It is normal to feel very scared when you see blood in your urine. Also, if you have difficulty urinating or are getting frequent urinary tract infections, you should not just ignore these symptoms. These can be symptoms of bladder cancer, especially its more serious form, Muscle Invasive Bladder Cancer. Although this is a serious condition, do not panic. Today, we will talk about this in simple terms, that is, the symptoms, causes, and treatments.
What is Muscle Invasive Bladder Cancer (MIBC)?
Simply put, this is a slightly advanced, or spread, case of bladder cancer.
Our bladder is a sac-like organ made up of several layers of walls. Bladder cancer usually starts in the innermost layer of this wall. About 70 out of 100 people with bladder cancer have this superficial cancer. It hasn't gone very deep.
However, in Muscle Invasive Bladder Cancer (MIBC) , the cancer cells invade the inner lining of the bladder and enter the thick muscle layer . Sometimes, they can spread beyond that layer. About 30 out of 100 people with bladder cancer develop this severe form.
Why does this type of cancer develop? What are the risk factors?
Like any cancer, it starts with changes (`mutations`) in the genetic information, or DNA, in our body's cells. These abnormal cells divide uncontrollably and form `tumors`. In MIBC, these tumors spread deep into the bladder wall.
Some people are more likely to develop this cancer. Let's look at what those risk factors are.
| Risk factor | Description |
|---|---|
| Smoking | This is the biggest and most important risk factor. The chemicals in tobacco damage the bladder when they are excreted through the urine. |
| Age and gender | Men are more likely to develop it than women and people over the age of 55. |
| Frequent urinary tract infections | Chronic bladder inflammation can cause changes in cells. |
| Exposure to chemicals | People who work in industries that make rubber, paints, and dyes are especially at risk. Chemicals like arsenic can also be a cause. |
| Previous cancer treatment | There is a risk if you have received radiation therapy to the hip area or medications such as cyclophosphamide. |
| Family history | If someone in the family has had bladder cancer or a genetic condition such as Lynch syndrome. |
What are the symptoms of this disease?
The main and first symptom of bladder cancer is blood in the urine . Sometimes the urine looks red, other times it looks pink. Also, there can be things like burning and pain in the urethra without any infection.
As the cancer progresses, that is, reaches the MIBC stage, other symptoms may also appear.
- Not being able to urinate at all.
- Pain in the lower abdomen or one side of the back.
- Loss of appetite and weight loss for no reason.
- Swelling of the legs.
- Pain in the bones.
These symptoms can also be present in other diseases. However, if you have blood in your urine along with one or more of these, see a doctor immediately.
How to diagnose the disease?
To diagnose MIBC, you need to look closely at whether cancer cells are present and how deep they have penetrated the bladder wall.
1. Urine test: The first step is a simple urine test. This checks for blood or cancer cells in the urine.
2. Cystoscopy and scans: Next, the doctor will insert a thin tube with a camera into the urethra and examine the inside of the bladder. This is called a cystoscopy. Special scans such as a CT urogram or a retrograde pyelogram may also be performed.
3. Biopsy: If a tumor is found inside the bladder, the patient is anesthetized and a small piece of the tumor is taken and sent to the laboratory for testing. This is called a biopsy. Sometimes, the entire tumor can be removed with this surgery (TURBT - Transurethral Resection of Bladder Tumor). This is used for both diagnosis and treatment.
4. Scans to see if the cancer has spread: Once the disease is confirmed, several other types of scans are done to see if the cancer has spread beyond the bladder, to the lymph nodes, liver, lungs, or bones.
- CT scan
- MRI scan
- PET scan
- Bone scan
- Chest X-ray
What is the 'Grade' and 'Stage' of cancer?
It is important to know the exact meaning of these two words.
- Grade: This refers to how abnormal or aggressive the cancer cells look under a microscope. `Low-grade` means the cells are not very aggressive and spread slowly. `High-grade` means the cells are very aggressive and spread quickly. MIBC is usually a `high-grade` cancer.
- Stage: This refers to how far the cancer has spread in the body. This is determined by the size of the tumor (T), whether it has spread to lymph nodes (N), and whether it has spread to other organs (M).
Stage II: The cancer has spread to the muscular wall of the bladder. (This is where MIBC begins.)
Stage III: The cancer has spread beyond the muscle wall into the fatty tissue surrounding the bladder.
Stage IV: The cancer has spread beyond the bladder, to lymph nodes, bones, or other organs.
To treat cancer properly, it is essential to know its exact stage.
What are the treatments?
Because MIBC is a serious condition, treatment can be a bit more intensive. The main treatment is surgery.
Surgery
- Cystectomy: This is a surgery to remove the entire bladder. It also removes nearby lymph nodes and organs where the cancer may have spread. The prostate gland in men and the uterus and ovaries in women may also need to be removed.
- A new way to pass urine: After the bladder is removed, a new way to pass urine from the kidneys out of the body has to be developed.
- Urostomy: This is the most common procedure. A small opening (stoma) is made in the abdomen and a bag is attached to collect urine.
- A reservoir: A part of the intestine is used to create a bag inside the body to collect urine. A tube (catheter) is inserted through a small hole in the abdomen to empty the bag.
- New bladder: A new bladder is made from a section of the intestine and connected to the urethra. In this method, urine is also excreted through a tube.
Bladder Preservation Treatment
For some patients, who cannot undergo surgery or do not want to have their bladder removed, there are other treatments. `TURBT` is a procedure in which the tumor is removed and chemotherapy and radiation are given at the same time.
Other treatments
- Chemotherapy: This treatment is given to shrink the tumor before surgery or to those who cannot have surgery.
- Immunotherapy: Administering modern drugs that stimulate the body's own immune system to destroy cancer cells.
- Targeted Therapy: Giving drugs that target specific proteins that are essential for the growth of cancer cells and stop them.
Your doctor will choose the treatment that is best for your condition. You can also talk to your doctor about clinical trials of new treatments.
Take-Home Message
- Muscle Invasive Bladder Cancer (MIBC) is a serious, advanced form of bladder cancer.
- Blood in the urine is the main and most common symptom. Never ignore this.
- Symptoms such as lower abdominal pain, back pain, and weight loss may also occur.
- Smoking is the main risk factor for this cancer.
- Accurately diagnosing the disease and determining its stage is essential for successful treatment.
- There are many modern treatments available today, including surgery, chemotherapy, radiation therapy, and more.
- Although life after treatment is a big change, most people can adjust to it and live a normal life. Your doctor and healthcare team will help you with that.
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