Vitamin D helps the body control iron, calcium, magnesium, phosphate and zinc levels. It is a fat-soluble vitamin produced by the body when ultraviolet rays from the sun come into contact with the skin which triggers the synthesis of vitamin D. This vitamin can also be obtained from food sources such as egg yolks and fatty fish.
Vitamin D obtained from sun exposure and food is a biologically inactive and has to undergo two hydroxylation phases (enzyme conversions) in the body in order for it to be activated. The first occurs in the liver where vitamin D is converted to 25-hydroxyvitamin D (calcidiol), and the second phase occurs in the kidneys where the physiologically active 1,25-dihydroxyvitamin D (calcitriol) is formed.
It has been noted that previous clinical studies have discovered an association between vitamin D deficiency and numerous health-related conditions including cognitive impairment, cardiovascular diseases, autoimmune disorders and the development of certain cancers. Individuals who are at risk of developing a vitamin D deficiency include those who live in countries where there's decreased exposure to sunlight, and also due to the fact that it's difficult to obtain enough vitamin D from food alone. People with a darker skin are also more prone to developing a vitamin D deficiency and in the U.K. in winter, up to 75% of these individuals develop a vitamin D deficiency.
Researchers from the University of Warwick in the U.K. decided to investigate if an association existed between vitamin D deficiency and an increased risk of developing bladder cancer.
The study and the findings
The investigators researched the data from seven previous studies, that were conducted on the same topic, which included test subjects ranging from 112 to 1125 individuals in each study. Five out of these seven studies showed a link between low levels of vitamin D and an increased risk of developing bladder cancer.
The researchers then conducted another study that looked at the cells that line the bladder (transitional epithelial cells) and discovered that these cells can actually activate and respond to vitamin D, which results in the stimulation of the immune system. This is an important finding because the immune system can then identify and destroy abnormal cells before they develop into malignant growths, therefore playing an important role in cancer prevention.
Clinical significance
These findings are quite significant as they suggest that healthcare professionals should identify patients who are at high risk for developing a vitamin D deficiency, and that they must be managed appropriately to avoid developing associated health-related conditions such as bladder cancer.
A vitamin D deficiency can be easily treated by suggesting increased sun exposure and consuming foods that contain the vitamin, and if that isn't possible, prescribing vitamin D supplements which are inexpensive and readily available.
The researchers of the study suggested that these findings need to be confirmed by performing further clinical trials though.
Overview Of Bladder Cancer
Although bladder cancer is rare, it is a medical condition that can be severely detrimental to a patient's health. This cancer usually begins on the inner wall of the bladder, affecting the transitional cells that line the wall of this organ.
In the early stages of the disease, bladder cancer can be managed effectively enough. The biggest issue with bladder cancer though is that it recurs easily, therefore these patients need to be followed-up by their healthcare providers regularly.
Risk factors
The cause of bladder cancer is due to DNA damage of the transitional cells which then grow abnormally and form malignant growths on the lining of the organ, but there are certain risk factors that are associated with the development of this disease. They are as follows:
- Advancing age - bladder cancer usually occurs inpatients over 40 years old.
- Caucasian - whites are more likely to develop this cancer.
- Being male.
- Chronic urinary system infections - conditions such as repeated urinary tract infections and cystitis (inflammation of the bladder lining), such as that caused by the parasite schistosomiasis, can increase the risk of developing squamous cell carcinoma of the bladder.
- Having a family history or previous history of bladder cancer.
- Cancers such as hereditary non-polyposis colorectal cancer (Lynch syndrome) can increase the risk of developing cancer in the urinary system, as well as in the ovaries, uterus and colon.
- Smoking - the inner wall of the bladder is exposed to the harmful chemicals found in tobacco products which accumulate in the urine. These chemicals cause damage to the cells of the bladder lining and therefore increases the risk for developing bladder cancer.
- Exposure to harmful substances - exposure to substances such as arsenic and chemicals used in the production of rubbers, dyes, leather, plant products and textiles can also accumulate in the urine and cause damage to the inner wall of the bladder.
- Cancer treatments - exposure to cancer treatments such as cyclophosphamide and radiation therapy used to treat pelvic cancers can also increase the risk of developing bladder cancer.
- Diabetic medication - patients using the drug pioglitazone, or pioglitazone containing medications, for a period longer than a year have an increased chance of being diagnosed with bladder cancer.
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Symptoms
Signs and symptoms of bladder cancer can be non-specific and they can occur in other conditions as well. It's important then that if these issues are experienced, that patients consult their physicians for further assessment and investigations to be performed.
- Haematuria (blood in the urine) - this can be macroscopic where one can see a change in colour of the urine with the naked eye, or it may not be visible and will need microscopic visualization to confirm the presence of blood.
- Painful urination.
- Frequent urination.
- Pelvic pain.
- Back pain.
Complications
Bladder cancer can recur after it has gone into total remission. A specialist physician will then have to follow-up with these patients and perform an internal investigation of the bladder via a procedure called a cystoscopy every 3 to 6 months.
This follow-up process is continued for the first few years after the initial bladder cancer was treated, and will then be continued every year thereafter.