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Bladder Cancer Treatment

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What Is Bladder Cancer

Bladder cancer is a malignancy that originates in the cells lining the bladder, which is the organ responsible for storing urine before it’s expelled from the body.  This type of cancer typically begins in the urothelial cells that form the inner lining of the bladder. Bladder cancer can also arise from other cell types present in the bladder.

Importance of early diagnosis and tailored treatment

Early diagnosis of bladder cancer improves the likelihood of successful treatment. Recognising symptoms and seeking timely medical intervention can lead to the identification of the cancer in its initial stages. Tailored treatment, which is a therapeutic approach specifically designed based on the type, stage, and other individual factors of the cancer, not only maximises the effectiveness of the treatment but also minimises potential side effects for the patient.

Types of Bladder Cancer

Bladder cancer can manifest in various forms, each characterised by the type of cell from which it originates. The primary types are:

Transitional Cell Carcinoma (TCC)

This is the most prevalent form of bladder cancer, accounting for approximately 90% of all cases. TCC originates in the urothelial cells, which form the inner lining of the bladder. These cells are also found in the renal pelvis, ureters, and urethra, making them susceptible to cancer in those areas as well. TCC can be further categorised based on how it grows:

  • Non-muscle invasive: These cancers are confined to the inner layer of the bladder and have not spread to the deeper muscle layer.
  • Muscle invasive: These cancers have spread to or through the muscular wall of the bladder.

Squamous Cell Carcinoma

Representing a smaller fraction of bladder cancers, squamous cell carcinomas develop as a result of prolonged irritation and inflammation in the bladder. They are not initially linked to the bladder lining but arise after a sustained stimulus, such as a long-standing infection or prolonged presence of a foreign body in the bladder.

Adenocarcinoma

Adenocarcinoma of the bladder is a rare type, accounting for a mere 1-2% of all bladder cancers. This cancer type starts in the mucus-producing glandular cells of the bladder. Adenocarcinomas usually present in the bladder’s innermost layer but can invade deeper layers over time.

Diagnosis

Cystoscopy

This procedure involves the insertion of a cystoscope, a thin tube with a camera and light at its tip, into the bladder via the urethra. It allows the doctor to visualise the inside of the bladder directly and identify any abnormal growths or lesions. If suspicious areas are detected, the doctor can use the cystoscope to obtain a tissue sample for biopsy, which will be subsequently analysed for the presence of cancer cells.

Urine Cytology

A urine sample is examined under a microscope to detect cancerous or precancerous cells. Although urine cytology is beneficial, it’s not definitive on its own. Negative results do not conclusively rule out bladder cancer, and positive results necessitate further tests to confirm the diagnosis.

Imaging Tests

    • CT (Computed Tomography) Scan: Produces detailed cross-sectional images of the body, which can highlight tumours in the bladder and indicate whether the cancer has spread to nearby tissues or organs.
    • MRI (Magnetic Resonance Imaging): Uses powerful magnets and radio waves to produce detailed images of the bladder and surrounding structures. It helps determine the depth of tumour invasion and the involvement of adjacent organs.
    • Ultrasound: Employs sound waves to generate real-time images of the bladder, enabling the assessment of the size, location, and extent of any tumours present.

Treatment Options

Surgery

  • Transurethral Resection of Bladder Tumour (TURBT): This surgical procedure is often employed for early-stage bladder cancers that have not invaded the muscle layer. A cystoscope is inserted into the bladder through the urethra. A tool is then used to burn away (cauterise) or cut out the tumour. This procedure may also be used to obtain a biopsy for diagnosis.
  • Partial Cystectomy: This involves the removal of a part of the bladder. It is suitable for cancers that have invaded the bladder wall but are still limited to one area. Surrounding lymph nodes might also be removed to check for cancer spread.
  • Radical Cystectomy and Reconstruction: Recommended for invasive cancers, this procedure involves the removal of the entire bladder. In men, the prostate and nearby lymph nodes might be removed. In women, the uterus, fallopian tubes, ovaries, anterior vaginal wall, and nearby lymph nodes could be removed. Post removal, a new way for urine to exit the body is created, which can be through an ileal conduit or neobladder formation.

Intravesical Therapy

  • Bacillus Calmette-Guerin (BCG): BCG is a type of immunotherapy wherein a live, attenuated strain of Mycobacterium bovis is introduced into the bladder. This instigates an immune response, targeting the cancer cells in the bladder.
  • Chemotherapy: Specific chemotherapy drugs are introduced directly into the bladder. This localised treatment reduces side effects and is particularly useful for non-muscle invasive bladder cancers.

Radiation Therapy

This employs high-energy beams, often X-rays, to target and destroy cancer cells. Radiation can be externally delivered, targeting the bladder from outside the body. It can be used alone or in conjunction with other treatments.

Chemotherapy

Systemic Chemotherapy involves the administration of drugs that travel through the bloodstream, targeting cancer cells throughout the body. Depending on the stage and type of bladder cancer, chemotherapy might be given before surgery (to shrink the tumour) or after surgery (to kill any remaining cancer cells).

Targeted Therapy

Targeted Therapy employs drugs designed to target specific characteristics of cancer cells, hindering their growth and spread. As they focus specifically on cancer cells, they often have fewer side effects than conventional chemotherapy.

Immunotherapy

These treatments harness the body’s immune system to recognise and combat cancer cells. Several immunotherapy drugs have been approved or are under study for the treatment of bladder cancer, particularly for cases where other treatments haven’t been effective.

Post-Treatment Care

Follow-up Appointments and Tests:

These appointments often involve physical examinations, discussions about any symptoms or concerns, and routine tests, including urine tests and imaging scans.

