The urinary
bladder is a hollow sac like organ situated in the pelvis. Its major function
is to store the
urine produced
by the kidneys before finally emptying it. Uncontrolled proliferation of normal
cells lining the bladder wall can lead to cancer.
Though the exact
cause of bladder cancer is unknown, there are certain well recognized risk
factors. Smoking is one of the most important risk factors, and smokers have
twice the risk of developing bladder cancer than non-smokers. People exposed to
certain chemicals like aromatic amines. which are especially used in dyeing,
rubber, leather and textile industries are also at increased risk if proper
precautions are not taken. Chronic irritation of the bladder wall due to any cause
can also lead to bladder cancer.
Symptoms
Some of the
common symptoms of bladder cancer are haematuria and recurrent urinary tract
infection. However, it is important to realize that most of the early cancers
may be totally asymptomatic. A patient with these symptoms should consult his
doctor if the symptoms persist for more than two weeks.
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The mainstay of
diagnosis is a cystoscopy and biopsy where a long tubular instrument is
inserted into the urinary bladder and the entire bladder lining is inspected.
If any tumour is seen, the urologist tries to resect as much tumour as
possible. Any abnormal looking tissue is taken for biopsy and sent to the
pathologist for examination under a microscope. The pathologist will confirm
any cancer if present, and the depth of penetration into the wall of the urinary
bladder. Some of the other tests that the patient may have to undergo for
diagnosis and staging are: urine for cytology, ultrasound, CT/MRI scan, and sometimes
PET-CT and bone scan, if indicated.
The purpose of
doing these tests is to find out the stage of the cancer as the prognosis and
treatment depends upon the stage. Broadly speaking, there are four stages
depending upon how deep the cancer has penetrated into the bladder wall, and
whether it has spread into other structures outside the bladder like lymph nodes,
bone, liver etc.
Treatment
There are three
main modalities of treatment of treatment - surgery, radiotherapy, and
chemotherapy, either alone or in combination. In very early bladder cancers
limited to the superficial layer of the bladder wall, immunological therapy is
used where the patient comes in for multiple sessions of a drug being instilled
into the bladder.
* Surgery is one
of the most widely used treatments. In most of the locally advanced tumours,
the surgery is called radical cystectomy where the entire bladder and some
adjoining structures are also removed. This operation requires some form of
urinary diversion for the urine to come out through a new pathway. In certain
less advanced tumours, a partial cystectomy may be sufficient where only a part
of the bladder will be removed.
* Radiotherapy
alone or in combination with chemotherapy is an alternative to surgery where
the patient wants to conserve his bladder. Radiotherapy is the use of high
energy X-rays which are focused on the area to be treated without affecting the
tolerance of surrounding normal structures. Today, there are a number of
sophisticated treatment techniques like IMRT, IGRT etc. To achieve this aim
using state of art linear accelerators.
* Chemotherapy
is the use of medicines given intravenously and is called systemic treatment as
it can kill cancer cells anywhere in the body.
Appropriate
treatment in a good multidisciplinary hospital can result in curing more than
50 per cent of patients. If the cancer is diagnosed at an early stage, the
results are much better.
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