Bladder cancer is the most common type of cancer in older adults especially men compared to women. The urinary bladder is a hollow organ located in the pelvis which stores the urine before expelled. Bladder cancer develops in the cells of the bladder and grows out of control, leads to the development of tumor which may spread to nearby tissues, lymph nodes and other areas. Most of the bladder cancers are diagnosed at an early stage with effective cure but there are high chances of recurrence which may need regular follow ups.
Symptoms of Bladder Cancer
- Frequent urination
- Burning sensation or pain during urination
- Feeling of full bladder
- Difficulty in urination
- Not able to urinate
- Weight loss and loss of appetite
- Feeling weakness and tired all the time
- Foot and ankle swelling
- Pain in the bones
- Urinalysis - Analysis of cells in the urine to detect the cancer cells.
- Cystoscopy- The doctor inserts a cytoscope through the urethra to visualise the lining of urethra and bladder to examine the signs of cancer.
- Biopsy- A small tool will be inserted through the urethra and scrap tissue sample from the bladder is taken to detect the cancer. This procedure called transurethral resection of bladder tumor (TURBT) which can also be used to treat bladder cancer.
- Imaging Tests- Imaging such as CT Urogram or Retrograde Pyelogram to examine the urinary tract. A contrast dye will be injected through the veins which flow through the urinary tract to obtain a clear view through the X ray images to determine the extent of cancer. Retrograde Pyelogram detects the cancer in the upper urinary tract through X- ray Images.
Stages of Bladder Cancer
- Stage 0 - Bladder cancer is within the lining of the bladder and not spread.
- Stage 1 – Bladder cancer has spread out of the lining but not reached the muscle layer of the bladder.
- Stage 2- Bladder cancer which spreads to muscle layer of the bladder.
- Stage 3- Bladder cancer which spreads to adjacent tissues of the bladder.
- Stage 4- Bladder cancer which has spread past to nearby areas in the body.
Treatment options depend on the stage of cancer, extent of tumor migration, overall health and treatment choice of the patient.
The urologist will perform a minimally invasive surgery either to treat or remove the bladder by the following ways:
- Transurethral Resection of Bladder Tumor (TURBT): This is a non-invasive procedure during which the physician uses a scope to remove small tumours and carcinogenic cells from the bladder.
- Cystectomy: This procedure will be done for advanced stage cancers where the bladder will be removed which helps in speedy recovery. After the procedure, a bladder reconstruction surgery will be done to arrange another pathway for urine elimination.
- Partial Cystectomy: A small portion of the bladder will be removed if the cancer is confined to that area. However, with the removal of a portion of the bladder it may become small and need frequent urination.
- Bladder Reconstruction: In the advanced stage of cancer where the bladder is completely removed the surgeon will create a new pathway to expel the urine.
- Ileal Conduit: The surgeon connects a piece of the intestine to the kidneys and creates an opening, called a stoma, at the front of the abdomen. Urine exits the stoma into a urostomy bag.
- Neobladder: In some patients, the surgeon may create a new bladder made from a piece of intestine which does not require a urostomy bag.
- Chemotherapy to the bladder (Intravesical chemotherapy) - The tumours which are confined to the lining of the bladder with high chances of recurrence or can transform to an aggressive type.
- Chemotherapy to the whole body (systemic chemotherapy) – This will be given to the patients where surgery is not an option or the tumor may have spread to the other tissues.
- Radiation- This will be given as a primary treatment using high-frequency X rays to destroy the cancer cells where surgery is not an option or sometimes concomitant with surgery.
- Immunotherapy – This therapy would be done to trigger the immune system to fight with the cancer cells in the bladder or in the whole body.
Sometimes combination of all treatment modalities will be recommended by the doctor for better prognosis.