Bladder cancer is a malignant tumor of the bladder which is the organ that holds urine. Most bladder cancers are a subtype called transitional cell carcinoma which is a tumor that springs from the lining of the bladder.
For many patients who have bladder cancer, the origin of the cancer is unclear. Risk factors include cigarette smoking, recurrent urinary infections, and chronic indwelling Foley catheter as well as exposure to aniline dyes.
Often bladder tumors are asymptomatic. Most cancers are discovered because of blood in the urine. This symptom will often necessitate visit to the doctor’s office and a referral to urologist. The blood in urine is evaluated with a cystoscopy, which is a test that entails looking inside the penis of the telescope when bladder cancer can be detected. Sometime patients with overactive bladder symptoms such as urinary urgency and frequency may also be harboring a cancer.
Usually it is found with a cystoscopy done in the office. Occasionally abnormal cells are seen in the urine (urine cytology) which necessitates a cystoscopy.
For the patients who do have bladder cancer, at the time of the cystoscopy confirmation of the cancer can be made with the small biopsy. Occasionally, if the tumors are very small, the biopsy itself will also be a treatment for the bladder cancer.
If the tumor is larger than the patient may need an additional workup which entails a CAT scan of the kidney and the bladder to confirm that the tumor is localized. In addition to this, the patients may need additional surgery at the hospital for further evaluation of the tumor. The most common surgery at the hospital, which is usually done under some form of anesthesia what called a transurethral resection of the bladder tumor (TURBT).
Transurethral resection of a bladder tumor (TUBRT) is done by placing a scope through the urethra of the penis and then resecting the tumor with special instruments. In addition to treating the tumor, this also permits better staging of the tumor.
We evaluate the pathology – that is what the tumor looked like under the microscope. This will tell us if the tumor is malignant, whether it is invading into the muscle and how high a grade the tumor is. This means what the cells look like and if they look particularly aggressive.
If the tumor is low grade, does not appear to be invasive, and is completely resected with the TURBT, then patients will typically require cystoscopy every three months for two years, then every six months for two years, and annually thereafter.
In tumors that appear to be high grade but not invading the muscle, the patients may be offered a second repeat TURBT to confirm that the entire tumor is resected. If this is the case, patients may also be offered the option of having chemotherapeutic agent placed into the bladder such as BCG that prevents the recurrence of cancer. If a high grade, non-invasive tumor recurs then treating that tumor as if it were invasive may be the best option.
If the tumor is invasive, invading into the muscle of the bladder, and the patient is otherwise in good health, the best option may be to completely remove the bladder by performing an operation called a radical cystectomy. In addition to removal of the bladder, the surgery entails removal of lymph nodes around the bladder. For men, often times the prostate is also removed.
Once this is removed, then either a new bladder can be created using intestine or the urine can be diverted through segment of intestine out into the abdomen in a surgery called an ileal conduit.
Although the surgery is big operation, bladder cancers are very aggressive tumors. The surgery typically offers high cure rate, which makes it worthwhile for most patients. In patients who do have aggressive tumors, chemotherapy before or after surgery, may be an option to increase the chances of cure.
Once patients undergo the surgery and have recovered from the operation, those with bladder cancer will often need to be monitored closely, typically with a cystoscopy and/or imaging and urine test, to confirm that the cancer has not recurred.
Although, bladder cancer can be aggressive and therefore require aggressive treatment, cure rates for most patients are very high and patients do well with the surgical treatment options that are available.
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