Cancer of the bladder

1. 1 Cancer of the bladder

2. 2 Aetiology and incidence More common in people between 50 and 70. 90% transitional cell carcinoma Squamous cell carcinoma Main cause cigarette smoking Cancers of prostate, colon, rectum and female genital organs may metastasize to bladder

3. 3 Clinical Manifestations Usually arise at the base; involve ureteral orifices and bladder neck. Painless haematuria – most common symptom Infection – common complication Frequency Urgency Dysuria Back pain may occur with metastasis

4. 4 Assessment and diagnostic findings Cystocopy Excretory urography CT scan USGM Biopsy Cytologic examination of the wahings of the bladder. Newer diagnostic indicators are being studied : Bladder tumour antigens Nuclear matrix proteins Adhesion molecules Cytoskeletal proteins Growth factors Molecular assay

5. 5 Risk Factors for Bladder Cancer Cigarette smoking; risk proportional to number of packets Environmental carcinogens, dyes, rubber, leather ink or paint Recurrent or chronic bacterial infection of the urinary tract Bladder stones High urinary pH High cholesterol intake Pelvic radiation therapy Cancers arising from the prostate, colon, rectum in males

6. 6 Treatment Standard therapies for bladder cancer include Surgery radiation therapy Chemotherapy Immunotherapy biological therapy. Immune system forms substances in the blood that work against "invaders," such as abnormal cells (that is, cancer cells).Sometimes, the immune system becomes overwhelmed by the very aggressive cancer cells. Biological therapy, or immunotherapy, helps bolster the immune system in its fight against the cancer.Biological therapy is typically given only in stages Ta, T1, and CIS bladder cancers.One widely used immunotherapy or biological therapy in bladder cancer is intravesical BCG treatment. A fluid containing BCG is introduced into the bladder through a thin catheter that has been passed through the urethra.The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances. The solution is held in the bladder for a few hours, then drained. This treatment is repeated every week for six weeks and repeated at various times over several months or even longer in some cases. Researchers are still working to determine the best length of time for these treatments. Over time, the treatments may be required on a less frequent basis. Immune system forms substances in the blood that work against "invaders," such as abnormal cells (that is, cancer cells).Sometimes, the immune system becomes overwhelmed by the very aggressive cancer cells. Biological therapy, or immunotherapy, helps bolster the immune system in its fight against the cancer.Biological therapy is typically given only in stages Ta, T1, and CIS bladder cancers.One widely used immunotherapy or biological therapy in bladder cancer is intravesical BCG treatment. A fluid containing BCG is introduced into the bladder through a thin catheter that has been passed through the urethra.The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances. The solution is held in the bladder for a few hours, then drained. This treatment is repeated every week for six weeks and repeated at various times over several months or even longer in some cases. Researchers are still working to determine the best length of time for these treatments. Over time, the treatments may be required on a less frequent basis.

7. 7 Medical Management Consider : The grade of the cancer (the degree of cellular differentiation) The stage of the tumour growth(the degree of local invasion and the presence or absence of metastasis) The multicentricity (having many centers) of the tumour The patient’s age, and physical, mental and emotional status

8. 8 Pharmacologic therapy Combination of methotrexate, 5-fluorouracil, vinblastine, doxorubicin (adriamycin), cyclophosphamide Gemcitabine and the taxanes – promising improvement Topical therapy – instillation into the bladder of thiotepa, doxorubicin,mitomycin, ethoglucid and BCG

9. 9 Surgical Management Transurethral resection or fulguration for simple papillomas After these procedures which spare the bladder intravesical administration of BCG is the treatment of choice Simple cystectomy – for invasive or multifocal bladder cancers Radical cystectomy – which involve near by structures Transurethral resection of the tumour + radiation + chemotherapy

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