Bladder cancer poster ( OCCUPATIONAL HEALTH MAURITIUS)

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Names:
TARUN KUMAR CHEDDY
Module : OCCUPATIONAL HEALTH
BLADDER CANCER
A Brief description of the organ, tissue, cell affected

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The bladder is an organ located in the lower abdominal area near the pelvic bones that acts as a
holding area for urine. The bladder expands and can hold about half of a litre of urine, but a
person usually feels the urge to urinate when the bladder is 25% full. The bladder will contract
and become smaller when it is empty. The ureters are two tubes that connect the kidneys to the
bladder, and empty urine from the kidneys, into the bladder. The urethra is a tube connected to
the bladder that releases urine to the outside of the body.
The bladder wall consists of 4 main layers of tissue. The innermost layer is called the urothelium,
or transitional epithelium, and is made up of cells called urothelial or transitional cells. Beneath
this layer is a thin layer called the lamina propria, which is made up of connective tissue, blood
vessels and nerves. The next layer is called the muscularis propria, which is made of muscle. The
last layer is a layer of fatty tissue that separates the bladder from other surrounding organs.
Bladder cancer occurs when there are abnormal cell mutation resulting into cancerous cells
growing uncontrollably in the lining of the bladder, the hollow organ in the lower abdomen that
stores urine. These cells begin to affect the normal function of the bladder and can spread to
surrounding organs.
The bladder wall has 3 main layers as shown in the diagram below. The bladder lining is the
urothelium, under this is connective tissue and deeper is the bladder wall muscle.

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Bladder cancers arise almost exclusively from the innermost lining of the bladder, so they are
called transitional cell or urothelial cancer. This simply means that the cancer started in the lining
of the bladder, which is made up of transitional. Less commonly, other types of cancers can arise
from the lining of the bladder, including adenocarcinomas, squamous cell carcinomas and small
cell carcinomas. Bladder cancer often begins in the cells (urothelial cells) that line the inside of
your bladder — the hollow, muscular organ in your lower abdomen that stores urine. Although
it's most common in the bladder, this same type of cancer can occur in other parts of the urinary
tract drainage system.
Types of bladder cancer include:
 Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma,
occurs in the cells that line the inside of the bladder. Urothelial cells expand when your
bladder is full and contract when your bladder is empty. These same cells line the inside of
the ureters and the urethra, and tumours can form in those places as well.
 Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation
of the bladder, for instance from an infection or from long-term use of a urinary catheter.
It's more common in parts of the world where a certain parasitic infection (schistosomiasis)
is a common cause of bladder infections.
 Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in
the bladder.

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Stage 0: This is an early cancer that is only found on the surface of the inner lining of the
bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not
invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also
called non-invasive papillary urothelial carcinoma.
This stage of cancer, also known as a flat tumour or carcinoma in site (CIS), is found only on the
inner lining of the bladder. It has not grown in towards the hollow part of the bladder, and it has
not spread to the thick layer of muscle or connective tissue of the bladder. This is always a high-
grade cancer and is considered as an aggressive disease because it can often lead to muscle-
invasive disease.
Stage I: The cancer has grown through the inner lining of the bladder and into the lamina
propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or
other organs.
Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called
invasive cancer or muscle-invasive cancer. The tumour has not reached the fatty tissue
surrounding the bladder and has not spread to the lymph nodes or other organs.
Stage III: The cancer has spread throughout the muscle wall to the fatty layer of tissue
surrounding the bladder (peri-vesical tissue) or to the prostate in a man or the uterus and vagina
in a woman. It is probable that the cancer has spread to the regional lymph nodes.

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 Stage IIIA: The tumour has grown into the peri-vesical tissue and has spread to the
prostate, uterus, or vagina but has not spread to the lymph nodes or other organs or the
cancer has spread to a single regional lymph node.
 Stage IIIB: The cancer has spread to 2 or more regional lymph nodes or to the common
iliac lymph nodes.
Stage IV: The tumour has spread into the pelvic wall or abdominal wall, or the cancer has spread
to lymph nodes outside of the pelvis or to other parts of the body.
 Stage IVA: The tumour has spread to the pelvic wall or the abdominal wall but not to
other parts of the body (T4b, any N, M0), or the cancer has spread to lymph nodes
located outside of the pelvis (any T, any N, M1a).
 Stage IVB: The cancer has spread other parts of the body (any T, any N, M1b).
Over 17,000 women are diagnosed with bladder cancer each year. Millions of women
experience overactive bladder starting in their 30s and 40s.
Different gender different risk level
It has been found that bladder cancer is more frequent in men than in women. This is usually
because more men consume alcohol, smoke tobacco and may have chosen careers that involve
incidental or chronic exposure to dangerous fumes and compounds.
For instance, certain professions, such as firefighting, machining and truck driving may increase
risk of cancer because people in these professions have more exposure to toxins and chemicals.
In addition to certain professions, stress is another factor that contributes to smoking and thus
increasing further the risk of cancer.

