4845 Knightsbridge Blvd, Suite 200, Columbus, Ohio 43214 (614) 442-3000
CANCEROUS BLADDER TISSUE |
Bladder
cancer is one
of the more common diseases treated by urologists. They exhibit the entire
spectrum of aggressiveness, from virtually benign superficial
tumors, to highly malignant aggressive tumors. Approximately 54,300
new cases of bladder cancer will be diagnosed in the United States in
2001. Bladder cancer is now the fourth most common cancer among
American men and the ninth most common cancer among American women..
This cancer is approximately 3 times more common among men than
women. It is estimated that approximately 12,400 bladder
cancer deaths will occur in 2001. Although bladder cancer can occur at any
age, it is generally a disease of the elderly, with a median age of
diagnosis being approximately 68. Factors thought to cause
bladder cancer include: occupational exposure to chemicals; cigarette
smoking; analgesics; artificial sweeteners; bacterial parasitic
infections; bladder calculus; pelvic irradiation, and some chemotherapy
agents. It is estimated that occupational exposure counts for
1/4 to 1/3 of bladder cancer cases in the United States. Cigarette
smokers have a much higher incidence of bladder cancer than non smokers,
and large doses of artificial sweeteners, including saccharin
and cyclamates, have shown in experimental studies to be bladder
carcinogens in animals. A variety of changes occur in the lining cells of the bladder in response to inflammation, irritation or carcinogens. This leads to displasia, which refers to changes in the lining cells that are intermediate between normal lining cells and cancer incitu. Cancer incitu is a velvety patch of red lining tissue, on cystoscopic examination, and consists of twirly differentiated cells of cancer confined to the lining of the bladder. |
More than 90% of bladder cancers are transitional cell carcinomas. The two major categories are superficial non-invasive and invasive cancers. When a bladder cancer invades it can perforate the boundaries of the bladder ,thus becoming metastatic disease. Approximately 70% of bladder cancers are low-grade superficial tumors.
Most patients, 80 to 90%, with invasive bladder cancer already have invasive disease at the time of the initial diagnosis.
The most common presenting symptom of bladder cancer is painless blood in the urine which occurs in about 85% of the patients. Other symptoms include: bladder irritability, with urinary frequency, urgency and pain with urination; flank pain, because of obstruction of the ureter; lower extremity swelling; weight loss; and at times abdominal and/or bone pain.
Malignant cells can be observed on microscopic examination of urine sediment ( bladder washings ) which is referred to as cytology.
X-ray pictures ,including the IVP, can show changes in the outline of the bladder. Cystoscopy , an examination where a small scope ,usually of flexible fiber-optic design, can be inserted into the bladder to observe the lining . When the bladder tumor is diagnosed ,by this method, the next treatment option is usually to use an instrument called a resectoscope to remove a sample of the tissue so it can be tested.
Management of bladder cancer. The transuretheral resection can be curative if the tumor is not invasive. At other times more aggressive treatment, such as removal of the bladder known as cystectomy is required . There are certain types of superficial bladder tumors that will respond to medication placed into the bladder, the most efficient being BCG, which is a tuberculus organism that creates a very intense immune response that can result in the bladder shedding its lining and being replaced with new healthy cells.
The invasive bladder tumors, however ,are usually treated by surgical removal of the bladder, known as radical cystectomy, this then creates the need for a way to bring the urine from the ureters (the tubes draining the kidneys to the outside).
The standard treatment in the past has been, an isolated intestinal conduit called ,an illeoconduit. An ostomy is created in the abdominal wall and a collection bag has is applied to this and then changed periodically.
Continent urinary diversion has developed a predominant place in the treatment of bladder cancer and since 1983, this involves creating a " substitute" bladder from intestine that can either be brought to the skin in an continent form so that through an ostomya small catheter is placed to empty the continent reservoir ;or this reservoir can be connected to the urethra in such a way that the normal sphincter mechanism can work and make the patient able to urinate in the normal fashion and be continent of urine.
The most sophisticated form of urinary diversion at this time is the koch pouch continent urinary diversion. In this situation a bladder reservoir is made from the ileum fashioned into a vessel like the bladder and attached to the urethra. Riverside Urology has had much experience and expertise in applying this type of treatment to the diagnosis of invasive bladder cancer, and this option has made it possible for patients ,who have been unfortunate enough to have bladder cancer, to be cured of their disease and to be able to urinate in an essentially normal manner. This type of urinary diversion can be used for both men and women.
