Dr Nguyen Hoang Duc


About the condition
The bladder is a hollow muscular organ located in the pelvis, which acts as reservoir to collect and store urine from the kidneys. The muscles of the bladder help to pass out urine from the lower urinary passage or urethra.

The inner lining of the bladder is composed of a layer of cells that protect the tissue from contact with urine. Occasionally, these cells start to multiply uncontrollably and form a growth or tumour.

When found and treated in the early stages, bladder tumours are less likely to be life threatening. Treatment of most of these tumours do not require removal of the bladder. Thus, regular checkups and prompt medical attention are necessary for early treatment of bladder cancer and for detection of new growths.

Symptoms and Detection
Early stage bladder cancer is usually without symptoms. The earliest clue that you may have a bladder tumour is the presence of blood in the urine. However, this is a non-specific symptom as other conditions such as urinary stones, urinary tract infections or enlarged prostate glands, can also cause blood in the urine.

Bleeding caused by bladder cancer is usually more severe and associated with the passing out of blood clots. Occasionally, the tumour may cause blockage of the bladder and there may be difficulty in passing urine.

Screening and Testing
Bladder cancer can be diagnosed through the following tests.

1. Intravenous urogram (IVU) or CT urography
A contrast solution is injected into a vein which passes quickly into the urine. X-rays or CT scan of the urinary system are taken as the contrast solution is excreted and this allows the urologist to see images of the kidneys, ureters and bladder so as to check for tumours.

Scans of the pelvis and abdomen is also performed to check if the surrounding tissues have been affected by the cancer.

2. Cystoscopy
A pencil-thin scope is inserted into the urethra and passed into the bladder to examine its lining. Tissue samples of the bladder tumour are taken to determine if it is cancerous.

Risk Factors and Causes
The exact cause of bladder cancer is not known although some risk factors have been identified.

These risk factors include:
  • Age (over 40 years old)
  • Sex (more men than women)
  • Race (more Caucasians than Asians)
  • Smoking
  • Exposure to certain chemicals in the workplace
  • Family history and own history of bladder cancer

Stage 1: The cancer cells are located on the surface of the inner lining of the bladder
Stage 2: The cancer cells are located within the inner lining of the bladder.
Stage 3: The cancer cells are now found in the muscle of the bladder.
Stage 4: The cancer cells have spread further to the tissue surrounding the bladder and may have invaded nearby organs.
Stage 5: The cancer has spread to the abdomen or pelvis and, may have spread to the lymphatic system or other organs of the body.

Treatment Options
The choice of treatment would depend on the bladder cancer profile, including:-
  • age and life expectancy
  • medical condition and risk factors<
  • presence of significant illnesses, such as heart problem, stroke, diabetes and so on
  • type and location or spread of the cancer
Your doctor will assess your cancer profile and recommend one of the following treatment options:
1. Surgery
If the tumour is confined to the bladder wall, a transurethral esection will be performed to remove the bladder tumour.

For tumours located within the bladder wall, a cystectomy is performed where part or the entire bladder may have to be removed. If the entire bladder is removed, a new bladder may be constructed using the person's small intestines or urine could be drained into a segment of the small intestine.

2. Radiotherapy
This treatment option employs high energy x-rays to destroy cancer cells. For bladder cancer, this is usually carried out to treat any remaining cancer cells or when the patient has other illnesses that prevent surgery.

3. Chemotherapy
This involves the use of drugs to kill the cancer cells. For early bladder cancer, the chemotherapy drugs are injected directly into the bladder to prevent recurrence of cancer. For bladder cancer that has spread, the drugs are injected into the bloodstream to slow the growth of the cancer.

4. Immunotherapy
Immunotherapy drugs are given to stimulate the body's immune system to fight off the cancer. The anti-tuberculosis vaccine, BCG, is injected into the bladder and has been shown to be effective in treating high risk superficial bladder tumours.

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