Information For The Patients
DR IRFAN AHMED
CONSULTANT UROLOGIST and CANCER SURGEON
Bladder cancer is a growing problem in our country. It is the fourth most common cancer in males and fifteenth most common in females in Pakistan. Unfortunately due to poor record keeping, the true incidence and prevalence of this disease is not known. Karachi cancer registry established in 1995 and Agha Khan University cancer surveillance for Pakistan started in 2000 are the only two organizations for this purpose. Shaukat Khanum Memorial Cancer Hospital in Lahore is publishing its own cancer registry.
- The main risk factor for bladder cancer is cigarette smoking. It is related to number of cigarettes smoked per day and years of smoking.
- Bladder cancer risk increases with age.
- Other risk factors include use of certain hair dyes, working in industries which deal with making rubber, leather and paint material.
- Exposure to certain drugs particularly used to treat other cancers may also increase the risk.
- Lifestyle, fluid consumption and use of fruits are protective factors.
ORIGIN OF CANCER
Bladder is a part of urinary system. Its main function is to store and excrete urine. It is lined by a special layer of cells to prevent absorption of waste products from the urine. The bladder cancer arises from this inner lining of the bladder wall and as it grows it can progress deep into the bladder wall. Like other cancers if it is left unattended it can spread outside the bladder and into various other body organs. Bladder Cancer is different from many other cancers due to its high recurrence rate which largely depends upon the nature of the disease. Good behaving cancers carry much lower risk for the patients as compared to poorly behaving ones.
Blood in the urine / dark coloured urine is the cardinal symptom of bladder cancer.
It may also present with other lower urinary tract symptoms like
- increased voiding frequency,
- urgency or
- difficulty in voiding.
The initial investigations which must be performed for diagnosis are
- routine urine test.
- ultrasound examination.
- In most case, internal examination of the bladder must be performed. It can be done with flexible cystoscopy, a procedure performed under local anaesthesia.
After the diagnosis is established certain additional tests like CT scan or MRI are also required for proper evaluation of the disease.
In most cases the initial treatment is by endoscopic surgery performed at the time of diagnosis.
The important thing in Bladder Cancer management is accurate evaluation of cancer stage and grade by biopsy and then to design a long-term surveillance program.
Due to the high recurrence in this disease it requires close follow up by repeated endoscopic examination of the bladder.
In more advanced cases which are still localized to the bladder, the whole bladder has to be removed. In these cases urinary diversion can be provided either through a stoma on the abdominal wall or through bladder replacement internally. Internal bladder is constructed from small intestine and in most cases function nearly like normal bladder.
- Early diagnosis and regular follow-up are absolute essentials to manage this cancer effectively.
- All cases of blood in the urine must be promptly investigated particularly in patients above 40 years of age in both sexes.
- If neglected and disease spreads outside the bladder, it becomes un- treatable whereas at an early stage it is not only treatable but potentially curable cancer.
THE KEY FACTORS IN REDUCING THE INCIDENCE AND PREVENTING DEATH FROM THIS CANCER ARE:
- Public health education and awareness.
- primary prevention by cessation of cigarette smoking.
- increasing the availability of professionals to deal with the problem.
Should you or your Doctor be concerned about symptoms then you should be seen by a Consultant Urologist. Your initial consultation will consist of a detailed history, relevant risk factors and an over view of your general health and previous medical conditions.
You will also need a physical examination which is likely to include a rectal examination.
Following on from your initial consultation your clinician is likely to request some blood tests to asses your blood count and the kidney function. For patients who have presented with just blood in the urine then they are likely to require radiological investigations like x-ray or ct scan to assess the urinary system. Some patients who present with more complex symptoms may however require additional targeted investigations. These will all be discussed with you at the time of your consultation.
Finally almost all patients will require a camera test to allow a full inspection of the inside of your bladder (cystoscopy). This is almost always performed initially as an out-patient procedure with the use of local anaesthetic. A small fibre-optic camera (flexible cystoscopy) is passed into your bladder via your urethra (the tube you pass urine through) and then the bladder is filled with sterile water to allow a full inspection of its lining. In some cases this may be performed under general anaesthetic.
Once your clinician has all your result then they will discuss how best to manage your bladder cancer in a time appropriate manner.