Chronic bladder
inflammation.
Chronic or repeated urinary infections or inflammations (cystitis), such as
may happen in people with congenital abnormalities of the urinary tract ,prolonged
use of a urinary catheter, or infestation with schistosomiasis (a parasitic
infection)
Personal or family history.
Having bladder cancer once makes it more likely you'll get it again. Tumours
may reoccur anywhere along the urinary tract as the same type of epithelial
cells occur in your kidneys, ureters and urethra.
Most bladder cancers begin in the epithelial cells that
line the walls of the bladder (transitional cells) and
are confined to the bladder lining (carcinoma in situ).
Others may invade the tissue below the epithelium(the surface
of the inner lining) through the bladder wall, and from
there into nearby structures e.g. prostate in men and uterus
in women. distant spread to other organs occur eventually
e.g. to the lungs, liver or bones
Types
Cancer originates in the epithelium, smooth muscle
and fibrous layer. They may be transitional, squamous (common
in Africa), anaplastic or adenocarcinoma.
Clinical Features
Bladder cancer does not usually manifest clinically with
signs or symptoms in its early stages. however they include:
Haematuria: principal symptom. Usually painless, becoming
painful with advance. It is usually the first warning sign.
Frequency: frequently passing urine. Usually occurs when
infection supervenes.
Urinary retention: if urethra is blocked
Bone pain, weight loss, anaemia etc
Investigation
Urine cytology. A sample of your urine may
be analyzed under a microscope to check for cancer cells.
Cystoscopy
Clinical Staging is based on;
(i) Urethrocystoscopy and a biopsy of the tumour.
(ii) Computerized tomography (CT),Magnetic resonance imaging
(MRI), Intravenous Urography or Ultrasound scan to see
an image of your kidneys and lower urinary tract, including
your bladder. it may show evidence of hydronephrosis
(iii) Chest X-ray- This test may help detect cancer that
has spread to your lungs. , radioisotope bone scan-used
to determine whether cancer has spread to your bones, routine
Liver function test.
Bladder cancer is staged using the numbers 0 to IV.
Stage 0 cancer. carcinoma in situ .occurs when the cancer
is limited only to epithelium of the bladder. Complete
removal of the cancer is achievable however recurrence
rate is high.
Stage I cancer. Cancer at this stage occurs in the bladder's
inner lining, but hasn't invaded the muscular bladder wall.
Stage II cancer. At this stage, cancer has invaded the
bladder wall but has not reached the surrounding structures
Stage III cancer. The cancer cells have spread through
the bladder wall to surrounding structures
Stage IV cancer. Distant spred to other organs e.g lungs,
liver or bones.
Recurrent. This refers to cancer that has returned after
having been treated. It may recur in the same place or
in another part of your body.
Treatment
This depends on the type of cancer, the stage
of the disease, the patient’s age and general health
status.
Therapeutic options include surgery, chemotherapy, radiotherapy,
immunotherapy or a combination of all modes.
Surgery:Surgical treatments are usually the best option
for people with bladder cancer.
(i) partial: resection of that part of the bladder to
which the tumour is limited.
(ii) radical: it is used for invasive bladder cancer
or for superficial cancer that affects a large portion
of the bladder. it involves total removal of the bladder
and the nearby lymph nodes. In men the prostate may be
removed as well; in women, a subtotal hysterosalphingectomy
may be done as well.
Transurethral resection (TUR). Using a cystoscope, the
cancer is removed with a small wire loop and any remaining
cells are cauterized (burnt with an electric current).
Chemotherapy: special drugs that destroy cancer cells
are administered orally, intravenously or directly into
the bladder (intravesical)
Usually, two or more drugs are used in combination.
Radiotherapy: used as an adjunct before or after surgery
with radioactive implants or external beam radiation. it
is seldomly used alone as in when other clinical condition
of the patient negates surgery.
Immunotherapy: used in low
grade cancer.Bacille Calmette-Guerin (BCG) is introduced
into the bladder through the urethra
for two hours, once weekly, at least six times to stimulate
the immune system to destroy cancer cells. It binds to
your bladder, where it triggers a response that inhibits
the formation and growth of tumors.It's usually used after
TUR to help prevent superficial bladder cancer from recurring.
Follow-up
Bladder cancer has a high rate of recurrence. Following
appropriate treatment of “curable” cancer,
watch should be kept for reoccurrence.
Urine cytology and cystoscopy are provided every 3 months
for the first 2years, then every 6 months for the next
2years.
I.V.U
Prognosis:
if untreated, few patients with invasive cancer of the
bladder survive 3years.
Prognosis varies with type and stage of the tumour, being
better in low grade than high
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