Bladder Cancer

The bladder is a hollow organ found in the lower abdomen that functions primarily as storage of urine. When its normal cells go through abnormal transformation and multiplication, cancer occurs. ^[1] Bladder cancer is usually categorized based on appearance under the microscope. The most common type is called urothelial carcinoma (also called transitional cell carcninoma) which is strongly associated with smoking. Adenocarcinoma and squamous cell carcinoma (SCC) are types associated with long-standing inflammation. The lower stage and grade, the better is the prognosis of the disease. ^[2]

Epidemiology

Bladder cancer is diagnosed in about 275,000 people worldwide and approximately 108,000 die annually. 90%  of cases in developed countries are transitional cell carcinoma while SCC, usually linked to Schistosoma haematobium infection, is more prevalent in developing countries. ^[3]          

Causes and Risk Factors

The exact cause and mechanism of bladder cancer are unknown. ^[4] Smoking is the greatest risk factor. Other risk factors include old age, chemical exposures such as aromatic amines, frequent infections,  diet rich in fried meats and animal fats and taking herb called Aristolochia fangchi found in certain dietary supplements and Chinese herbal remedies. Bladder cancer affects more men than women and Caucasians have much higher risk. ^[1] In developing countries, parasitic infection like bilharzia or schistosomiasis are a major cause of bladder cancer. ^[4]

Symptoms

The most common symptom is blood in the urine which may be bright red or dark brown. Passing of blood is often painless. Other symptoms are frequent urination, urinary urgency and pain in urination. ^[5] Some patients may experience pelvic or bony pain, flank pain and edema on the lower extremities. ^[3]   

Diagnosis

After obtaining the patient's history, a thorough physical examination is performed which may include an abdominal, pelvic, rectal or bimanual exam. ^[3]  Since blood in the urine is the first warning sign, urinalysis is usually preformed. To detect cancerous cells, urine cytology is commonly done as confirmatory test. Since some early bladder cancers may be missed out by this test, other laboratory exams may be helpful to diagnose the disease or to check the spread if cytoscopy is positive. These exams include ultrasound, CT scan, MRI, cystoscopy and biopsy. ^[2]             

Treatment

The following are standard therapies for bladder cancer: surgery, radiationtherapy, chemotherapy, and immunotherapy or biological therapy. ^[1]

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin C [1, 24, 25, 26, 27, 28, 29]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.

Recommendation: No recommendation (Observational and clinical trials have not shown any evidence that vitamin C has a protective or treatment effect on cancer or chronic diseases)

Grade of Evidence: moderate quality of evidence

* www.gradeworkinggroup.org

Selenium Supplement [5, 15, 16, 17, 18, 19. 20, 21, 22, 23]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. IMPORTANT: Selenium is toxic in high doses. Massive overdoses can cause kidney failure, breathing difficulty and death. Selenium should only be taken at healthy levels which the body is able to tolerate.

Recommendation: Weakly in favor (Observational studies have shown that taking adequate daily amounts of selenium can help prevent bladder cancer. However, these are very unreliable studies, and more research is needed.)

Grade of Evidence: very low quality of evidence

Oleander Leaf (Nerium Oleander) [5, 11, 12, 13, 14]:

WARNING: This plant is toxic! Not to be ingested. Causes nausea, appetite loss, vomiting, drowsiness, bloody diarrhoea, seizures, irregular heartbeat, heart failure, respiratory depression and death. The plant and any of its extracts should be strictly avoided, especially by children and pregnant women.

Recommendation: Strongly against (Although laboratory tests have shown that Oleander may slow the growth of cancer cells, human studies have not yet been conducted. Also, please note that this plant and its extracts are poisonous, even when ingested in dry form. Many people have died of heart or respiratory failure after eating parts of the plant or its extracts.)

Grade of Evidence: low quality of evidence

Green Tea [5, 6, 7, 8, 9, 10]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Laboratory studies have shown promise with regards to the prevention of bladder cancer with green tea, but very few reliable clinical trials have been done. More research is needed.)

Grade of Evidence: low quality of evidence

* www.gradeworkinggroup.org 

Summary References

Treatments:

1. http://www.jcojournal.org/cgi/content/abstract/19/3/666

2. http://www.ncbi.nlm.nih.gov/pubmed/6403716

3. http://www.redjournal.org/article/S0360-3016%2897%2900579-8/abstract

4. http://www.merck.com/mmpe/sec17/ch241/ch241b.html?qt=bladder%20cancer&alt=sh#sec17-ch241-ch241b-1415a

5. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

6. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/green-tea

7. http://www.ncbi.nlm.nih.gov/pubmed/16968850

8.  http://www.denverpost.com/nationworld/ci_4326770

9. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-green_tea.html

10. http://nccam.nih.gov/health/greentea/index.htm

11. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/oleander-leaf

12. http://www.nerium.com/index-2.html

13. http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/WarningLettersandNoticeofViolationLetterstoPharmaceuticalCompanies/UCM165406.pdf

14. http://www.inchem.org/documents/pims/plant/pim366.htm

15. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/selenium?sitearea=ETO

16. http://www.cancer.gov/Templates/doc.aspx?viewid=ED8AD8E8-6AE5-458D-8091-393F4CB73F0D

17. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-selenium.html

18. http://www.ncbi.nlm.nih.gov/pubmed/9290116

19. http://www.ncbi.nlm.nih.gov/pubmed/9829869

20. http://www.ncbi.nlm.nih.gov/pubmed/10335455

21. http://www.ncbi.nlm.nih.gov/pubmed/2136228

22. http://www.springerlink.com/content/v0r644v4ju5153k2/

23. http://jnci.oxfordjournals.org/cgi/content/full/101/5/283

24. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/vitamin-c

25. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-vitaminc.html

26. http://www.nlm.nih.gov/medlineplus/vitaminc.html

27. http://www.nlm.nih.gov/medlineplus/ency/article/002145.htm

28. http://nccam.nih.gov/research/results/spotlight/070106.htm

29. http://www.merck.com/mmhe/sec12/ch154/ch154i.html?qt=vitamin c&alt=sh

References:

1.      http://www.emedicinehealth.com/bladder_cancer/article_em.htm

2.      http://www.medicinenet.com/bladder_cancer/page2.htm#types

3.      http://emedicine.medscape.com/article/438262-overview#a0156

4.      http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/typescancer_bladder.shtml

5.      http://cancerhelp.cancerresearchuk.org/type/bladder-cancer/about/bladder-cancer-symptoms

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