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The occupational cancer with relation to Mauritius
According to the latest WHO data published in 2017, Bladder Cancer Deaths in Mauritius
reached 19 or 0.21% of total deaths. The age adjusted Death Rate is 1.30 per 100,000 of
population Mauritius is ranked #134 in the world.
Bladder cancer is the 45th most common cancer in Mauritius.
Bladder Cancer Prevention
Bladder cancer typically affects older adults, though it can occur at any age. The great majority
of bladder cancers are diagnosed at an early stage. When bladder cancer is highly
treatable. However, even early stage bladder cancer is likely to recur.
Risk of Bladder cancer can be reduced by following:
 Stopping smoking: Cigarette smokers are much more likely to get bladder cancer than non-
smokers.
 Avoid exposure to industrial chemicals, such as benzene substances and aryl
amines. Occupational exposure from working with dyes, rubbers, textiles, paints, leathers,
and chemicals raises the risk for bladder cancer.
 Avoid exposure to arsenic. Have your drinking water if you think that your water
tested. Drink bottled water if you think that your water is contaminated with arsenic.
 Eat healthy foods. Choose a low-fat, low cholesterol diet that includes plenty of fruits and
vegetables.
 Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-
causing chemicals.

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Bladder Cancer: Symptoms and Signs
 Blood or blood clots in the urine.
 Pain or burning sensation during urination.
 Frequent urination.
 Feeling the need to urinate many times throughout the night.
 Feeling the need to urinate, but not being able to pass urine.
 Lower back pain on 1 side of the body.

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Any facts and/or figures concerning the prevalence of the cancer
Exposures in construction
The figure below shows the estimated number of bladder cancer registrations attributable to
exposures in the construction industry only, as a proportion of total bladder cancer registrations
attributable to occupation. Construction overall accounted for an estimated 106 (13%) of all
occupation attributable bladder cancer registrations in 2003.

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Exposures by industry/job
The figure below shows those industry categories from CAREX and the CoE, and job categories
from the LFS, which accounted for the highest numbers of workers exposed during the period
1955-1994 to an occupational bladder cancer carcinogen. Construction workers and those
employed in land transport and personal and household services were exposed to PAHs and
diesel engine exhaust, the other occupations all had single exposures, as indicated the figure.
Industry /Occupation classes with over 150,000 everexposed 1955-1994

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The table below shows: Number everexposedto an occupational carcinogen for bladder
cancer in the period 1955-1994, and attributable registrations and by level of exposure.
Substances considered in the estimation of the attributable fraction for bladder cancer.

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Exposure to mineral oils made the largest contribution to the overall burden due to occupation
for bladder cancer, followed by exposure to diesel engine exhaust and work as a painter. Large
numbers of workers were exposed during the period 1955-1994 to occupational bladder cancer
carcinogens; including mineral oils in metal work production, involving tool operators and
machine fitters; and polycyclic aromatic hydrocarbons (PAHs) and diesel engine exhaust (DEE)
in construction, and employment in land transport and personal and household services.
Tobacco smoking and occupational exposure to aromatic amines are the two major established
environmental risk factors for bladder cancer. Substantial epidemiological evidence supports a
relationship between bladder cancer and cigarette smoking.

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Aromatic amines are formed as combustion products and are present in both mainstream and side
stream tobacco smoke, and so tobacco smoke is the most common and widespread source of
exposure to aromatic amines.
Environmental factors, in addition to tobacco smoke, that are suspected of playing an important
role in the development of bladder cancer include the presence of arsenic and disinfection by-
products in drinking water, fluid intake, dietary factors (coffee and alcohol intake, artificial
sweeteners), drugs (analgesics, cyclophosphamide), hair dyes and a number of urologic
conditions (Silverman et al., 2006)
Occupations in which PAH exposure is associated with an excess bladder cancer risk include
painters, machinists, aluminum processing, other metal workers, workers in the textile industry,
leather workers and shoemakers, printers, hairdressers and transport workers (Kogevinas et al.,
2003). A number of epidemiological studies have documented an increased risk of bladder
cancer among workers exposed to petrochemicals and combustion products in different
industries suggesting an association with PAHs, their nitro-derivatives as well as diesel exhausts
(Siemiatycki et al., 2004; Pirastu et al., 1996).
Approximately 3000 million tons of petroleum fuels, solvents, lubricants, bitumen and other
products are produced annually from crude oil. Process operators and maintenance workers may
be exposed to several substances, which occur in crude oil, process streams, intermediates,
catalysts, additives and final products
The associations between paint components and PAHs and risk of bladder cancer were most
pronounced for current smokers…...

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Reference :
1. http://www.hse.gov.uk/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071204/
3. http://laser-prostate-robot.co.uk/bladder-cancer/epidemiology/modifiable-risk-factors-for-
bladder-cancer/
4. https://health.clevelandclinic.org/bladder-cancer-your-personal-risk-and-how-to-
reduce-it/
5. http://www.islandinfo.mu/health-tips/bladder-cancer-prevention-291.html)
6. https://www.mayoclinic.org/diseases-conditions/bladder-cancer/symptoms-causes/syc-
20356104
7. https://www.cancer.net/cancer-types/bladder-cancer/stages-and-grades
8. https://www.doereport.com/generateexhibit.php?ID=13494&ExhibitKeywordsRaw=&TL
=&A=
9. https://www.sciencedirect.com/science/article/pii/0091743576900426

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