The frequency of these appointments typically decreases over time if no signs of cancer recurrence are observed. Periodic cystoscopies might be scheduled, especially in the initial years after treatment, to inspect the bladder directly and ensure there are no signs of returning cancer.

Potential Side Effects and Their Management:

Like all medical treatments, bladder cancer therapies can result in side effects. The nature and severity depend on the specific treatment received and individual patient factors.

  • Surgical Procedures: Common post-operative issues include pain, risk of infection, and potential urinary complications. Patients may also experience changes in urinary function, especially if there’s been significant reconstruction.
  • Chemotherapy and Radiation: These treatments might lead to fatigue, nausea, increased risk of infections due to lowered white blood cell counts, and skin irritation.
  • Immunotherapy and Targeted Therapies: Possible side effects encompass skin reactions, fatigue, and specific organ-related effects such as thyroid dysfunction.

Support Groups and Counselling:

The emotional impact of a cancer diagnosis and its treatment can be significant. Feelings of anxiety, depression, fear of recurrence, or changes in body image and self-esteem are not uncommon.

  • Support groups: A platform for patients and survivors to share their experiences, insights, and coping strategies. Engaging in these groups can provide emotional relief and a sense of belonging.
  • Professional counselling or therapy: Assist in addressing emotional and psychological challenges. Therapists trained in oncology issues can offer coping mechanisms, stress-reducing techniques, and guidance on navigating the complexities of life post-cancer treatment.

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Factors Determining Treatment Approach

The treatment approach for bladder cancer is determined by multiple factors to ensure the most effective and personalised care for the patient:

Stage and Grade of Cancer

  • Stage: The stage of bladder cancer describes the extent of cancer’s spread. This encompasses the size of the tumour, its depth of invasion into the bladder walls, and its reach to adjacent tissues or distant organs.

Early-stage cancers, such as those confined to the bladder’s inner lining, often require less aggressive treatments compared to advanced-stage cancers that have spread deeper into the bladder or to other parts of the body.

  • Grade: The grade indicates how much the cancerous cells resemble normal bladder cells. High-grade cancer cells appear very different from normal cells and tend to grow and spread more aggressively than low-grade cancer cells.

High-grade tumours necessitate more intensive treatments due to their aggressive nature, while low-grade tumours might be treated with more conservative methods.

Patient’s Overall Health and Age

The general health of the patient plays a pivotal role in deciding the treatment approach. Aggressive treatments might be too rigorous for individuals with existing health concerns or those of advanced age.

Age, though not a limiting factor on its own, can influence the body’s resilience and capacity to recover from treatments. For older patients, the potential benefits of a treatment are weighed against the potential risks and the likely impact on quality of life.

Patient Preferences

The patient’s own preferences and values are integral to the treatment decision-making process. After being informed of the benefits, risks, and potential outcomes of each treatment option, some patients might opt for more aggressive treatments to maximise cancer removal. Others might choose less invasive treatments due to potential side effects or a desire for a specific quality of life post-treatment.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

Our Clinic Locations

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Farrer Park Medical Centre, #08-05
1 Farrer Park Station Rd, Singapore 217562
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Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

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3 Mount Elizabeth, #11-16 Medical Centre, Singapore 228510
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Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

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    Frequently Asked Questions

    What are the symptoms of bladder cancer?
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    The primary symptom of bladder cancer is blood in the urine, medically termed haematuria, which may be visibly reddish or detectable only through microscopic examination. Other symptoms include painful or frequent urination, urgency to urinate even with an empty bladder, and back or pelvic pain. It’s essential to consult a doctor if any of these symptoms are observed, as early detection often leads to better outcomes.

    How is bladder cancer diagnosed?
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    Bladder cancer is primarily diagnosed through a combination of urine tests, imaging scans (like CT, MRI, and ultrasound), and a procedure known as cystoscopy where a thin tube with a camera is inserted into the bladder to directly examine its interior. A biopsy may also be taken during cystoscopy to assess for cancerous cells.

    Are there any risks associated with bladder cancer treatments?
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    All medical treatments come with potential risks. Surgical procedures can lead to infections, bleeding, or urinary complications. Chemotherapy might result in fatigue, nausea, or a lowered white blood cell count increasing infection susceptibility. Radiation therapy can cause skin irritation and changes in urinary function. It’s crucial to discuss potential risks and benefits of each treatment option with a healthcare provider.

    How effective is immunotherapy for bladder cancer?
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    Immunotherapy has shown promise in treating certain types of bladder cancer, especially for cases where conventional treatments haven’t been effective. It harnesses the body’s immune system to identify and combat cancer cells. The effectiveness varies depending on the specific drug used, the stage and type of cancer, and the patient’s overall health.

    How often should I have follow-up visits post-treatment?
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    Follow-up visits are frequent, often every 3 to 6 months during the first few years post-treatment. If no signs of cancer recurrence are observed, the duration between visits may be extended to annually. Regular cystoscopies and urine tests are typical components of these check-ups.

    What lifestyle changes can help in recovery and prevention?
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    Adopting a healthy lifestyle can aid in recovery and reduce the risk of recurrence. This includes a balanced diet, regular exercise, avoiding tobacco products, and limiting exposure to certain industrial chemicals linked to bladder cancer. Staying hydrated and frequently emptying the bladder can also be beneficial.

    How does bladder cancer treatment affect daily life?
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    The impact on daily life varies based on the treatment received. Surgical treatments, especially those involving significant bladder reconstruction, can affect urinary functions, necessitating adjustments. Chemotherapy or radiation might cause fatigue, necessitating periods of rest. Open communication with employers, family, and social circles is key, as is seeking support when needed, be it in the form of counselling or support groups.