Bladder Cancer Prognosis

Uncontrolled growth of abnormal cells that line the inner aspect of urinary bladder (a balloon shaped organ that is responsible for storing urine) is a fairly common cause of morbidity and mortality in certain high risk individuals. Most cases are reported in elderly patients though young individuals can also develop malignancy(Malignancy Wiki  Page) of bladder. Due to higher rate of recurrence, bladder cancer survivors must keep up with periodic examinations to minimize the risk of recurrence.

According to data reported by World Journal of Urology (1) approximately 2.7 million people have bladder cancer at any given period of time.

Histological classification of bladder cancer is dependent on the types of cells involved and extent of invasion. Bladder cancer may include one more types of cells. Following are the histological types of bladder cancer.

• Transitional Cell Carcinoma: It affects the inner lining of the bladder cells that is mainly responsible for contracting and expanding when the urinary bladder is empty or full respectively.

• Squamous Cell Carcinoma: Squamous cells are generally not present in the lining of bladder but these cells may appear in the setting of chronic inflammatory/ infectious process. Due to extensive inflammation and persistent irritation, these cells may undergo malignant transformation. One such example is shistosomiasis (a parasitic infection that is strongly associated with squamous cells carcinoma of bladder).

• Adenocarcinoma: It affects the mucous secreting cells of the bladder and is usually rare.

Presentation of Bladder Cancer

Bladder Cancer Prognosis

Bladder cancer may remain concealed for a significant period of time depending upon the site and size of tumor (Bladder Tumor Removal Page). Most common symptoms that are suggestive of bladder malignancy are.

• Frequent and painful urination (Painful Bladder Syndrome)

• Back pain

• Pelvic pain (Pelvic Inflammatory Disease Page)

• Hematuria(Hematuria, All You Need To Know About) (Blood in urine)

• Difficulty in maintaining normal micturition reflex/ habits

• Weight loss (Superfood Alternatives) and other non-specific symptoms

How to Manage Bladder Cancer?

Surgical Intervention

Different types of surgeries can be performed depending on the type and stage of bladder cancer. Following are the most frequently used procedures.

• Tumor detach surgery

• Tumor detach surgery with small portion of bladder

• Entire bladder removal surgery

• Urine bypass surgery

Immunotherapy

The aim of this therapy is to stimulate the body’s immune system to combat cancer cells. Therapeutic agents are typically administered into the bladder (intravesical therapy). Drugs used in biological therapy include.

• An immune stimulating bacterium i.e. Bacille Calmette-Guerin (BCG)

• Artificial immune protein i.e. Interferon alfa-2b (Intron A)

Chemotherapy

Chemotherapy directly attacks cancers cells and helps in elimination process of malignant cells. It is especially helpful in cases where the cancer has metastasized to distant organs via blood vessels and lymphatics. Chemotherapeutic drugs can be administered via intravenous route (through vein) or intravesical route (directly into the bladder). Chemotherapy can also be administered prior to surgery to reduce the size of the tumor but it can also be advised after surgery to successfully kill the remaining cells.

Radiotherapy

Radiation therapy, a rarely used method, utilizes high energy beams to destroy and kill cancer cells. It can also be combined with chemotherapy for effective treatment or after surgery to kill the remaining cells.

Factors That may Influence the Prognosis of Bladder Cancer

Bladder Cancer Prognosis

Prognosis of bladder cancer is dependent on several factors such as, age at diagnosis, stage of malignancy, metastasis, (or involvement of associated structures/ organs/ vessels) and histological variety of cancer.

• Absence or presence of some growth factors/ neurochemicals; such as high levels of Epidermal growth factor are associated with a higher risk of cancer progression and spread to distant organs (2)

• Number of tumors

• Size of tumor

• Grading of tumor

• History of prior malignant lesions (involving urinary tract)

According to Statistics Reported by American Cancer Society (3)

• 5-year survival rate of bladder cancer is 98% at Stage 0, 88% at Stage I, 63% at Stage II, 46% in Stage III and 15% in Stage IV.

• The rate of recurrence of bladder cancer at one year ranges from 15 to 61%.  The 5-year probability of recurrence or progression of bladder cancer is 31 to 78%. (4)

• About 10% of all bladder cancers spread to distant organs in which case the prognosis is poor (less than 30% survive beyond 5 years)

Based on these factors, investigators suggested that the overall prognosis of bladder cancer is satisfactory in the presence of excellent therapeutic options.

How to Prevent Bladder Cancer

Certain strategies that can help in minimizing the risk of bladder malignancy are.

• Quit smoking (Smoking Risks, It’s Time to Stop Smoking Page)

• Avoid alcohol (Alcohol Binge Drinking, Dr. Elist’s Advice Page) and other hazardous chemicals

• Eat healthy fruits and vegetables (Superfood Alternatives Page) that are richly supplied with antioxidants (Pomegranate Health Benefits Page).

References:

Ploeg, M., Aben, K. K., & Kiemeney, L. A. (2009). The present and future burden of urinary bladder cancer in the world. World journal of urology, 27(3), 289-293.
Neal, D. E., Sharples, L., Smith, K., Fennelly, J., Hall, R. R., & Harris, A. L. (1990). The epidermal growth factor receptor and the prognosis of bladder cancer. Cancer, 65(7), 1619-1625.

Survival rates for bladder cancer by stage

Sylvester, R. J., van der Meijden, A. P., Oosterlinck, W., Witjes, J. A., Bouffioux, C., Denis, L., … & Kurth, K. (2006). Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. European urology, 49(3), 466-477.