Bladder cancer is a type of cancer that begins in your bladder — a balloon-shaped organ in your pelvic area that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age.
The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests to look for bladder cancer recurrence for years after treatment.
Signs & Symptoms
- Blood in urine
- Pain and/or burning during urination (dysuria)
- Frequency, urgency
These symptoms are non-specific and may be linked with other conditions that are unrelated to cancer. Urinary bladder cancer often causes no symptoms until it reaches an advanced stage. If you experience, any of these symptoms, you must see the doctor immediately.
Staging:
- Stage CIS: Flat cancer limited to the innermost lining of the bladder. It is high grade.
- Stage T1: Cancer penetrated into the submucosal tissue.
- Stage T2: Cancer penetrated the muscular bladder wall.
- Stage T3: Cancer penetrated through muscular bladder wall into the surrounding fat.
- Stage T4: Cancer penetrated into the adjacent structures (prostate, uterus, or vagina). Regional lymph nodes not involved yet.
- Stage T1-4N1-2M1-2: Cancer spread out of abdomen/pelvic wall to lymph nodes or distant organs like liver, lungs, or bones.
Diagnosis
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.
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There are three
main modalities 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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