Bladder Cancer Overview

In the United States There are more than 67,000 new cases and approximately 13,700 deaths related to bladder cancer each year. Bladder cancer is the fourth most common cancer among men. It is less common among women, with a ration of 3:1(men: women). The incidence of bladder cancer increases with age.

The Bladder is a hollow organ positioned in the lower abdomen. It primarily collects and stores urine produced by the kidneys. As the bladder fills with urine, it expands increasing in size. On reaching its capacity of urine voluntary contraction allows the urine to be expelled from the bladder. The urine flows through a narrow tube called the urethra, leaving the body.
Types of cancers
The bladder walls are formed of different cells. Cells lining the internal walls are most likely to develop cancer. Bladder cancers are classified by how deep they invade the bladder wall. Physicians tend to classify bladder cancer as superficial or invasive. Resulting bladder cancers are named after their cell types
  • Urothelial carcinomas – Also known as transitional cell carcinoma is the most common type of bladder cancer in the United States. It accounts for more than 90% of bladder cancers. These transitional cells are cells forming the innermost lining of the bladder wall. In transitional cell carcinoma these cells undergo changes, metastasizing.
     
  • Squamous cell carcinomas – These are less common, occurring in patients with chronic mucosal irritation (bladder inflammation). The inflammation may have occurred many months/years prior. These cancer types are invasive.
     
  • Adenocarcinomas – These cancers result from cells that compose the glands. Most adenocarcinomas are also invasive and usually detected after they have already invaded the bladder wall.
Symptoms
  • Unexplained hematuria (blood in urine)
  • Frequent urge to urinate (burning sensation)
  • Pelvic pain
  • Low back pain

 Risk Factors

  • Smoking – is the most common risk factor, causing more than 50% of all new cases
  • Exposure to chemicals in the work place
  • Analgesic abuse (Phenacetin) – Pain and discomfort are mostly treated with (OTC) over the counter analgesic type medications. Even though these drugs are relatively safe, can cause serious side effects. Phenacetin and products containing phenacetin have been shown in to be carcinogenic.
Diagnosis
Usually, if your physician suspects bladder cancer a urine cytology and cystoscopy with abnormal cell biopsy will be done. A cystoscopy is a test allowing your doctor to view the interior lining of the bladder. The procedure is performed in an outpatient setting administering local or general anesthesia. A rigid or flexible fiberoptic instrument (Cystoscope) is inserted into the urethra and advanced into the bladder. The doctor is able to remove samples (biopsy) of tissue for examination by inserting tiny surgical instruments through the cystoscope. Complications may involve excessive bleeding, UTI and bladder perforation.
Treatment
  1. Transurethral resection: This is a surgical procedure used to diagnose and remove cancerous tissue from the bladder. Superficial cancers are completely removed by transurethral resection. Administration of chemotherapeutic drugs may reduce the risk of recurrence.
  2. Cystectomy: Is the surgical removal of part or the entire bladder. This procedure treats cancer that has penetrated the bladder wall or recurred following previous treatments. Cystectomies are of two categories
    1. Partial Cystectomy is removal of part of the bladder
    2. Radical Cystectomy is removal of the entire bladder and surrounding tissues containing cancer cells
What to expect after Surgery
Generally, Cystectomy requires a hospital stay of up to 7 days. Patients will experience some discomfort which can be minimized with medication. Full recovery may take up to 6-8weeks. Immediately following surgery, once your bladder is removed, your surgeon would have to create a channel for you to void urine from your body. Urinary diversion involves routing urine through an ileal conduit to an abdominal stoma and collecting it in an external drainag
  • An ileal conduit is created from a segment of your intestine connected to a stoma (Opening) in your abdomen. Urine passes from the ureter through the ileal conduit to a plastic bag attached to your body. Content collected on the bag would have to be emptied up to 4 times a day.
     
  • A continent reservoir uses part of your intestine to form a storage pouch attached inside your abdominal cavity. Two types of internal continent reservoirs exist.
     
  • Abdominal diversion reservoir - The reservoir is connected to a continent abdominal stoma. Patients are able to empty the reservoir by self-catheterization at regular intervals throughout the day.
     
  • Orthotopic diversion - The reservoir is connected to the urethra. Patients are able to empty the reservoir by relaxing the pelvic floor muscles and increasing abdominal pressure. The urine passes through the urethra almost naturally. Further treatment may be required following surgery and may include radiation therapy or chemotherapy. Patients unsuited for surgery or if refused, radiation therapy alone or with chemotherapy may provide 5-yr survival rates of 20 to 40%. Patients are monitored 3 to 6 months for progression and recurrence.