The bladder is that part of the urinary tract that stores urine until the person is ready to pass urine. Urine is produced by the kidneys. Urine travels from the kidney down a narrow tube, the ureter, and is stored in balloon-like muscular organ, the bladder. Urine is discharged through the urethra during urination.
The inside, or inner lining, of the bladder is called urothelium. Next to this is a layer of loose connective tissue called the lamina propria. Deeper to this is the bladder muscle and the outer most layer is fat (as shown in the figure). Occasionally, if these urothelial cells start to multiply uncontrollably a new growth or tumour starts. When found and treated in the early stages, bladder cancers are not likely to be life threatening. In addition, treatment of most of these tumors does not require removal of the bladder. Prompt medical attention and regular checkups are necessary to treat bladder tumors and to watch for new growths.
It is 9th most common cancer worldwide. The median age of bladder cancer diagnosis is 70 years.
Bladder cancer is unusual in people under 40 years of age. Men are affected 3 to 4 times more often than women, and cigarette smokers have an increased risk of developing bladder cancer. Exposure to certain industrial chemicals (paints and aromatic amines) in the workplace also has been associated with an increased risk of developing bladder cancer.
The earliest clue of bladder tumour is the presence of blood in your urine. Blood in the urine is usually not accompanied by pain, for those with bladder cancer. Sometimes you may not see the blood in urine and it can be seen only under a microscope. People with kidney stones or urinary tract infections and men with enlarged prostate glands may also have blood in their urine. Blood in urine is a potential warning sign of cancer and should not be ignored. Other symptoms include frequent urination or burning urination in the absence of urinary infection.
Your doctor will perform further tests after physical examination. These tests may include urine analysis, urine cytology (to look for cancer cells that may have been shed into the urine from the bladder lining), ultrasound study of the abdomen, contrast CT (computed tomography) of the abdomen. CT will tell if there are other similar lesions in the kidneys and ureter. In addition to the bladder details, CT also tells us involvement of surrounding organs. In most of the cases cystoscopic examination under anesthesia (medication that puts you to sleep) is mandatory. All of the tests above may be performed by an urologist without requiring you to stay overnight in a hospital. Cystoscopy In cystoscopy, an endoscope (cystoscope) is inserted gently into the urethra and passed into the bladder to directly view the inside of the bladder lining. This is done under I.V. sedation. If any tumor is found you will be rescheduled for resection biopsy (TUR-BT i.e., Transurethral resection of bladder tumor) under spinal or general anesthesia. Based on the biopsy report, further treatment plan would be discussed with you.
The treatment for bladder cancer depends on how deeply the tumour has grown into the bladder wall. The growth may be superficial, i.e., it is confined to urothelium and lamina propria, or deep muscle invasive, if it involves the bladder muscle. Also the size, location and number of tumors are noted. During resection both the superficial and deep tissues are sent separately for biopsy testing. The biopsy report also gives the grade of tumor (either low or high grade). With all these clinical details, along with age, co-morbidities, performance score your doctor will decide on further treatment.
If the doctor believes that you are likely to develop new cancer (recurrence), you may be advised to undergo additional treatments like having medications instilled into the bladder (refer to BCG brochure). Some bladder cancers are muscle invasive. In such cases, the urologist may recommend that the bladder be completely removed and urine will be diverted by one of the several methods. This operation is called a cystectomy. The doctor may also recommend additional treatment with radiation and chemotherapy drugs. Regular follow up is required because bladder cancers often recur, especially within the first year or two after discovery of the first cancer. Because tumours can recur, it is important for the urologist to do Cystocopy and cytology regularly.
Smoking cessation, increased fluid intake, and a low-fat diet may all reduce the risk of recurrence. Second, is by regular follow-up visits and cystoscopy as advised by your doctor. Third, is by medications instilled into the bladder.