Urinary Bladder Carcinoma : An Overview

Dr. (Prof) B.P.Singh
Carcinoma bladder is the second most common urological malignancy affecting elderly population. It is more common in chronic smokers. In such patients the cancer arises from the mucosal  lining of the urinary bladder and can subsequently infiltrate bladder musculature deeply. When there is no infiltration into muscle it is a non-invasive bladder  cancer but if cancer has gone into muscle it is invasive bladder carcinoma. These patients present with painless haematuria (blood mixed urine) with or without clots. Sometime haematuria stops spontaneously and recurs later. Even a single episode of haematuria  should not be ignored and investigated  to establish cause of bleeding. Many times the patient presenting in an advanced stage reveals in the detailed evaluation that a few month earlier they had  blood in urine but it stopped spontaneously.
Patient must consult an urologist if he has blood in urine. A simple ultra sound  of abdomen can diagnose the presence of bladder cancer or other causes of bleeding. In case of bladder carcinoma  it can also suggest roughly whether the cancer is invasive  patient  will be submitted for endoscopic  removal of tumour  which is called as trans-uretheral resection  of bladder tumour (TURBT).  In this surgery whole tumour is removed endoscopically through the urinary passage. Further treatment depends upon histapathology. If there is no muscle involvement  and the tumour is low grade, only regular follow-up is required. If the tumour is moderate  or high grade, the patient requires weekly instillation of BCG  for 6 weeks which is done as an OPD procedure and is kept if follow-up. If ultrasound shows invasive carcinoma or TURBT  shows muscle invasion, patient requires CT scan/ MRI to stage bladder cancer. If disease is localized to bladder, patients require removal of bladder with prostate (radial cystectomy) after confirmation of histo-pathological diagnosis if not done. This is best option for cure. If a patient is not suitable for surgery because of medical  co-morbidities then radiotherapy can be considered. After removal of bladder an alternate passage is created for passing urine.
Common method has been to make a stomain abdominal wall (IIeaL conduit) where patient uses appliance  for lifelong to collect urine. Today in suitable cases a new urinary bladder can be made from the intestine and can be joined  to natural passage so that patients passes urine as he/ she was passing before. This is called orthotopic neo-bladder. Poorly performed surgery can lead to incontinence in these cases and patient will be forced to use diapers.
The author is the Director – Institute of Urological Sciences, Max  Healthcare, Delhi.
Thanks,
21/10/2012