A bladder is a muscular hollow organ that stores urine. It is located in the pelvic region. Urine from both the kidneys passes through ureter and reaches the bladder. When the bladder gets filled up to a certain level, the nerves send signal to the brain and we may feel the urge to urinate.
Normally, cells grow and divide to form new cells as the body needs them. Cancer merely indicates towards a condition in which the cells start multiplying in an abnormal way. These extra cells can form a mass of tissue called a growth or tumor. Tumors can be benign or malignant: Bladder cancer refers to any of several types of malignant growths of the urinary bladder. The process of invading and spreading to other organs is called metastasis. Bladder cancers are most likely to spread to neighboring organs and lymph nodes prior to spreading through the blood stream to the lungs, liver, bones, or other organs. Bladder cancer affects 3 times as many men as women
The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas. All squamous cell carcinomas are invasive. This means that they gradually spread to deeper layers of the bladder wall if they are not treated. By the time these cancers are detected, they have usually already invaded the bladder wall. Many transitional cell carcinomas are not invasive. This means that they go no deeper than the transitional, or urothelial, layer.
Bladder cancers are classified or staged based on their aggressiveness and the degree that they are different from the surrounding bladder tissue. There are several different ways to stage tumors. Recently, the TNM staging system has become common. This staging system contains several sub stages, but it basically categorizes tumors using the following scale:
There is no particular cause that has been found out. But Studies have found the following risk factors for bladder cancer:
The symptoms described below are not sure signs of bladder cancer. Infections, benign tumours, bladder stones, or other problems also can cause these symptoms. So incase of these symptoms, one must consult an urologist or correct diagnosis. Moreover most of the symptoms listed below can be associated with bladder cancer, but they can also be associated with non-cancerous conditions. Nevertheless, medical evaluation is critical.
Additional symptoms that may be associated with this disease are Bone pain or tenderness, abdominal pain, Anaemia, Weight loss, Lethargy (tiredness).
If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:
The choice of an appropriate treatment is based on the stage of the tumor, the severity of the symptoms, and the presence of other medical conditions. The treatment for patients with stage II and stage III disease is changing. While the accepted treatment has been removing the entire bladder but there is growing interest in conserving the bladder.
In this operation, the entire bladder is removed, as well as its surrounding lymph nodes and other structures that may contain cancer. This is usually performed for cancers that have invaded through the bladder wall or for superficial cancers that extend over much of the bladder. In women this involves the removal of the whole bladder, the urethra, and the lower end of the ureters, the front wall of the vagina, the womb (hysterectomy), fallopian tubes and ovaries. In younger women the ovaries may be preserved. As a result the vagina will be shorter and narrower following the operation. In men the whole of the bladder, the prostate gland, the lower ends of the ureters and sometimes the urethra is removed.
Many people with stage II or III bladder cancer may require bladder removal. This surgical procedure is also called complete or radical cystectomy. Radical cystectomy in men usually involves removal of the bladder, prostate, and seminal vesicles. In women, the urethra, uterus, and the front wall of the vagina are removed along with the bladder. Often, the pelvic lymph nodes are also removed during the surgery for examination in the laboratory. About half of the people treated with radical cystectomy will be completely cured; the other half shows signs of metastasis at the time of the surgery.
A urinary diversion surgery is usually performed with the radical cystectomy procedure. In this, an alternate method for urine storage is created. Three common types of urinary diversion are:
A continent urinary reservoir is another method of creating a urinary diversion. In this method, a segment of colon is removed and used to create an internal pouch to store urine. This segment of bowel is specially prepared to prevent reflux of urine back up into the ureter and kidneys, and also to reduce the risk of involuntary loss of urine. Patients are able to insert a catheter periodically to drain the urine. A small stoma is placed flush to the skin. Possible complications include: bowel obstruction, blood clots, pneumonia, and urinary tract infection, skin breakdown around the stoma, ureteral reflux, and ureteral obstruction.
Partial bladder removal may be performed in some patients. Removal of part of the bladder is usually followed by radiation therapy and chemotherapy to help decrease the chances of the cancer returning. For those patients who undergo complete bladder removal, chemotherapy is also given after surgery to decrease the risk of a recurrence. . Some patients may be treated with chemotherapy before surgery, to try and shrink their tumor down, so that they might be able to avoid having the entire bladder removed.
This surgery is becoming more common in patients undergoing cystectomy. A segment of bowel is folded over to make a pouch (a neobladder or "new bladder"), then attached to the urethral stump, which is the beginning of where the urine normally empties from the bladder.
This procedure allows patients to maintain some degree of normal urinary control, although there are complications, and the urination is usually not the same as before surgery. For example, this procedure can be associated with leakage of urine at night, the need to perform manual catheterization periodically, and other complications listed above for the continent urinary reservoir.
Bladder cancer surgery may affect a person's sexual function. Because the surgeon removes the uterus and ovaries in a radical cystectomy, women are not able to get pregnant. Also, menopause occurs at once. If the surgeon removes part of the vagina during a radical cystectomy, sexual intercourse may be difficult. In the past, nearly all men were impotent after radical cystectomy, but improvements in surgery have made it possible for some men to avoid this problem. Men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they have dry orgasms. Men who wish to father children may consider sperm banking before surgery or sperm retrieval later on.