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Bladder cancer

CISS relies strongly in its evaluations below on impartial analyses by the International Cochrane Collaboration and the British Medical Journal’s Clinical Evidence Group – two groups of researchers who specialise in Evidence Based Medicine.Conventional medicine supports the paradigm that the tumour is the first stage of cancer, therefore, treating and removing the cancer should cure the cancer.

Unfortunately statistics will show this is rarely the case. Conventional medicine also advocates treatment should only be used if supported by appropriate clinical trials showing efficacy. In fact evidence based medicine suggests that the only reliable evidence needs to come from properly run randomised controlled trials. Again, with conventional cancer treatment, this is generally not the case.

The following is based on the conventional cancer paradigm.

The bladder is a hollow organ in the lower part of the abdomen that stores urine until it is passed out of the body.

The most common type of bladder cancer is urothelial carcinoma (about 90%), which begins in urothelial cells that line the inside of the bladder. Urothelial cells are transitional cells, which are able to change shape and stretch when the bladder is full. This type of cancer is also called urothelial carcinoma. Other types of bladder cancer include squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder, about 8%) and adenocarcinoma (cancer that begins in cells that make and release mucous and other fluids, about 1-2%) (National Cancer Institute).

Most bladder cancers are non-invasive, that is they are found only in the inner lining of the bladder (urothelium) and haven’t grown into the deeper layers of the bladder wall. One such cancer is known as carcinoma in-situ. However, sometimes the cancer has spread beyond the lining of the bladder into the muscle or right through the bladder wall. This is known as an invasive tumour. (Cancer Council NSW)

Risks:

  • Smoking increases risk by more than 3 times due to chemicals from smoking accumulating in the bladder.
  • Increasing age, bladder cancer is rare in people under 40.
  • Being white and/or being male increases chances of bladder cancer.
  • Exposure to certain chemical such as those used in the manufacture of dyes, rubber, leather, textiles and paint products or arsenic
  • Previous cancer treatment with the drug cyclophosphamide or radiation treatments in the pelvic area.
  • Diabetes medication with pioglitazone.
  • Chronic or repeated urinary infections or inflammation (cystitis).

Signs and Symptoms:

  • Blood in the urine. This is the most common symptom. It is usually not painful. Can come and go, be red or brown. Never ignore any blood in the urine.
  • Change in bladder habits. Pain or burning when passing urine. Need to urinate more often or urgently. Not being able to urinate when you feel the urge.
  • Although not common, some people have pain in one side of their lower abdomen or back.

(Cancer Council NSW).

Treatment:

Treatment for bladder cancer will depend on the type and stage of your bladder cancer which your doctor will explain to you. It can include some or all of the following:

  1. Surgery – most people with non-invasive bladder cancer will undergo a type of surgery called transurethral resection of bladder tumour (TURBT). If your bladder cancer was diagnosed using a cytoscope ( a small tube passed through the urethra into the bladder with a light and lens), then your Dr may perform this procedure at time of diagnosis as the cytoscope has a small looped wire which can catch and remove the tumour via the urethra. The TURBT takes 15-40 minutes under general anaesthetic and requires no external cuts to the body.

If the cancer is invasive the surgeon may remove part of or all of the bladder (this will result in a smaller bladder for urine storage). If the whole bladder is removed nearby lymph nodes will also be removed and in most cases the appendix as well. In males the prostrate, urethra and seminal vessels may also be removed, and in females the uterus, ovaries and a small portion of the vagina, and perhaps the fallopian tubes may also be removed.

If the whole bladder is removed the surgeon will need to create a new method of storing urine and excreting urine. There are 3 options.

  1. Ileal conduit (urostomy) – most common. The Doctor uses a piece of your small bowel (ileum) to make a passage way (conduit) connecting the ureters (tubes that propel urine from the kidney to the bladder) to a hole (stoma) created on the outside of the abdomen. A watertight bag is placed over the stoma to collect urine. It needs emptying several times a day.
  2. Continent urinary diversion – The Dr uses a small piece of bowel to create a pouch with a valve to hold urine. This allows urine to be stored inside the pouch until it is removed via a stoma (hole) created in the abdomen. The pouch is connected to the ureters and stoma. Several times a day a slender tube (catheter) is inserted in the stoma to the pouch to drain the urine, then the catheter is removed. There is no need to wear a bag over the stoma.
  • New bladder (neobladder) – a pouch is created from 45-75cm of your small bowel. The surgeon stitches the ureters to the top of the neobladder. A specialist continence nurse will then educate you on retraining your urination techniques and habits to being able to use your new bladder. (See Cancer Council NSW website for more detailed explanation of the above)

Please note: there is little evidence that cancer with surgery has any benefit on increased 5 year survival except in cases where the tumour is in a life threatening position (The Efficacy of Cancer Surgery, D.Benjamin). However, stage 1 bladder cancer with minor surgery has good prospects, with about 90% of people still being alive 5 years after diagnosis. Survival rates decrease the more a cancer has progressed when first diagnosed.

  1. Radiation – uses high energy x-rays to kill cancer cells. Please note: radiation has been shown to reduce recurrence with many types of cancer but this rarely results in increased survival. (The efficacy of radiotherapy, DJ Benjamin).
  2. Chemotherapy – the use of toxic drugs to kill the cancer cell or stop them from growing. Research by Morgan et al concludes that impact of cytotoxic chemotherapy in bladder cancer in Australian adults gave a 0% 5 year survival benefit. The research showed that out of 2802 Australian adults, none survived 5 years due to chemotherapy.
  3. Immunotherapy – An antibody drug which can make it easier for the immune system to find and destroy cancer cells.

