The urinary bladder is a hollow purse like storage organ which collects urine from the kidneys and stores it until it can be passed out of the body through the urethra during the process of micturition or urination. It has a thin inner lining of cells called urothelial cells and a thick muscular wall, which exerts pressure to push the urine out of the body.
Causes of Bladder Tumors
In most cases, the bladder tumor develops on the inner layer due to a combination of some of the following factors.
- Hereditary: A strong family history of cancer predisposes a person to cancer.
- Gender: Men are 3 times more prone for bladder cancer than women.
- Ethnicity: White people are more prone for bladder cancer black people.
- Smoking / Tobacco use: Smokers develop bladder cancer 2-6 times more frequently than non-smokers. Tobacco contain toxic, carcinogenic substances which reach the kidney and are stored in the bladder, leading to cancerous changes in bladder.
- Occupational hazards: Some workplaces have a higher likelihood of causing bladder cancers, especially dye and rubber industries. The effects can be damaging, and the person may develop cancers years after the exposure has happened.
- Recurrent bladder infections: In some people, this can also lead to bladder cancer in the long run.
Types of Bladder Tumor Depending on the extent of the cancerous spread, it can be of two types:
- Non-muscle-invasive bladder tumors: The tumor spread is limited to the inner part of the bladder (urothelial cells)
- Muscle-invasive bladder tumor: The tumor has spread to the thick muscular outer layer.
This is more advanced and prognosis is poor compared to the noninvasive type. The most common and diagnostic symptom of bladder cancer is the presence of blood in the urine without pain in abdomen, known as painless hematuria. This is usually intermittent and stops on its own. Therefore any person who is more than 40 year old, has blood in urine, must be checked to rule out bladder tumor. If you miss these early warning symptoms by just thinking simple infection, you may miss the tumor and will be diagnosed later when tumor is advanced. Other symptoms include pain in the lower abdomen and frequent urination.
From the most non-invasive to the most invasive diagnostic test, these include:
- Urine microscopy and cytology to detect blood and cancer cells in the urine
- Ultrasound and CT Scan can define the bladder tumor, its size and spread.
- Cystoscopy and biopsy is when a is tube inserted into the urethra to look into the inner wall of the bladder and biopsy is taken from lesion. It is highly diagnostic and confirmatory.
Once the tumor is diagnosed, first step of the treatment is endoscopic surgery known as transurethral resection of the bladder tumor (TURBT). The cancerous bladder lesion is resected and removed through a cystoscope. Muscle tissue from the base of tumor is also resected to check the spread of tumor in the muscle. The bladder is then flushed with chemotherapy agent to kill any residual cancer cells in the bladder.
- Intravesical BCG Therapy: If muscle is not involved with tumor, this is called superficial tumor. As there is high chance that this tumor may recur or progress, bladder is treated with BCG injection therapy repeatedly for at least 6 weeks to many months. Check cystoscopy is usually done thereafter to check for any recurrence at frequent intervals.
- Radical Cystectomy with Ileal conduit or Neo-Bladder: If tumor is involving muscle layer of bladder then whole urinary bladder is removed surgically and urine passage is made at abdominal wall using part of intestine called Ileal conduit. Patient has to wear a bag on abdomen to urine collection and discharge. Now-a-days, artificial bladder is made by patients own intestine which functions like normal bladder and patient passes urine per urethra.
- Radical Radiotherapy: This is also an alternative treatment for muscle invasive bladder cancer where bladder is preserved and treated by radiotherapy. Repeated check cystoscopy is required thereafter to check for recurrence.
- Chemotherpy: If tumor has advanced to lymph nodes and other body organs, then treatment is chemotherapy where anticancer drugs are injected into veins. In Summary, Bladder cancer is usually caused by Tobacco consumption. Blood in urine even if it stops on its own or by medications, in person over 40 years of age must be evaluated for bladder cancer. In early stage it can be treated by cystoscopy. If it involved muscle, bladder is removed and neo-bladder is made.
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