About The Bladder
The urinary bladder sits on the pelvic floor. It is a hollow muscular and distensible organ that collects urine excreted by the kidneys before being disposed via the urethra.
What Is Bladder Cancer?
Bladder cancer is a type of cancer arising from the inner lining of the bladder. The most common type of bladder cancer is known as Transitional Cell Carcinoma.
The most common symptom is blood in the urine, also known as hematuria. Hematuria occurs in 80 to 90% of patients with bladder cancer. Hematuria can be visible to the naked eye (macroscopic hematuria) or detectable only by a microscope (microscopic hematuria).
Other symptoms include:
- Frequent urination
- Pain during urination
- Feeling of wanting to urinate without being able to do so.
Risk Factors For Bladder Cancer
- Tobacco smoking is the main cause of bladder cancer. The more and longer a person smokes the greater the risk.
- Occupational and environmental exposure to cancer causing chemicals.
This is a procedure where a flexible camera is introduced into the bladder to assess the inner lining of the bladder. This is the most reliable way of diagnosing bladder cancer.
To find out more about Flexible Cystoscopy (Male) Click Here.
To find out more about Flexible Cystoscopy (Female) Click Here.
This is where urine samples are taken to check for cancer cells shed in the urine. A negative result does not reliably exclude bladder cancer.
Stages Of Bladder Cancer
The different stages of bladder cancer are:
This is where the cancer is in the lining of the bladder and has not progressed deeper into the bladder muscle.
Carcinoma Insitu (CIS)
This is an aggressive variant of superficial bladder cancer that can progress deeper if left untreated.
This is where the cancer has grown into the muscles of the bladder wall or beyond.
Treatment of bladder cancer depends on stage of the cancer.
This is where the bladder cancer is “Shaved off” or resected using an electrocautery device. This procedure is called Trans Urethral Resection of Bladder Tumour (TURBT).
The specimen obtained is analysed under a microscope to assess depth of invasion. If it is confirmed to be superficial the TURBT is in itself curative.
However, patients will require regular surveillance of the bladder by cystoscopy to check for possible future recurrence.
To find out more about TURBT Click Here.
In cases of CIS or recurrent superficial TCC the recurrence and progression of TCC can be reduced by administering a medication called Bacillus Calmette-Guerin (BCG).
BCG is a vaccine against tuberculosis that is prepared from a weakened bacteria called Mycobacterium Bovis.
When this is administered into the bladder it stimulates the body’s immune system to kill any cancer cells hence reducing the chances of it coming back or growing deeper into the bladder.
Muscle invasive stage
In such cases the treatment is called Radical cystectomy.
This is where the entire bladder and nearby organs are removed with the lymph nodes that are located in the vicinity of the bladder.
Once this is done the ureters from the kidney are attached to a section of the small bowel which serves as a conduit for the urine. A small part of the conduit called stoma is brought out on to the abdominal wall, and a urinary bag is placed around this to collect the urine.
In other situations it is possible to use a section of the small bowel to form a continent reservoir for urine that is located inside the abdomen and is attached to the urethra. This is called a neobladder. Such patients empty the reservoir using a catheter.
This needs to be done several times in a day. A radical cystectomy may also be needed in patients who have recurrent superficial bladder cancer despite undergoing BCG treatment.
It is possible that some patients may require radiotherapy and/or chemotherapy after a radical cystectomy if the lymph nodes or other organs are involved with cancer.
To find out more about Radical Cystectomy Click Here.