The above therapies all come with risks and side effects which should be discussed in detail by your treating physician. For a complete comprehensive overview of conventional treatments used for bladder cancer with up to date information on % effectiveness of each treatment on mortality and morbidity, please follow this link to The Ralph Moss Reports.

Conventional medicine supports the paradigm that the tumour is the first stage of cancer, therefore, treating and removing the cancer should cure the cancer. Unfortunately statistics will show this is rarely the case. Conventional medicine also advocates treatment should only be used if supported by appropriate clinical trials showing efficacy, again, with conventional cancer treatment, this is generally not the case.

Other paradigms believe cancer is a systemic disease and the tumour is in fact a late stage symptom of that disease. Therefore treating the disease should be systemic and holistic (meaning treating the whole body) and should include the following components:

  1. Cause no harm
  2. Holistic (whole body)
  3. Look after our health. This latter paradigm is supported by CISS (See Introduction to CISS).

Alternative cancer therapies generally support the above 3 components. There are approximately 200 alternative cancer therapies that have been shown or anecdotally reported to help a person with cancer have better morbidity and longer mortality. What is important in any cancer treatment is to both understand and believe in your chosen therapy.

There are a few alternative cancer therapies claimed to produce benefits with bladder cancer. Those claimed to have the most benefits in most types of cancer include psychotherapy and immunotherapy although there are very few patients with bladder cancer who have been in trials.

  • Psychotherapy

Although there were no patients with bladder cancers enrolled in the psychotherapy trials, psychotherapy was found to provide benefits in all types of cancers with solid tumours, so bladder cancer would not be expected to be an exception.

  • Immunotherapy

Issels’ Wholebody Therapy

Although not based on RCTs the most successful therapy for late stage cancers was Issels’ Whole Body Therapy that focussed on restoring the body’s immune systems.

Wholebody immunotherapy as used by Josef Issels up to the 1970s produced 16.6% five year survival with late stage cancer patients and 15% fifteen year survival using a random sample of the 750 patients who had attended his clinic up to May 1954. This figure included a small number of patients with late stage bladder cancer (ie there were 3 out of the sample of 252 cancer patients who had bladder cancer).

Reference: Issels, J. Immunotherapy in Progressive Metastatic Cancer – A Fifteen-Year Follow-up. Clinical Trials Journal, August 1970: 357-365 – editorial by Phillips S. Dr Joseph Issels and the Ringberg Klinik. Clinical Trials Journal. August 1970: 355-56.

For Bladder cancer, Ralph Moss (Cancer Therapy, The Independent Consumers Guide to Non-Toxic Treatment and Prevention) reports the following alternative therapies have been shown to benefit.

  1. Bacillus Calmette-Guerin (BCG) – Is a weakened strain of the microbe Mycobacterium bovis, which is used worldwide as a vaccine for tuberculosis. It was one of the first immune boosters used in cancer therapy.

The mechanism of action of BCG is still poorly understood, but basically it stimulates the white blood cells, particularly the lymphocytes and macrophages, to attack cancer cells.

One BCG preparation (Thera-Cys from Connaught Laboratories, Ltd., Ontario, Canada) has been approved by the American FDA for use in bladder cancer.

However, there are side effects. Its use in bladder cancer saw side effects in over 50% of cases. This included a burning sensation and increased frequency and urgency, as well as some bleeding, upon urination. Fever and flu like malaise are commonly described. Irritation of the prostate has also occurred.

References. Bruley RM, et al. In vivo and in vitro macrophage activation by systemic adjuvents. Agents Actions. 1976; 51:594-607.

  1. B Vitamins – enhance immune function; restore the nutritional status of cancer patients, especially those receiving conventional treatment. There are a number of B vitamins which all play their role in immune function.

Nicotinic acid (a form of niacin) in particular has shown positive support for people with bladder cancer. In 1987, Russian scientists studied 106 people with advanced bladder cancer who had been operated on and who received radiotherapy, 51 people were given nicotinic acid or aspirin at commonly used doses before and after receiving gamma-ray radiation therapy. The rest did not receive the vitamins or drugs.

The results were dramatic: there were 76.3 percent relapses in the group that received standard therapy, but only 33.3 percent relapses in the nicotinic acid/aspirin group. Five year survival in the vitamin treated group was 72.5 percent but only 27.4 percent in the controls. Administration of nicotinic acid and aspirin to patients during radiation therapy was shown to raise the body’s antitumour resistance, Russian scientists reported.

References – Popov AI. (Effect of the nonspecific prevention of thrombogenic complications on late results in the combined treatment of bladder cancer). Med Radiol (Mosk). 1987;32:42-5.

  1. Aspirin – See B Vitamins.

If you or someone close to you have just been diagnosed with bladder cancer, it is important you research and understand your chosen treatment, whether that be conventional, alternative or a mixture of both. For the best results your treatment should include physical, mental, emotional, psychological and spiritual treatment.

For more information on some more common evidenced based alternative treatments please go to the alternative treatment tab. If you don’t know where to begin in your journey to wellness then we suggest you read where to start.

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