Clinical Condition

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Bladder cancer

Bladder cancer arises from epithelial lining of the urinary bladder. Rarely bladder tumour can develop from the wall of the bladder.

Who can have bladder cancer?

Bladder cancer usually develops in old age with 6th and 7th decade being the most common age group. Males are twice as commonly affected as females. Individual with family history of bladder cancer are more likely to have this disease.

What causes bladder cancer?

Smoking creates the greatest risk for bladder cancer

Chronic urinary infection, kidney and bladder stones, and chronic bladder infections tend to raise the risk of bladder cancer. Environmental factors, such as arsenic in drinking water, and chemicals involved in specific occupations increase risks. The cancer is seen more frequently in hairdressers, machinists, printers, painters, truck drivers and people who work in rubber, chemical, textile, metal and leather industries.

How do I know that I have bladder cancer?

Blood in the urine (hematuria) is one of the symptoms of bladder cancer. It may be gross hematuria (visible to the naked eye) or visible only under a microscope. Other symptoms include frequent urination or pain upon urination. Flank pain is also a symptom of bladder cancer.

These symptoms can appear with a host of illnesses such as urinary tract infections, benign tumors, bladder stones and others in addition to bladder cancer.

In advanced disease with spread of cancer to other organs patient can have

Tiredness

Loss of appetite and/or weight

Low-grade fever

Pain in the side

Bone pain

A general sense of not feeling well

How the bladder cancer is diagnosed?

A diagnosis of bladder cancer begins with a discussion of the patient’s medical history. This is followed by a physical exam in which the doctor will feel the abdomen and pelvis for any physical signs bladder cancer tumors. The doctor may also include a rectal or vaginal exam.

Urine examination-for blood in urine and cancerous cells in urine

Blood tests

Ultrasound examination

Computerised tomography (CT Scan)-for presence of tumour in the bladder as well as spread of tumour in to the surrounding organs and to the other organs in the abdomen.

Cystoscopy and biopsy of tumour-A thin metallic scope is passed through the urethra to inspect the inside of the bladder and part of the tumour or whole tumour is removed for pathological examination.

Chest X-ray-to detect spread of tumour to the lung.

What are the types of bladder cancer?

Bladder cancers are characterized by type, stage and grade. This characterization will help determine the therapy that is most likely to be successful.

Transitional cell (urothelial) carcinoma

Transitional cell (urothelial) carcinoma has its origins in the transitional cells that line the bladder. These cells are also found in kidneys, ureters, and the urethra. About 90 percent of bladder cancers are transitional cell carcinoma.

Squamous cell carcinoma

Squamous cell carcinoma begins in thin flat cells that can be found throughout the body including the bladder. About 6 to 8 percent of bladder cancers are squamous cell cancers. Adenocarcinoma- Adenocarcinoma begins in glandular cells in other body organs and spreads to the bladder. Adenocarcinomas account for about 2% of bladder cancers.

What are the stages of bladder cancer?

Bladder tumors may take different forms. Superficial urothelial tumors may or may not be invasive. They seldom spread deeply into the bladder wall. Papillary urothelial tumors are slender projections resembling the arm of a cactus that grow from the bladder wall toward the center of the bladder. Those that grow only toward the center are called noninvasive papillary urothelial tumors. Papillomas are benign (non-threatening) urothelial tumors, the removal of which can usually be accommodated by simple surgical procedures such as transurethral resection of the bladder (TURB). These tumors can recur in the bladder or elsewhere in the urinary tract.

Patients who have experienced the removal of papillomas undergo re-examinations at regular intervals to check for recurrence. Papillary urothelial carcinoma is an abnormal papillary tumor. Its cells have irregular sizes, shapes and arrangements. When these abnormalities are slight, the tumor is called “low grade.” They seldom invade the bladder wall but often return following removal. The risk of bladder wall invasion is greater when cells in these tumors show greater abnormal characteristics. Flat urothelial tumors (carcinoma in situ or CIS) affect only the cells in the interior bladder lining. In the great majority of instances, these cancers are limited to the lining. When they invade the muscle layer they are called flat invasive urothelial carcinomas.

