Bladder Cancer

What are the causes of bladder cancer

  • Cigarette smoking
  • Family history of bladder cancer
  • Men are more vulnerable to developing bladder cancer possibly due to a greater incidence of cigarette smoking and exposure to toxic chemicals.
  • Exposure to dangerous chemicals such as arsenic, phenols, aniline dyes
  • Radiation therapy for prostate or cervical cancer and chemotherapy with cyclophosphamide (Cytoxan)
  • Chronic infections of the bladder due to stones or other foreign substances
  • Infections caused by  certain fluke

What are the symptoms of bladder cancer?


Blood in the urine or hematuria is the most common symptoms, other symptoms include Frequency, urgency, dysuria, pain in the flanks, bone pain.

How to diagnose a bladder cancer?

Majority patient diagnosed while evaluation for blood in urine. Always to be considered in a person with hematuria with more than 50 years of age. Tests used to diagnose are

  1. Urinalysis- will confirm hematuria
  2. Urine cytology- usually done in a centrifuged sample of urine. If positive high grade bladder tumor to be considered
  3. Ultrasound- it helps to detect presence of bladder tumor
  4. CT/MRI- it can also detect small tumor in the urinary system
  5. Cystoscopy/Biopsy- most important test to detect bladder tumor. It usually associated with TURBT. Resected tissue and Deep biopsy sent for Histopathological exam.

What are the treatment of bladder cancer?

The first surgical procedure is Transurethral Resection of Bladder Tumor or “TURBT.” This procedure is performed with the help of special instruments connected to a cystoscope and involves removing the tumor from the bladder with the help of electrical cautery equipment. This surgery is done through the normal urinary passage and does not involve an external incision on the body.

Next treatment depends on Grade and stage of diseases( TNM classification)

Diseases is mainly divided into superficial and muscle-invasive bladder cancer


What is the treatment of superficial bladder cancer?

  1. Intravesical therapy- BCG, Mitomycin, Gemcitabin etc
  2. Regular check up- by imaging , urinalysis, urine cytology, cystoscopy. Per se it is the most important part of treatment of bladder tumor treatment.


What is the treatment of muscle invasive bladder tumor?

Muscle invasive bladder cancer normally requires an aggressive treatment plan compared to superficial bladder cancer. Main treatment options are radical surgery or Radiotherapy

The most effective treatment for muscle-invasive bladder cancer is Radical Cystectomy. This process involves the surgical removal of the bladder and diverting the urinary stream using intestinal segments.

The procedure involves removal of the bladder, prostate, seminal vesicles, and the fatty tissue surrounding the bladder through an incision created in the abdomen. The lymph nodes in the pelvis are also removed in order to detect the presence of cancerous cells. This also helps in deciding further management measures post- surgery including the requirement for chemotherapy.

Radical cystectomy could be performed either through open surgery, laparoscopy, or with robotic assistance.After the removal of the bladder, the urine has to be diverted. This is done using any of the three urinary diversion methods namely; Ileal conduit, Orthotopic neobladder (where the patient passes urine from the normal passage) or Continent catheterizable pouch. All these methods use intestinal segments which are still attached to their blood supply but have been separated from the gastrointestinal tract

Radical cystectomy in combination with one of the three urinary diversion methods is the accepted and most effective treatment of muscle invasive bladder cancer and certain cases of high-grade superficial bladder cancer.

In certain cases Radiotherapy with or without chemotherapy is also considered as an options.

What is the role of chemotherapy?

Patients who have been diagnosed with metastatic bladder cancer are generally treated with chemotherapy. Chemotherapy may also be recommended for “locally advanced” bladder cancer in order to reduce the chances of recurrence of cancer after radical cystectomy. This process is called “Adjuvant chemotherapy.” “Neoadjuvant chemotherapy” is sometimes administered before radical cystectomy so as to improve the results of surgery and to reduce the size of the tumor.