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Bladder Cancer Gall - Symptoms and Treatment

Benign or malignant tumors may develop on the bladder wall surface or grow within the wall and quickly invade underlying muscles. About 90% of bladder cancers are transitional cell carcinomas, arising from the transitional epithelium of mucous membranes. They may result from malignant transformation of benign papillomas. Less common bladder tumors include adenocarcinomas, epidermoid carcinomas, squamous cell carcinomas, sarcomas, tumors in bladder diverticula, and carcinoma in situ.

Bladder tumors are most prevalent in people over age 50, are more common in men than in women, and occur more often in densely populated industrial areas.

Causes

Certain environmental carcinogens, such as tobacco, nitrates, coffee, and 2-naphthylamine, are known to predispose a person to transitional cell tumors. This places certain industrial workers at high risk for developing such tumors, including rubber workers, weavers, aniline dye workers, hairdressers, petroleum workers, spray painters, and leather finishers. The latency period between exposure to the carcinogen and development of signs and symptoms is about 18 years.

Squamous cell carcinoma of the bladder is common in geographic areas where schistosomiasis is endemic, such as Egypt. What is more, it's also associated with chronic bladder irritation and infection in people with renal calculi, indwelling urinary catheters, chemical cystitis caused by cyclophosphamide, and pelvic irradiation.

Signs and Symptoms

The following are the most common symptoms of bladder cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • visible blood in the urine
  • hematuria - the presence of microscopic red blood cells (RBCs) in the urine.
  • painful urination
  • urgency - frequently feeling the need to urinate without results.
  • frequent urination
  • pelvic or flank pain

The symptoms of bladder cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnostic tests 

To confirm a bladder cancer diagnosis, the patient typically undergoes cystoscopy and biopsy. If the test results show cancer cells, further studies will determine the cancer stage and treatment. Cystoscopy should be performed when hematuria first appears. If the patient receives an anesthetic during the procedure, he also may undergo a bimanual examination to detect whether the bladder is fixed to the pelvic wall.

Excretory urography can identify a large, early­stage tumor or an infiltrating tumor; delineate functional problems in the upper urinary tract; assess hydronephrosis; and detect rigid deformity of the bladder wall.

Laboratory tests, such as a complete blood count and chemistry profile, may be ordered to evaluate conditions such as anemia that are associated with bladder cancer.

Treatment

The cancer's stage, the patient's lifestyle, other health problems, and mental outlook all help to determine which therapy is selected. Surgery, chemotherapy, radiation therapy, or one of several new treatments may be used.

Superficial bladder tumors are removed cytoscopically by transurethral resection and electrically by fulguration. This usually is adequate treatment if the tumor hasn't invaded the muscle. Additional tumors may develop, and fulguration may have to be repeated every 3 months for years. When the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.

Intravesical chemotherapy is used for treating superficial tumors (especially tumors in many sites) and for preventing tumor recurrence. This therapy directly washes the bladder with anticancer drugs. Commonly used agents include thiotepa, doxorubicin, and mitomycin.

Intravesical administration of the live, attenuated bacille Calmette-Guerin (BCG) vaccine has proved successful in treating superficial bladder cancers, particularly primary and relapsed carcinoma in situ.

Tumors too large to be treated cytoscopically require segmental bladder resection. This surgery, which removes a full-thickness section of the bladder, is feasible only if the tumor isn't near the bladder neck or ureteral orifices. Bladder instillations of thiotepa after transurethral resection also may help.

For infiltrating bladder tumors, the treatment of choice is radical cystectomy with a pretreatment course of 2,000-rad external beam radiation therapy directed at the bladder. During the operation, the surgeon removes the bladder with prevesical fat, lymph nodes. urethra, and the prostate and seminal vesicles (in men) or the uterus and adnexa uteri (in women). Next, a urinary diversion is constructed, usually an ileal conduit. After surgery, the patient wears an external pouch continuously. Other diversions are ureterostomy, nephrostomy, continent vesicostomy (Kock pouch), ileal bladder, and ureterosigmoidostomy.

Prevention

Stopping smoking is the most significant thing that can be done to reduce the risk of getting bladder cancer. Even if a superficial bladder cancer has been diagnosed, stopping smoking will reduce the risk of developing more tumours in the future.

There is currently limited evidence that diet and alcohol play a part in the development of bladder cancer, but a diet high in fruit and vegetables and low in fat may help reduce the risk.



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