- Signs and Symptoms of the Bladder Cancer
- The Process of Diagnosing the Cancer
- The Procedure of Urinary Cytology
- Managing the Disease
Bladder cancer is considered to be the most frequent urologic cancer to occur. Besides, compared to all the rest malignant tumors, this one has the highest recurrence rate. Transitional cell carcinoma is known to most frequently occur in North and South America and Asia. There exist some other types of the cancer. They are squamous cell carcinoma and adenocarcinomas. You can see the image of the squamous cell carcinoma below.
Signs and Symptoms of the Bladder Cancer
When the disease occurs, there may be the followings symptoms present:
- Painless gross hematuria. Actually, about 80 to 90 % of patients suffer from it.
- Symptoms that imply that your bladder is being irritated. For instance, dysuria, urgent or frequent need to go to the toilet. About 20 to 30 % of patients are subjects to the symptoms mentioned.
- Painful sensations in the bones or pelvis. Lower-extremity edema or flank painful sensations. Those patients who suffer from an advanced case of the disease deal with the symptoms.
- A mass that is possible to palpate while you’re examined by your doctor. Actually, the symptom is quite rare in case of superficial bladder cancer.
The Process of Diagnosing the Cancer
The list of necessary procedures includes:
- A sample of your urine is to be studied under a microscope.
- Urine culture is to be studied with the view of detecting an infection if your doctor assumes that you may have it.
- Voided urinary cytology.
- Marker testing of urinary tumor.
The Procedure of Urinary Cytology
- Standard noninvasive diagnostic method is used.
- In case it is about an early stage of the cancer, there is low sensitivity for low grade.
- FISH or Fluorescence in situ hybridization is carried out so that to make the cytology results more accurate.
- The primary modality to diagnose the bladder carcinoma in your organism.
- Biopsy as well as resection of papillary tumors are allowed.
The Imaging of Upper Urinary Tract
- It is necessary to work up the hematuria.
- A contrast CT scanning of abdomen and pelvis is recommended by American Urologic Association Best Practice Policy. The procedure should include the stage of preinfusion and postinfusion.
- Ideally, the imaging procedure is to be carried out together with CT urography. Here, the doctors will need a multidetector CT.
- As a rule, ultrasonography is carried out. However, it may miss urothelial tumors located in the upper tract and small stones.
If your cystoscopy is negative, the strategy is as follows:
- A usual follow-up involving FISH.
- If the FISH is positive and your urine cytology is negative, the frequency of surveillance is increased.
- If urine cytology is positive and FISH is either positive or negative, you have cancer up until it’s proven to be otherwise.
There are no particular blood tests to be carried out in case of bladder cancer. However, there is a need to evaluate your general state before the therapy that involves intravesical BCG (Calmette-Guerin) vaccine.
As for the laboratory tests, there is a need for the following ones:
- CBC or complete blood count.
- Tests to evaluate the functioning of your liver.
- Bony fraction or alkaline phosphatase assay. This one is necessary only in case bone metastasis is suspected.
- Kidney function studies.
Managing the Disease
The treatment procedures in case you’re dealing with non-muscle invasive bladder cancer (stages Ta, T1 or CIS) include transurethral resection of bladder tumor (or TURBT for short) at the very beginning of treatment.
There may be the following subsequent treatment provided:
- If you’re fighting against a small-volume Ta low-grade bladder cancer, you need an immediate, postoperative dose of intravesical chemotherapy session. The session is to be carried out only once.
- If it’s about high-risk Ta, T1 or CIS stage of the carcinoma, the solution is intravesical BCG vaccine.
- If you’re dealing with either persistent or the disease that has a high rate of recurrence, you need to undergo resection once again before any additional intravesical therapy (for example, interferon alfa or gamma). Cystectomy is also a solution in this case.
The list of treatment procedures in case of muscle-invasive bladder cancer includes the following:
- Radical cystoprostatectomy in case of men.
- Anterior pelvic exenteration in case of women.
- Bilateral PLND (pelvic lymphadenectomy). It may be either standard or extended.
- Creation of a urinary diversion.
- Neoadjuvant chemotherapy sessions with the view of improving cancer-specific survival.
A bladder-sparing approach of TURBT may as well be followed by concurrent radiotherapy or systemic chemotherapy sessions (also known as trimodality therapy).
As for the chemotherapeutic regimens in case of metastatic bladder cancer, there are the following options:
- Methotrexate, vinblastine, doxorubicin (also referred to as Adriamycin), and cisplatin (also known as MVAC).
- GC or gemcitabine and cisplatin.