller in volume after radiation therapy especially if it is small to begin with – this means that you may need to go more frequently over the long term. This is why if there are a lot of previous treatments to the bladder causing scarring to the bladder, radiation therapy may not be the best option. If the bladder is working well before the treatment then this is not likely to be a problem.
Bowel and other side effects such as second cancers caused by radiation are rare after radiation therapy to the bladder.
The best person to discuss radiation therapy for bladder cancer is a radiation oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you.
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