Controlling bladder cancer

Bladder cancer is one of the top 10 most severe cancers killing  Malawians.

It attacks the body part that holds and releases urine.

The tumour located in the lower abdomen is among the world’s 10 most common cancers, with about 550 000 new cases annually.

The World Health Organisation reports that there were 415 deaths in Malawi, making it the seventh most severe cancer.

Developed communities are the worst hit globally, but this is likely to change over the next decades.

Risk factors for bladder cancer include chronic bilharzia, smoking, and exposure to occupational cancer-causing substances.

Tobacco is the number one risk factor, accounting for half of  the cases. 

Bilharzia or schistosomiasis is now being recognised as a group one cause of cancer.

In 2020, research led by Pocha Kamudumuli showed a high prevalence of chronic bilharzia in Malawi, recommending more emphasis on the snail fever in the management of diseases associated with cancer.

The researchers also recommended targeted screening for schistosoma infection in cancer suspects.

Bladder cancer patients may experience no symptoms or blood clots in the urine, pain or a burning sensation when urinating and frequent urination.

Other symptoms include a persistent feeling to urinate throughout the night, feeling the need to urinate but not releasing urine and lower-back pain on one side of the body.

None of these symptoms definitely indicate cancer. They may be found in other urinary tract infections, but they need to be investigated.

Often, bladder cancer is diagnosed when a patient tells a doctor about blood in the urine, also called hematuria.

Some 20 percent of people with blood that is visible in the urine have bladder cancer.

However, about 1.3 percent of people with invisible blood in the urine will have the cancer.

Routine urine examination is to diagnose bladder cancer because the blood can be a sign of several other non-cancerous conditions, including kidney stones.

A more specific test involves examining the urine under a microscope to look for cancer cells. 

Apart from urine tests, a doctor looks inside the body using a thin, lighted and flexible tube called a cystoscope inserted into the urethra—the tube leading to the bladder. The short procedure can detect tumours and growths in the bladder to determine the need for surgery or removal of a small tissue for examination under a microscope.

Cystoscopy should be performed in all patients with gross hematuria and anyone aged at least 35 with microscopic hematuria.

It can also be considered for younger patients with invisible blood in their urine.

Anyone with blood in urine and risk factors for bladder cancer—smokers or exposed to cancer-causing chemicals—should be evaluated with cystoscopy regardless of their age.

If abnormal tissue is found in the process, the doctor will perform a surgical procedure called a transurethral bladder tumour resection as the first stage of treatment.

Some specialised imaging tests may follow to determine the stage of infection and if the cancer has spread.

These include ultrasound, computed tomography scans, magnetic resonance imaging `and positron emission tomography.

Some types of cancer produce specific proteins that can be detected in the bloodstream.

These tumour markers are potentially useful for screening cancer, monitoring the course of the disease and detecting if a relapse has occurred.

Unfortunately, no tumour marker is routinely available for bladder though a protein called tissue polypeptide antigen has shown promise in research studies for diagnosis and monitoring.

Effective management of bladder cancer in Malawian patients will depend on the eradication of bilharzia and detection of the cancer at an early stage when it may be cured.