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Non-Muscle Invasive Bladder Cancer

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Nonmuscle-invasive bladder cancer is the most common type of bladder cancer.

Medically reviewed by

Dr. Rajesh Gulati

Published At February 19, 2024
Reviewed AtMarch 13, 2024

Introduction:

The most common cancer worldwide is bladder cancer. Bladder cancer accounts for the fifth and sixth most prevalent cancer in the European Union and the United States, respectively. In 2015, 75000 cases were diagnosed in the United States. Bladder cancer refers to cancer of the urinary bladder (an organ in the humans responsible for excretory function). Bladder cancer is of two types based on penetration depth. Muscle-invasive (MIBC) and nonmuscle-invasive (NMIBC) bladder cancer are two types of bladder cancer. NMIBC accounts for 75 percent of newly diagnosed bladder cancer. The primary therapeutic options still involve transurethral resection and intravesical procedures. Bladder cancer is a disease that needs thorough therapy because up to 31 to 78 percent of recurrence is seen in the patients.

What Is Non Muscle Invasive Bladder Cancer?

Muscle-invasive (MIBC) and nonmuscle-invasive (NMIBC) bladder cancer are two types of bladder cancer based on the depth of penetration. 70 percent of bladder cancer cases and about 75 percent of the disease's financial burden are caused by non-muscle-invasive bladder cancer (NMIBC). Non-muscle invasive bladder cancer (NMIBC) is a type of cancer that affects the cells lining the bladder. It is typically less aggressive than muscle-invasive bladder cancer, but it can still be serious and requires prompt treatment.

The following are the stages of the NMIBC:

  • Stage Ta - If the bladder tumors are confined to the mucosa (first layer of the organ), it is called stage Ta.

  • Stage T1 - If the bladder tumors invade the lamina propria but not the muscularis propria, it is called stage T1.

  • CIS - It is called high-grade tumors, carcinoma-in-situ. If a tumor invades the organ, then it is called CIS.

What Are the Causes of Non Muscle Invasive Bladder Cancer?

NMIBC is caused by various risk factors, but the exact cause of bladder cancer is not known.

The following factors can cause NMIBC:

  • Chewing tobacco.

  • Smoking.

  • Mutation (genetic alterations).

  • Previous history of family history of bladder cancer.

  • Occupation such as - exposure to industrial items such as metals, paints, dyes, and petroleum products

  • History of pelvic radiation therapy before taking some chemotherapy medications, such as Cyclophosphamide or Ifosfamide.

  • Drinking impure water that contains arsenic or chlorine.

  • Bladder infection history.

  • Chronic urinary catheter prolonged use.

What Are the Symptoms of Non Muscle Invasive Bladder Cancer?

Hematuria is a common symptom of NMIBC. However, some patients may be asymptomatic.

The following are the symptoms of NMIBC:

  • Hematuria (blood in the urine).

  • Frequent urination.

  • Painful urination.

  • A feeling of urgency to urinate.

  • Back pain.

  • Pelvic pain.

How to Diagnose Non Muscle Invasive Bladder Cancer?

The most typical initial symptom in patients with NMIBC is hematuria, although it is not exclusive to bladder cancer, and in the vast majority of instances, no malignancy is discovered.

Patients need to undergo additional evaluation to get the exact diagnosis.

The following are the ways to diagnose the NMIBC:

  • Urine Test - A routine urine test detects the presence of blood (hematuria) or infection in the urine.

  • Biopsy - The biopsy can detect the stages of bladder cancer.

  • Urinary Tract Imaging - Radiographic imaging is crucial for detecting upper tract malignancies and tumor spread and can help distinguish malignant from other urinary tract stones. Newly developed Computed Tomography (CT) urography protocols are used to detect.

  • Magnetic Resonance Imaging (MRI) - MRI offers high soft-tissue contrast without ionizing radiation, although it is more expensive than CT and relatively insensitive for detecting stones. Improvements in MRI technology include imaging combining anatomical and functional sequences, which offers the possibility of bladder cancer's local and nodal staging and can potentially provide prognostic information.

  • Cystoscopy - Cystoscopy is a technique in which a flexible tube with a camera is inserted through the urethra and into the bladder. If NMIBC is suspected, a tissue sample is taken for further analysis. Cystoscopy is a definitive diagnosis currently. The treatment choice relies on cystoscopy and transurethral resection of suspicious lesions in the operating room, followed by pathological assessment of the resected tissue. Several advanced optical imaging tools are improving the visualization of cystoscopy in clinical development. During the bladder examination, White-Light Cystoscopy (WLC) with techniques such as photodynamic diagnosis using Blue-Light Cystoscopy (BLC) is used to increase the detection of neoplastic (cancerous) lesions.

How to Treat Non Muscle Invasive Bladder Cancer?

Treatment for NMIBC typically involves a combination of surgery and medication. The primary goal of treatment is to remove the cancerous cells and prevent cancer from recurrence. Surgery may involve removing the cancerous cells through a procedure called Transurethral Resection of Bladder Tumor (TURBT) or, in some cases, removing the entire bladder. The standard of care for follow-up entails routine cystoscopy, which is time-consuming and expensive for society, increases patients' concern and discomfort, and does not always stop cases of advancement or recurrence.

The following are the treatment options for NMIBC:

  • Chemotherapy - BCG+intravesical gemcitabine and Metformin can be given in primary NMIBC. In addition, the FDA recently approved Pembrolizumab for high-risk patients or those who are BCG-unresponsive. Cabazitaxel, Cisplatin, and Gemcitabine are medicines prescribed early in NMIBC.

  • Gene Therapy - Nadofaragene Firadenovec is an intravesical human IFN-a2b gene-mediated therapy that delivers the IFN-a2b gene to increase IFN-a2b expression which helps to kill cancer cells.

  • Surgery - Transurethral resection is the mainstay for the treatment of NMIBC. A Transurethral resection of bladder tumor is performed under general anesthesia. It is a type of surgery in which a visible tumor has been resected. Good-quality transurethral resection is crucial to make the correct diagnosis and ensure the complete removal of all visible lesions to maximize the prognosis. A second transurethral resection is often recommended within 2–6 weeks of the initial resection to increase the probability of complete removal of the lesions.

Conclusion:

Non-muscle invasive bladder cancer is a common type of cancer that affects the bladder lining. While it can be less aggressive than muscle-invasive bladder cancer, it still requires prompt treatment and ongoing monitoring to prevent a recurrence. A positive prognosis for patients with NMIBC depends on several variables, including the cancer's features, the available technology, the surgeon's expertise, the method, and multidisciplinary support. These elements will be successfully included in NMIBC care to lower healthcare expenses and raise patient compliance and quality of life. Considering the vast amount of continuing study into enhancing technology and therapeutic methods, the diagnosis, treatment, and follow-up of patients with NMIBC will be significantly improved. In addition to surgery and medication, lifestyle changes can also help manage NMIBC. These may include quitting smoking, drinking plenty of fluids, and avoiding foods and drinks that may irritate the bladder.

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Dr. Rajesh Gulati
Dr. Rajesh Gulati

Family Physician

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bladder cancer
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