Cancer of the Urinary Bladder
Introduction
o more in people between 50 and 70.90%
o Usually transitional cell carcinoma
o At times Squamous cell carcinoma
o Main cause cigarette smoking
o Metastatic Cancers : Cancers of prostate, colon, rectum and female genital organs may metastasize to bladder
Clinical Manifestations
o Usually arise at the base; involve ureteral orifices and bladder neck.
o Painless haematuria - most common symptom
o Infection - common complication
o Frequency
o Urgency
o Dysuria
o Back pain may occur with metastasis
Investigations
o Cystocopy
o Excretory urography
o CT scan
o USGM
o Biopsy
o Cytologic examination of the wahings of the bladder.
o Newer diagnostic indicators are being studied :
o Bladder tumour antigens
Nuclear matrix proteins
Adhesion molecules
Cytoskeletal proteins
Growth factors
Molecular assay
Risk Factors for Bladder Cancer
o Cigarette smoking; risk proportional to number of packets
o Environmental carcinogens, dyes, rubber, leather ink or paint
o Recurrent or chronic bacterial infection of the urinary tract
o Bladder stones
o High urinary pH
o High cholesterol intake
o Pelvic radiation therapy
o Cancers arising from the prostate, colon, rectum in males may infiltrate into bladder
Medical Management
Consider :
o The grade of the cancer (the degree of cellular differentiation)
o The stage of the tumour growth(the degree of local invasion and the presence or absence of metastasis)
o The multicentricity (having many centers) of the tumour
o The patient's age, and physical, mental and emotional status
Surgical Management
o Transurethral resection or fulguration for simple papillomas
o After these procedures which spare the bladder intravesical administration of BCG is the treatment of choice
o Simple cystectomy - for invasive or multifocal bladder cancers
o Radical cystectomy - which involve near by structures
o Transurethral resection of the tumour + radiation + chemotherapy
Pharmacologic therapy
o Combination of methotrexate, 5-fluorouracil, vinblastine, doxorubicin (adriamycin), cyclophosphamide
o Gemcitabine and the taxanes - promising improvement
o Topical therapy - instillation into the bladder of thiotepa, doxorubicin,mitomycin, ethoglucid and BCG
Radiation Therapy
o Exterma radiation therapy is a cancer treatment that uses high-energy x-rays
o Internal radiation therapy - radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer
Indications
o Preoperatively - to reduce microextension of the nepoplasm and viability of tumour cells
o Done also in combination with surgery
o For inoperable tumour
Other modalities of treatment
o Hydrostatic therapy with balloon filled with water - pressure necrosis
o Instillation of formalin, phenol, or silver nitrate relieves haematuria and stranguary in some patients
Therapy under Investigation
o Photodynamic techniques - haematoporphyrin - a photosensitizing agent - injected IV - cancer cells pick up - laser light through - haematoporphyrin converted into toxic medication
