Bladder Cancer

What is Bladder Cancer ?

Bladder cancer is a condition characterized by presence of blood in urine which is characteristically not associated with any pain (Painless hematuria). Related risk factors include smoking, exposure to dyes and certain chemicals and various genetic and racial factors. This cancer can affect individuals above the age of 35 years and is the leading cause of painless gross hematuria or blood in urine above the age of 50 years. Bladder cancer can arise from various layers of the bladder but the most common variety is the one which arises from the mucosa of the bladder which is also called the urothelium. Such a tumor is called as urothelial cancer. Cancers arising from other layers are different and could be rhabdomyosarcomas (Arising from the muscle layer), Adenocarcinomas (Arising from the urachal remnants), Fibromyosarcoma, Squamous cell carcinomas (Arising from metaplastic epithelium) etc.

Lets learn about the Bladder

Bladder is a hollow organ in the body that stores urine and helps in passing it out. The bladder is situated in the lower abdomen and is connected with the kidneys by the means of the two ureters. The floor of the bladder contains the urethral opening and it is through the urethra that the urine is discharged. The bladder has three main layers, the first layer being the epithelium or the Urothelium. Below this lining is the muscular layer which contains the detrusor muscle which contracts to flush out urine. The last layer of the bladder is the adventitia which is closely associated with the perivesical fat. You can read more about the bladders anatomy in the Anatomy of the Urinary Tract Section.

How does Bladder Cancer Behave ?

Once the bladder cancer arises from the surface of the bladder wall (called epithelium) it begins to invade into the deeper layers as well as the lumen of the bladder in order to establish its blood supply. As the cancer progresses the tumor keeps invading until it either involves the entire wall of the bladder or gains access to the main vessels and travels into various parts of the body. Most commonly the bladder cancer cells metastasize or make home in the lungs, liver and brain. The cancer also spreads to the lymph nodes surrounding the bladder. As the cancer grows more and more, it becomes difficult to eradicate the cancer completely. In such cases the chances of cure as well as years of survival reduce.

What is the average Survival rate in a Bladder Cancer Patient ?

There are many factors which govern survival in a patient with bladder cancer including:

• Size of the tumor
• Grade of the Tumor (Which reflects how mature the tumor is)
• Level of Invasion of the tumor into the various layers of the bladder
• Involvement of Lymph nodes
• Involvement of any distant organs via the bloodstream

Based on these factors Dr. Raman Tanwar decides the further course of management of the cancer and explains the pros and cons of various available treatment modalities. The various questions that need to be answered to manage bladder cancer include:

• Duration of bleeding
• Association with pain
• History of recurrence
• Presence of symptoms indicating involvement of adjacent organs
• Presence of risk factors for bladder cancer
• Size of the tumor
• Extent of tumor involvement
• Systemic Symptoms like loss of appetite and weight
• Extent of tumor on examination

How is Bladder Cancer Treated ?

Treatment of Bladder cancer depends on the location and size of the tumor. The size and location can be ascertained by the following tests:

• Ultrasonography of the abdomen and pelvis
• Contrast enhanced CT scan of the abdomen and Pelvis
• Cystoscopy

Tumors that are superficial and less than 3 cms can be directly removed using a scarless procedure called transurethral resection of the Bladder Tumor (TURBT). Tumors more than 3 cms can also be removed by this procedure but not completely. Many times a simple piece of the tumor may be taken and sent for analysis to confirm the cancer. Once the tumor has been completely removed using endoscopy, the patient need to follow up for prevention of recurrence of the tumor. During the follow up, patient is given immunotherapy to reduce the chances of recurrence and regular cystoscopy is performed for early detection. Know more about the follow up protocol for bladder tumor patients.

Tumors which cannot be removed with endoscopic surgery or those that have spread to deeper layers of the bladder are managed with removal of the urinary bladder itself. This surgery is called radical cystectomy. The passage of urine is then reconstructed using the intestines. Dr. Raman Tanwar discussed the options of reconstruction with the patient and the family before taking the final decision. Many times the tumor spreads beyond the bladder and is then best managed with radiation and chemotherapy. The spread of the tumor is assessed with imaging tools such as CT scan or a PET scan.