Once the bladder tumour invades the muscle layer , chance of spread of tumour to the surrounding tissue and distant organs increases. Bladder tumour can spread into distant organs like lung, liver and bones.

What is the treatment for bladder cancer?

Treatment of bladder cancer depends on the stage of tumour. There are 4 main treatment modalities available which include surgery, chemotherapy radiotherapy and intravesical therapy. Sometimes combination of different modalities are used.

Surgery

Transurethral resection of bladder tumour(TURBT)-people with small tumours and early stage tumours are treated by TURBT. This involves passing small metallic tubes with scope through urethra and removing cancerous tumour.

Radical cystectomy-entire bladder is removed along with surrounding fatty tissue and lymph nodes. This is done when the tumour invades the muscle wall of the bladder. After removal of bladder, there are two options for passing the urine. First, an artificial bladder is created using the intestines enabling the patient to pass urine through urethra. Second, a small urinary passage is created to the right lower abdomen over which a plastic appliance is worn all the time for collection of urine and is emptied frequently.

Partial cystectomy-only the portion of invasive bladder tumour is removed, thus preserving most of the bladder. This option is rarely considered and usually tumour is single involving only the part of the bladder, especially dome. This modality is mostly combine with chemotherapy, radiotherapy or both

Intravesical therapy

In this modality different chemotherapeutic agents and biological agents are introduced into the bladder and kept for a period of one hour. It is usually done after removal of small tumour by TURBT and these tumours doesn’t invade the muscle layer of bladder. Intravesical therapy treats small tumours, both macroscopic and microscopic. It has the added advantage of preventing the recurrence. It reduces the recurrence by 25-50%.

Chemotherapy

Different chemical agents are administered by intravenous route or oral route for treatment of malignancy. These agents attack rapidly dividing cells which are mostly cancerous cells. Chemotherapy is used alone or in combination with surgery or radiotherapy. Chemotherapy is usually reserved for advanced stage of cancer. In stage III it is used to facilitate surgery or in stage IV for palliation of symptoms. In some patients it is used after surgery depending on the biopsy report.

Radiotherapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

How do I pass urine after removal of bladder?

Several options are available to the patient who has lost a bladder. In a procedure called urostomy, a segment of intestine is removed and reattached to the ureters. This leads urine from the kidneys an opening (stoma) near the belly button. A light, leak proof bag is attached to the stoma to collect urine. The bag can be emptied as needed.

A segment of intestine can also be formed into a small pouch or a larger “neobladder.” The pouch or bladder is placed in the cavity left by the bladder and stores urine. A conduit, again made from intestine, leads to a stoma in the abdomen but in this instance a valve allows the pouch to be drained whenever he or she wishes. No bags are involved. The neobladder may be attached to the urethra to allow urine to be drained normally. The application of these procedures is dependant upon a number of factors. They are not available to all patients but these bladder cancer treatments can be successfully implemented in many.

Are all bladder cancers lethal?

No. As with any malignancy if the cancer is diagnosed early , bladder cancers are curable. It is important to consult the doctor at the earliest if you the symptoms of bladder cancer which is mentioned earlier.

Can bladder cancer be prevented?

Try to avoid environmental factors, such as arsenic in drinking water, and chemicals involved in specific occupations (for example, hairdressers, machinists, printers, painters, truck drivers and people who work in rubber, chemical, textile, metal and leather industries). Also, do not smoke.

CARE OFFERED FOR BLADDER

We treat all range of bladder pathologies which includes

  1. Cystitis-bladder infection
  2. Bladder stones
  3. Bladder cancer
  4. Neurogenic bladder-Abnormal bladder dynamics because of some neurological conditions like stroke, parkinsonism, spinal conditions like disc proapse.
  5. Interstitial cystitis.

We are equipped with latest technology in treating these bladder pathologies. Most of the conditions are managed by Endourological procedures with LASER as energy source. We also perform bladder reconstructive procedures laparoscopically.

For details about individual condition, refer to our section on clinical conditions.