What is Urothelial Cancer?

The bladder functions to store urine. It swells when urine fills and shrinks when urine passes out of it. The urethra is the tube-like structure through which urine passes out of the body. The bladder and kidney work together to remove harmful toxins and pass out from the body. The abnormal growth in cell linings of bladder or urothelial cells is known as urothelial cancer. It is commonly referred to as transitional carcinoma or bladder cancer. These cells are located in the kidney and ureter (kidney to bladder tube). This cancer is well known as the silent killer because it spreads and reaches the last stage even without showing any signs or symptoms. The cure is possible only if cancer can be found early. However, there is a possibility that it will return even after successful therapy. That's why it is advisable to screen regularly and follow testing for bladder cancer. Cancer spreads to lymph nodes, renal pelvis, lung, liver, and kidney if not treated on time.

Basic facts to be known about Urothelial Cancer

● Urothelial cancer is the 9th most deadliest cancer in the world.

● It is estimated that around 6,14,298 people are diagnosed with urothelial cancer across the world. Out of which 2,20,596 people died from urothelial cancer in 2022.

● India reported over 17,668 men and 4,880 women cases of colorectal cancer in 2022.

● In India, around 12,353 deaths were reported in 2022. Out of which approximately 9,754 were men and 2,599 were women.

Signs and symptoms of Urothelial cancer

Urothelial cancer is also known as a silent killer. As it spreads to other parts without signs and symptoms. Having one or more symptoms doesn't prove that you have bladder cancer. These signs may also be related to other diseases. Some of the major signs and symptoms may include:

● Blood in urine (Hematuria)

● Frequent and painful urination

● Lower back pain

● Loss of appetite

● Sudden weight loss

● Joint pain

● Tiredness

● Low-grade fever

Risk factors causing Urothelial cancer

Urothelial cancer is diagnosed as changes and changes in cell function and abnormal growth. The main cause of bladder cancer is still unknown. Some major risk factors can be responsible for urothelial cancer. Some of them are listed below:

● Smoking and alcohol consumption: The risk can be decreased of getting bladder cancer by avoiding smoking and alcohol.

● Not drinking enough fluids: Low intake of water causes infection in the urinary tract. The severe stage of infection leads to bladder cancer.

● Family history: People having cancer history in their bloodline are most prone to this disease.

● Exposure to paints and petroleum products: Direct contact with petroleum and harmful chemicals elevates the risk of bladder cancer.

● Chlorine water: Drinking high chlorine and arsenic-exposed water elevates the chances of bladder cancer.

● Catheters: The use of urine catheters for a prolonged time may lead to urothelial cancer.

● Bladder infections: Chronic bladder infections such as UTIs and parasite infections can cause bladder cancer.

● Personal History: Personal medical history, including past radiation and chemotherapy, can elevate the chances of having this cancer.

Type of Urothelial Cancer

There are four types of Urothelial cancer based on their location and cells of origination.

● Urothelial carcinoma: It is the most common type of urothelial cancer. This carcinoma occurs in the cell line inside the bladder. It occurs in the cell that expands when the bladder is full and contracts when empty.

● Squamous cell carcinoma: It is caused due to chronic bladder infections or long-term use of a urine catheter.

● Adenocarcinoma: It is a rare type of bladder cancer that begins at mucus-secreting cells.

Stages of Urothelial Cancer

Cancer stages show the extent of cancer, size, and how much it has spread to other body parts. It is important to know the staging of cancer because it helps to determine further treatment plans. There are five major stages of colorectal cancer. These are discussed below:

● Stage 0: Known as carcinoma in situ. This stage is detected as cancer cells begin to grow in the inner cell lining of the bladder. It is the most difficult stage to diagnose with no or mild symptoms.

● Stage 1: Cancer cells start to spread in connective tissue within the bladder, not in the muscular cell lining of the bladder.

● Stage 2: In this stage, cancer starts to spread in the muscular wall of the bladder.

● Stage 3: Cancer spreads to muscular cells and walks towards outside blood vessels and bladder muscles.

● Stage 4: This is the last stage, in which cancer cells have spread to lymph nodes and other nearby organs.

Method used in the detection of Urothelial cancer

If you are seeing any symptoms listed above, visit a urologist for a proper diagnosis. Some of the major diagnosis methods to detect urothelial cancer are listed below:

● Physical examination and medical history: The doctor will feel the lower abdomen for unusual pain or lumps. He will go through the history of the patient, including alcohol consumption, past illness, and family cancer records.

● Urine tests: Tests are done to check the color of pee and its contents. This also checks for the presence and growth of cancer cells in urine flow under a microscope.

● Cystoscopy: In cystoscopy, The doctor will insert a thin, flexible tube-like structure with a small camera in the end, down to your bladder through the urethra. This will help the doctor examine the lining of the urethra, renal pelvis, and bladder.

● Biopsy: During cystoscopy,if the doctor suspects unusual growth in your bladder. A narrow tube with a small needle at the end will go down through the wall of your bladder to get a sample for biopsy. This sampling will be further used to test cancer or tumor growth in your bladder.

● Imaging tests: The doctor will prescribe some imaging tests to diagnose cancer. Some tests are CT scan urogram or retrograde pyelogram, X-ray, and MRI scan. These tests help to visualize the area affected, and tumor size and confirm the stage of cancer.

Way to prevent Urothelial cancer

Many things in our daily lives increase and decrease the risk factor for urothelial cancer. Changes in a few habits in daily routine will prevent urothelial cancer. Some prevention ways are:

● Avoid smoking and alcohol consumption

● Add watery fruits and green vegetables to your diet.

● Stay away from arsenic and chlorine exposure

● Drink a lot of fluid to lower the risk of UTI

● Engage yourself in a healthy lifestyle and daily routine.

Treatment method for Urothelial Cancer

Doctors provide treatment based on detection stages and nearby organs. It is estimated that urothelial cancer causes 90% of all bladder cancer, and 7% of kidney and its associated parts cancers. Some of the treatment options include:

● Surgery: Surgery is the best option for all-stage cancer. In this procedure, the tumor or cancer cells are either removed or high-energy laser rays are used to destroy them, with a process known as fulguration. Cystectomy is a surgical procedure that is used to remove all parts of the bladder.

● Chemotherapy: Chemotherapy uses anti-cancer medicines to kill the cancer cells. It can be performed after or before surgery.

● Radiation therapy: External beam therapy such as protons and X-rays is used in radiation therapy for bladder cancer. This therapy shrinks and kills the tumor cells before or after surgery. This therapy is used in combination with chemotherapy in cases where surgery can't be done.

● Targeted therapy and immunotherapy: Antibody-conjugated drugs are drugs used as targeted drug therapy. These medicines boost the immune system and empower it to fight against cancer cells.

Reference
https://www.wcrf.org/preventing-cancer/cancer-statistics/bladder-cancer-statistics/
https://www.cancer.gov/types/bladder
https://www.cancer.gov/types/bladder/survival
https://my.clevelandclinic.org/health/diseases/6239-transitional-cell-cancer

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