Bladder Cancer

The commonest presentation for bladder tumors is bleed in the urine which is generally painless. However if a large volume of bleed occurs then the patient may have clot retention of the urine, which can be very painful.

How are Superficial Tumor best Diagnosed ?

Initial ultra-sonography is the best screening tool for bladder mass detection. However the gold standard for bladder mass detection is flexible cystoscopic evaluation of the patient. This procedure is performed on an outdoor basis. The procedure is done under local anesthesia. Since the patient is fully conscious he can see the procedure while having little or no pain, since the examining telescope is flexible.

What is the management for superficial Bladder cancer ?

The most common variety of bladder tumors are the superficial tumors. These are not invasive and therefore do not breach the bladder muscle wall. Therefore although these tumors can recur they do not change or reduce the life expectancy of the patient. These tumors generally are caused by habitual smoking

What is TURBT ?

Trans-urethral resection of bladder tumor or TURBT, is the gold standard treatment for superficial bladder tumors. This procedure is performed via the urine passage without the need to place any incision. The uro-surgeon using a resectoscope can visualize the tumor and resect the tumor using electrical or laser energy. Once the tumor is resected then the base of the tumor is sealed to control the chance for bleed. The patient is usually discharged after three days, and needs to take rest at home for 2 weeks after the procedure. This is essential since the bladder tumor resection wound heals completely in 2 weeks time, therefore the rest allows unhindered healing of the tumor scar.

What is the prognosis and followup for superficial bladder cancer ?

The prognosis of superficial bladder tumor management is excellent, provided the patient quits smoking completely. The patient leads a normal and healthy life with normal life expectancy. However the patient is maintained on follow up with periodic check cystoscopy. This procedure is performed at increasing interval of time, and since it is a painless day care procedure therefore the patients quality of life remains excellent.

What is the Invasive Bladder cancer ?

Cancer of the urinary bladder and bladder wall, cutaway side view. Shown are the seven stages of vesical neoplasm development, beginning at the bottom of the bladder and continuing in a clockwise manner. Also shown are the perivesical fat, deep muscle, superficial muscle, submucosa, and mucosa.

One out of ten bladder cancers can be aggressive and invasive. These tumors have the tendency to spread locally outside the bladder wall and also spread via the blood stream to distant organs like the liver and the lungs. This tumor has to be diagnosed by a transurethral bladder biopsy. Once diagnosed the tumor along with the affected bladder should be removed without further delay.

What is the management for invasive Bladder cancer ,Radical cystoprostatectomy ?

Radical cysto-prostatectomy is the gold standard and till date the best curative option for the management of bladder tumors which are invasive in nature. This surgery performed by laparoscopy or by open surgical incision removes the entire bladder along with its enveloping fat, its drainage lymph nodes along with the prostate. After such a surgery the ureters are drained via an ileal conduit. This conduit drains the urine through a urostomy bag attached by adhesive to the lower part of the abdomen.

Continent urinary Diversion after radical cystoprostatectomy 

After the bladder and the prostate has been removed in a case with advanced cancer of the bladder, the kidneys cannot drain the urine directly to outside the body via the penis.
In this case a new bladder can be created. This neobladder can be used to replace the cancer damaged older bladder. This bladder is created from the patient’s small intestine.
The surgeon harvests 70 cm of the intestine, this tubular structure is then de-tubularized to create a pouch. This pouch is then attached to the two ureters. (Ureters are the tube via which the kidneys drain the urine into the bladder)
The surgeon then attaches this bladder to the urethra, which is the tube which drains the urine via the penis in the male to outside the body.
This procedure is possible in organ confined cancer, wherein the cancer is removed and the patient is able to get a new bladder created replacing the older damaged bladder. He is also able to pass urine via the normal urine passage.

Neo bladder Substitution

BLADDER INVASIVE CANCER IN FEMALES

Bladder cancer is more common in males. And has a direct correlation with smoking cigarettes and Bidi. However females can also be affected by this cancer.

