Bladder Cancer

About Bladder Cancer

Bladder cancer is the second most common urological cancer.  It arises from the cells that line the bladder, which is a bag-shaped organ inside the pelvis.  The bladder’s function is to store urine produced by kidneys.  There are three different types of bladder cancer – these include transitional cell carcinoma or TCC, squamous cell carcinoma, and adenocarcinoma.  Transitional cell carcinoma is the most common form of bladder cancer in the United States. Squamous cell carcinoma tends to occur in inflamed or irritated bladders, such as in patients with chronic bladder infections.  Adenocarcinoma is a cancer of mucinous secreting glands at the dome of the bladder, and is the rarest form of bladder cancer in the United States. Bladder cancer is much more common in adults, and is very rare in children.  Luckily for most patients, this type of cancer is usually diagnosed early, which presents the patient with promising treatment options at an early stage.  Symptoms that may lead to early detection include blood in the urine or hematuria, frequent urination, painful or burning urination (dysuria), and pain in the lower abdomen or lower back area. 

Risk Factors

Certain predispositions can make one more likely to develop cancer of the bladder.  Possible risk factors include cigarette smoking, exposure to certain chemicals such printing dyes, chemotherapy and radiation treatment, chronic bladder inflammation and infections, and a history of cancer in the family.  Older individuals and men are also more likely to develop this cancer.  Because of the seriousness of this condition, everyone should seek medical attention if they ever notice blood in the urine.

Bladder Cancer Diagnosing

If a doctor suspects bladder cancer, he or she may run a series of tests to diagnose the patient.  The first step is collecting the urine for a microscopic examination to identify the presence of cancerous cells, for a test which is called urinary cytology examination.  The next step is obtaining a sonogram or CT-Scan and then lastly a cystoscopy is performed, where the physician will use a very small camera to examine the inside of the urethra and urinary bladder.  The small scope that is inserted into the urethra allows the doctor to view any areas that may be abnormal and perhaps perform a biopsy of suspicious areas for further microscopic evaluation.  Anesthetics and occasionally light sedation are commonly administered for this routine procedure.
   
Imaging tests such as the CT scan may be used for further investigation of the bladder and the upper urinary tract such as kidneys and ureters which connect the kidneys to the bladder. 

Bladder Cancer Treatment

If bladder cancer is diagnosed, the patient then undergoes a more advanced endoscopic procedure called TURBT (transurethral resection of bladder tumor) under general anesthesia. TURBT is a surgical procedure in which surgeons use a small wire tool to excise or burn and destroy tumor cells with an electric current or high-energy laser.  By doing this procedure, the urologist may be able to shave off some or possibly the entire tumor from the bladder wall.  The tumor specimens then will be submitted for pathological evaluation.  A pathologist then examines the tumor cells under a microscope and assesses the aggressiveness of the tumor cells (grade of the cancer) and the stage of the cancer (the depth of penetration through the bladder wall). Based on convention, bladder cancer has four stages, stage 1, when the tumor is small, superficial and not invasive to stage 4 when the tumor is aggressive and has most likely spread to the surrounding bladder tissues and possibly extended to the lymph nodes.  Any further treatment will be based on the pathological grade and stage of the disease. 

Treatment for cancer of the bladder depends on a number of factors, ranging from the health of the patient to severity of the tumor.  Sometimes when the tumor is superficial, using the TURBT procedure alone, the entire tumor can be removed from the bladder and the cancer thus treated.  However, it should be noted that often, the TURBT procedure will have to be repeated several times to remove any new recurring cancerous tissue that may form.  The urologist may also regularly and periodically check a patient’s urine for the presence of cancer in the urine.

 If the cancer is high grade or invasive, the patient may have to undergo surgical resection (removal) of the tumor and a portion of the bladder (partial cystectomy).  This is usually performed if the cancer is located in a section of the bladder that can be removed without permanently harming the function of the remaining part of the organ.  During this procedure, an incision is made in the abdomen, and the patient will be placed under general anesthesia. The patient will usually be observed in the hospital for 3 to 5 days after the surgery. 
   
For cases in which the cancer has spread to the deeper layers of the bladder wall, the urologic surgeon may need to remove the entire bladder, and design a new way for the body to expel urine which is called Urinary Diversion.  This is more extensive surgery and there are several forms of urinary diversions which can be created based on the patient’s medical condition and the extent of the cancer. 

Some patients may be treated with chemotherapy and radiation before or after this surgery.

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