MUSCLE-INVASIVE BLADDER CANCER

The urinary tract is your body’s system for removing waste and extra fluid. It includes several vital organs that work together, including:

  • The kidneys, which filter waste from your blood and produce urine.
  • Thin tubes called ureters that transport urine from your kidneys to your bladder.
  • The urethra, a tube that carries urine from your bladder out of your body.
  • The bladder, a balloon-shaped organ located in the lower abdomen.

The bladder stores urine from the kidneys until you’re ready to urinate. Its muscular wall contracts when it’s time to void, and its lining, made up of cells, can stretch to accommodate varying amounts of urine.

bladder-cancer webpage

WHAT IS BLADDER CANCER?

Bladder cancer begins when abnormal cells grow uncontrollably in the bladder’s lining. While most bladder cancers remain confined to the inner lining, some become more aggressive, invading the bladder wall and surrounding tissues.

Bladder cancer is classified into two main types based on how deeply the cancer has spread.

  1. Non-Muscle-Invasive Bladder Cancer (NMIBC). In this type, cancer cells stay in the bladder’s inner lining and do not invade the muscle layer. When detected early, NMIBC is often treatable with a good prognosis.
  2. Muscle-Invasive Bladder Cancer (MIBC). With MIBC, cancer has spread into the muscle layer of the bladder wall. This form of cancer is more aggressive and requires more intensive treatments. MIBC may also spread, or metastasize, to other parts of the body, such as the lymph nodes or bones.

CAUSES OF MIBC

It is often difficult to identify the exact cause of bladder cancer. Typically, underlying risk factors increase someone’s likelihood of developing it. Genetics, lifestyle factors, and environmental toxins can increase risk. Specific examples include:

  • Smoking
  • Occupational hazards that cause exposure to industrial chemicals
  • Chronic bladder issues like bladder stones and UTIs
  • Arsenic in drinking water
  • Parasitic infections
  • Family history of bladder cancer
  • Medications like cyclophosphamide (chemotherapy) and pioglitazone (diabetes medication)

SYMPTOMS OF MIBC

MIBC symptoms often overlap with other common urological conditions like urinary tract infections (UTIs), bladder stones, or an enlarged prostate. However, any persistent or recurring symptoms should be evaluated by a doctor. Symptoms to look out for include:

  • Blood in the urine (hematuria)
  • More frequent urination without added fluid intake
  • A sudden, strong urge to urinate that’s hard to control
  • Burning or pain during urination
  • Persistent pelvic or lower back pain
  • Unexplained weight loss
  • Ongoing tiredness despite rest

MIBC DIAGNOSIS

As with most cancers, diagnosing bladder cancer as early as possible increases positive outcomes. By the time MIBC has been diagnosed, the cancer has advanced enough to penetrate the muscle layer. There are usually multiple steps in the diagnosis process.

  1. Physical Examination and History: A doctor will review medical history, symptoms, risk factors, and previous medical records to look for clues about what may be causing urinary symptoms and perform a physical exam to look for abnormalities.
  2. Cystoscopy: A small camera attached to a thin, flexible tube is inserted through the urethra to allow a full view of the inside of the bladder. If any masses, tumors, or other abnormal areas are found, a biopsy can be taken at the same time.
  3. Urine Tests: A urine sample can be examined under a microscope for cancer cells and other types of cells (urine cytology). A culture can also be performed to check for the presence of bacteria.
  4. Imaging Studies: Several different imaging studies can be done to help diagnose bladder cancer.
    1. Intravenous Pyelogram (IVP): A dye is injected into a vein, and a series of X-rays are taken to follow its path through the kidneys, ureters, and bladder.
    2. CT Scan: A detailed image of the bladder is made using X-rays. This can help identify tumors.
    3. MRI: An MRI can also create an image of the bladder and help determine how deep a tumor has penetrated the bladder wall.
  5. Biopsy: The only way to truly diagnose bladder cancer is with a biopsy. A small piece of the tumor is removed and examined by a pathologist.

MIBC TREATMENTS

The exact approach depends on both the stage of the cancer and your overall health.
Staging refers to how far the cancer has spread. In MIBC, staging starts at Stage II since the tumor has already invaded the bladder’s muscle layer:

  • Stage II: Cancer has grown into the muscle layer but hasn’t reached the fatty tissue or other areas.
  • Stage III: The cancer has spread to the surrounding fatty tissue and may involve nearby organs like the prostate, uterus, or vagina, but not the lymph nodes or distant areas.
  • Stage IV: Cancer has spread to the abdominal or pelvic wall, nearby lymph nodes, or distant organs such as the bones, liver, or lungs.

If you’ve been diagnosed with MIBC, your management strategies will likely involve a combination of surgery, radiation therapy, and chemotherapy.

  1. Cystectomy – Bladder Removal Surgery
    The most common treatment is a radical cystectomy, where the entire bladder is removed. This surgery is recommended when the cancer has deeply invaded the bladder wall or spread to nearby tissues.
    A partial cystectomy is less common and only performed when the cancer is small and isolated in one part of the bladder.
  2. Radiation Therapy
    High-energy X-rays can kill cancer cells. Radiation therapy is often used in combination with surgery and chemotherapy. Radiation targets cancer cells left behind after surgery and can also reduce tumor size before surgery.
  3. Chemotherapy
    Medications can be used to kill cancer cells throughout the body. In MIBC, chemotherapy is commonly used in combination with radiation or surgery to destroy cancer cells that may have spread beyond the bladder.
  4. Immunotherapy
    Immunotherapy helps your immune system recognize and attack cancer cells to stop them from growing and spreading. Certain drugs have been effective in treating advanced bladder cancer that has not responded to other treatments.

OPTIONS FOR SURGICAL RECONSTRUCTION FOLLOWING CYSTECTOMY

After a radical cystectomy, the bladder must be replaced, or a new path for urine to leave your body must be created. The possible approaches include:

1.Incontinent urinary diversion

In this procedure, also known as a urostomy, the surgeon uses a small part of your small intestine to create a new urine pathway. The pathway connects the ureters to a small opening in your abdomen called a stoma, allowing urine to drain continuously. Urine is collected in a pouch that you wear on the outside of your body.

2. Continent cutaneous urinary diversion

A continent urinary diversion allows you to have more control over urination. In this option, the surgeon uses a small section of your stomach or intestine to create an internal pouch that stores urine. You can empty this pouch by inserting a small plastic tube into a stoma when needed, so there’s no need to wear an external bag.

3. Bladder substitute

If your urethra is left intact during bladder cancer surgery, the surgeon may use a part of your intestine to create a new internal bladder called a neobladder. This new bladder is connected to your ureters and urethra, allowing you to urinate voluntarily as you did before surgery.

FAQs

  1. How is muscle-invasive bladder cancer diagnosed?

    Muscle-invasive bladder cancer is diagnosed using imaging tests like CT scans, cystoscopy- a procedure where a camera is inserted into the bladder, and biopsies. If muscle invasion is suspected, your doctor may recommend more advanced imaging to assess the extent of the disease.

  2. Can MIBC spread to other parts of the body?

    Yes, it can spread to other areas, such as the lymph nodes, bones, and lungs. This is why aggressive treatment is necessary, and regular follow-ups are essential to monitor for any signs of metastasis.

  3. Are there non-surgical treatment options for MIBC?

    While surgery is often the first-line treatment, non-surgical options like chemotherapy, radiation therapy, and immunotherapy are available. These treatments can be used in conjunction with surgery or as alternatives when surgery is not an option.

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