Bladder Cancer

Introduction

Urinary bladder of human body is responsible for collection and storage of formed urine that is made in the kidneys and travels to the bladder via the tubes called ureters. Once its optimum capacity to hold urine is reached, urine is evacuated via the urethra. Like most other organs cancer may also affect urinary bladder. Various risk factors like smoking, exposure to certain chemicals etc are responsible for development of cancer. Urinary bladder can be treated in different methods. These are often used in conjunction to allow for maximum chance of survival. The therapeutic modalities include surgery, chemotherapy (treatment with anti cancer drugs) or radiation therapy. Choice on treatment depends on type and extent of cancer. Mode of treatment is decided by the treating oncologist.

Procedure and considerations

Surgery is considered depending on the extent of spread of cancer. If the cancer is detected at an early stage and localized at the bladder, then the cancerous area is removed with or without a surrounding healthy portion of the bladder wall. Before the surgery evaluation of health is done. This includes routine blood tests that look at liver and kidney functions of the patient. An Ultrasound and CT scan are done for proper localisation of the tumour. The surgery is usually performed under spinal or epidural anaesthesia. In this method an anaesthetic is injected in between two vertebral bones and this results is numbness and paralysis waist downwards during the operation. The tumour is approached through the urethra. Once the cancerous area is reached the portion of the bladder that contains the cancerous cells are removed. If the bladder wall is invaded by the cancerous cells then the entire bladder along with its surrounding lymph nodes are removed. This procedure is called radical cystectomy. After removal of part or whole of the bladder a pouch is created to collect and evacuate the urine. The risks associated with surgery are chances of infection, bleeding etc.The surgery is usually performed under spinal or epidural anaesthesia.

Chemotherapy is another option to treat bladder cancer. Drugs are used to kill the cancerous cells. The drugs can be introduced through the veins or in can be directly introduced into the bladder through a tube. This procedure may be combined with surgery or radiation. Chemotherapeutic drugs are associated with several side effects and risks. These include loss of appetite and hair, diarrhea, nausea and vomiting and susceptibility to infections. Drugs that modify immune system may also be used. This is called biological therapy or immune therapy. Drugs may be directly introduced into the bladder. Drugs that are used in biological therapy are BCG, interferon etc.

Radiation is another important tool for treatment of cancer. Radiation beams are used to destroy the cancer cells. Radiation may be used to decrease the size of the tumour before surgery. Radiation may be used in two ways. One is by the use of a machine that focuses beams or rays at the tumor. This is called external beam radiation. This entails visiting the radiolotherapist for each sitting over a few weeks. The other is by placing a radioactive device inside the bladder to localize the effects of radiation and to minimize side effects. Common side effects with radiation include nausea, fatigue, suppression of bone marrow, loss of fertility etc