Every year, an estimated 50,000 Americans develop bladder cancer and 11,000 die from it. It is the fifth common cancer in American men. It is more frequent in men than in women with a ratio of 3:1. Average age at the time of diagnosis if 65 years. Fortunately, most patients are diagnosed in early stages, when cure is possible.
CAUSES OF BLADDER CANCER
• Cigarette smoking is responsible factor in up to 50% of the patients who develop this condition.
• Chronic bladder infections
• Certain medications, if taken for many years (Phenacetin).
SIGNS AND SYMPTOMS
Painless bleeding in the urine is the most common sign of this disease. The cancer tissue in the bladder has a tendency to break and bleed.
Diagnosis:
When suspected, an endoscopy study of bladder (Cystoscopy) should be performed. This procedure will allow for obtaining a biopsy at the same time. CT scan or Ultrasound examination of the abdomen and pelvis may establish the extent of the cancer.
Staging:
Endoscopic ultrasound is a very sensitive study that should be done to determine the depth of invasion of the cancer into the tissues around bladder, as well as evaluation of the local lymph glands. CT Scan of abdomen, as well as bone scans may have to be done to complete the staging work up.
• Stage 0, In situ cancer
• Stage A, Disease that is limited to the inside surface of bladder
• Stage B, Disease that extends though the thickness of bladder
• Stage C, Disease that extends to the outside of bladder
• Stage D, Disease spread to other organs, like bowels, rectum, lungs, liver, etc.
Information obtained from the Cystoscopy examination, along with X rays, CT Scan, etc. will help in determining the best treatment option.
TREATMENT
Stages 0 and A: Management of the disease relies on surgery, attempting to remove most or all of the cancer form bladder. This is done at the time of Cystoscopy, whereby, the physician is able to see the sites of the disease and can remove them. This procedure is known as Transurethral bladder resection. Additional use of topical chemotherapy to the cancer site, in form of infusing the drugs directly into the bladder, has become an important part of treating very early cancers.
BCG, the tuberculosis vaccine, is another method of local treatment of early stages of bladder cancer. The mechanism action of BCG is rather unclear, but it seems it may have a stimulating effect on the immune cells in the bladder wall and cause indirect damage to the cancerous tissue. BCG contains bacterial particles and the bladder tissue reacts to these particles, in order to destroy them. This response to bacteria may also damage and destroy the superficial cancer cells.
Chemotherapy drugs (Thiotepa, Adriamycin) are introduced into the bladder by way of using a bladder catheter (which is plastic rubbery tube that is inserted into the penis and further up into the bladder.)
Stage B: The treatment of choice for these patients is aggressive surgery and complete removal of the bladder. In certain patients, in whom the disease is limited to one site in the bladder, a partial removal of bladder may be appropriate.
Stage C: This stage bladder cancer is mostly diagnosed after the surgery, when the removed bladder is studied by the pathologist. Such patients should be best treated with radiation and chemotherapy.
Stage D: When the disease is widely spread to different places, patients are best treated with radiation and chemotherapy.
