Bladder Cancer

Bladder Cancer

Bladder cancer stands as the most prevalent malignancy of the urinary tract, with a higher incidence among men. According to national statistics, it ranks as the fourth most common cancer among Singaporen males, trailing behind lung, colorectal, and nasopharyngeal cancers. Typically, bladder cancer is diagnosed around the age of 70.

The primary culprit behind over half of bladder cancer cases is cigarette smoking, believed to introduce genetic mutations in bladder cells, fostering cancer development. Additional contributing factors include occupational exposure, particularly prevalent among individuals in the aluminum industry, a diet high in fat and lacking in folic acid, genetic predisposition, and parasitic infections like Schistosoma haematobium (bladder fluke).

Hematuria, or blood in the urine, ranks as the most frequently reported symptom by patients, followed by urinary frequency and a painful burning sensation during urination. However, these symptoms are also common in urinary tract infections, necessitating further investigations for accurate diagnosis.

Diagnostic procedures typically include urine tests to detect cancer cells under a microscope, radiological investigations like ultrasounds, intravenous pyelograms, and chest X-rays, as well as cystoscopy, where a flexible telescope is inserted through the urethra to examine the bladder lining and obtain tissue samples for analysis.

Treatment strategies vary depending on the stage of the cancer. Endoscopic resection is performed for tumors present on the bladder lining (stage 1), while partial or complete bladder removal may be necessary if the tumor has invaded the bladder's muscle wall (stage 2). Despite surgery, tumor recurrence rates range from 30 to 80 percent, often requiring intravesical chemotherapy to manage superficial tumor recurrences.

For patients unfit for surgery or those who decline it, radiotherapy offers an alternative. Long-course radiotherapy aims for a curative outcome, while short-course radiotherapy serves a palliative purpose in cases where the disease has spread, alleviating symptoms. Though radiotherapy can induce side effects like dysuria, diarrhea, and lethargy, these are typically temporary and manageable.

Early detection and treatment significantly improve the prognosis of bladder cancer, but outcomes worsen once the disease has metastasized. Preventive measures include smoking cessation, adopting a folic acid-rich diet, particularly from green leafy vegetables, and implementing appropriate safety precautions in high-risk occupational environments.