When the cancer becomes invasive then there is a chance of spread to distant sites in the body and there is risk to life.
In these cases the best management is laparoscopic radical cystectomy. This sugery can cure these patients since the affected bladder along with the uterus and a cuff of the vagina is removed .
This surgery can nowadays be performed by laparoscopy wherein the patient has lesser invasion and therefore faster recovery. Laparoscopy means the organ removal is performed via five small ports (small incisions)

After removal of the bladder cancer we also create a new passage for passage of urine. We can create a new bladder in patients with early bladder cancers. This bladder is created from the patients own intestine. And patient can pass urine via the normal urine passage. However in advanced cancer we create a new passage called an ilial conduit for the urine to pass from a new opening created in the right lower part of the abdomen. A bag can be attached to this mouth so urine can be collected within this bag. Therefore bladder cancer even if life threatening, can be cured today by keyhole surgery.

1. What is bladder cancer?

Bladder cancer is a disease where malignant (cancer) cells form in the tissues of the bladder.

2. What are the early signs and symptoms?

The most common early symptom is blood in the urine (hematuria), usually without pain. Others include frequent urination, pain during urination, and lower back pain.

3. What causes bladder cancer?

Primary causes include smoking, exposure to industrial chemicals, chronic bladder infections, and prior cancer treatments (radiation/chemotherapy).

4. Is bladder cancer common?

Yes it is a very Common cancer in India .

5. What are the types of bladder cancer?

 Urothelial carcinoma (most common)

Squamous cell carcinoma

Adenocarcinoma

6. How is bladder cancer detected?

Through urine tests, cystoscopy (a scope to view inside the bladder), biopsies, and imaging scans (CT, MRI, ultrasound).

7. What are the stages of bladder cancer?

Stages range from Stage 0 (non-invasive) to Stage IV (spread to distant organs).Stage 0 Indicate the cancer is still within the Bladder while Stage 2-4 indicate it has spread to surrounding tissue ,Near by organs or distant parts of the body .

8. What are the grades of bladder cancer?

Low-grade: Slow-growing, less aggressive

High-grade: Fast-growing, more likely to spread.

9. Can bladder cancer be cured?

Yes, especially if detected early. Treatment success depends on the stage and grade of the cancer.

10. What are the treatment options?

Surgery (TURBT, cystectomy)

Chemotherapy

Immunotherapy (e.g., BCG)

Targeted therapy

What are the treatment options for treatment?

Fot non invasive disease laser turbt is the best treatment. For invasive disease however radical.cancer surgery is the best option.
Chemotherapy is used when distant spread is present,
Radiation therapy has lot of side effects and is best avoided

What is local chemotherapy?

When pow grade cancer bladder recurs within the bladder we use local insode bladder chemotherapy with mitomycin to reduce cancer recurrence.

How often does bladder cancer recur?
Superficial bladder cancer has a tendency to recur so we advise cystoscopy under anesthesia to follow up the case. Whenever recurrence is found we will use laser to remove the growth and use mitomycin to sterilize the cancer cells

Who is at highest risk?

Bladder cancer is common in men above 50.
More common in smokers.
Risk increases with use of hair dyes.
Industrial chemical exposure also increases chance of cancer.

Can women get bladder cancer?

Bladder cancer is less common im women. But can happen. It is more common if there is history of smoking. Also bladder dysfunction and increased residual urine increases the chance of cancer.

Is Bladder Cancer Painful?

Initially bladder cancer causes no pain but if there is retention of blood clots it can cause pain. And in mpre.advanced cases pain can be severe due to spread

What Lifestyle Change’s Can Help?

Please stop smoking and use less hair dye. Also avoid industrial chemicals

Can Bladder cancer affect sexual function ?

Bladder cancer can affect sexual function by weakness and blood loss. After radical surgery generally patient has sexual dysfunction.

Who Is the Best Bladder Cancer Surgeon?

Dr Avishek Mukherjee MS MCh is one of the best bladder cancer surgeons in eastern india.
He did one of the first laparoscopic radical bladder cancer surgery in eastern india.
He is also the pioneer of laparoscopic radical surgery in eastern india.