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Friday, 19 Oct 2018

Bladder cancer

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What is bladder cancer?

Bladder cancer is abnormal growth of the cells that line the inside of the bladder. The growth is often referred to as a bladder tumor.
A bladder tumor may be either invasive and grow into the muscular wall of the bladder, or it may be noninvasive (superficial). A superficial tumor is usually small and has not yet grown into the bladder wall. When a bladder tumor is invasive, the cancer cells advance into the bladder wall and then can potentially spread to other organs through the bloodstream and lymphatic system.
Bladder cancer affects men more often than women and is most likely to occur in Caucasian men over the age of 50.
In most cases, bladder tumors occur after the cells lining the urinary tract have been exposed to cancer-causing chemicals in the urine for many years. Chemicals in the urine can come from:

  • Cigarette smoking
  • The workplace, such as from rubber, aniline dye, textiles, and, rarely, hairdressing supplies. Leather workers, rubber workers, painters, dry cleaners, truck drivers, and aluminum workers are at increased risk. If you are exposed to any of these chemicals and are a smoker, your risk increases greatly.
  • Overuse of pain medicines that contain phenacetin. Fortunately, these medicines are no longer available in the US.


What are the symptoms and signs?

Symptoms and signs of bladder cancer are:

  • blood in the urine
  • pain when you urinate
  • frequent need to urinate
  • trouble starting to urinate
  • lower back pain.


How is it diagnosed?

The urine tested to check for blood and for abnormal cells in the urine.
Evaluation of the bladder is by a fiberoptic procedure called cystoscopy. During this exam your doctor passes a slim, flexible, fiberoptic instrument called a cystoscope through the urethra and into the bladder to look inside your bladder. Additionally, a biopsy may be performed in order to examine the bladder tumor to see if it is cancerous.
You may also have the following X-rays or scans:

  • CT scan of your abdomen
  • ultrasound of the kidneys.


How is it treated?

Treatment of a bladder cancer depends first on whether it is invasive. If it is found early and is noninvasive, resection of the tumor can be curative. For more extensive tumors, BCG immunotherapy may be required post-operatively and is performed in the office as an outpatient.
Large tumors that have grown into the muscle of the bladder wall must be surgically removed. Sometimes all or part of the bladder is removed. This type of surgery is called a cystectomy. If cystectomy is required, your surgeon will divert the urine into a neo-bladder or ileal conduit. Other treatments for invasive tumors include radiation therapy to the bladder and/or chemotherapy to help destroy cancer cells that may have spread beyond the bladder.
The probability of cure is very good for superficial bladder cancer. Regular cystoscopic exams and urine studies are then required for surveillance because the tumors often recur.