Diseases / Bladder Cancer

Cancer of the bladder
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Bladder cancer is a malignant cancerous growth occurring in the urinary bladder which is the storage organ for urine before the urine is passed out through the urethra. Majority of the bladder cancers (around 70%) are called superficial cancers which means they are confined to the inner most lining of the bladder. The remaining of the bladder cancers has potential to invade the depth of the bladder muscles and also spread to the other organs and cause harm.

Symptoms of Bladder Cancer

Bladder cancers can present with passing blood in the urine. Other symptoms like frequent urination and irritation when passing urine maybe also symptoms of bladder cancer. Bladder cancers can also present without any particular symptoms related to urination but can present with symptoms of spread out cancer though this is  not common.

Treatments Available

How are the Bladder Cancers diagnosed?

When there is a suspicion of bladder cancer particularly if someone presents with symptoms of blood in the urine either visible or non-visible or unexplained urinary symptoms, the following tests will be recommended
1. A bladder examination with a camera. This is usually a quick examination of the bladder with a flexible camera (flexible cystoscopy) to examine the whole of the bladder. This is will detect any tumour or suspicious changes in the bladder.
2. Ultrasound scan of the kidneys – This scan will help to identify any other causes for bleeding in the kidneys and any obstruction to the kidneys caused y the bladder cancer
3. Contrast CT scan of the urinary tract. This CT scan involves and injection of x-ray contrast through the vein which will show up in the kidneys and while  this contrast pass down through the urine will line the tubes coming from the kidney (ureter). This will help to detect any blockage to the tubes coming from the kidney or any growths in the tubes coming from the kidney all the way up to the kidney. Since the lining of the bladder (Transitional cell epithelium)  is same as the lining of the tube coming from the kidney, cancers similar to bladder cancers can occur in the tubes coming from the kidney.

Treatment Options

If they are low risk cancer or less aggressive variety of cancers, they can be treated by removing them through an endoscope. This operation is called Transurethral resection of bladder tumour (TURBT). This is done as a day case or may need one day of hospitalisation. There will be a brief period of a catheter being placed in the bladder which would be helpful to continuously wash (irrigate)  the bladder for a few hours. Generally, there will be a single dose of administration of a chemotherapy type medication called Mitomycin or Epiruicin into the bladder to kill the bladder cells released at the time of the operation. All being well the patient may be discharged on the same day of the operation or the following day. More aggressive bladder cancers will need treatment depending on the depth of invasion into the bladder muscle. If the microscopic analysis of the tissue taken from the bladder shows spreading of the bladder cancer to the depth of the bladder muscle, then this would be treated by Radical radiotherapy to kill all the cancer in the bladder muscle or by complete removal of the bladder. If the bladder is removed the urine has to be diverted with the help of a stoma using a piece of bowl called urinary conduit or creation of a new bladder using segments of the bowel. Such new bladder may not function to expel urine completely and  this has to be helped by using self-catheterisation. More aggressive superficial cancers can be also treated by bladder preserving treatment options such as introducing some medications like BCG into the bladder. This would be given on a weekly basis for 6 weeks and the bladder will be re-examined after the treatment. If the treatment is working, then the treatment can be given on a maintenance dose of 3 doses per every 6 months for up to 3 years though usually it’s given up to a year.