Bladder cancer is now the 7th most common cancer in Singapore. Men are affected 3 times more often than women, and this happens mostly in those over 50 years of age. Causes of bladder cancer are aging, chemical agents, and smoking.
Diagnosis
A) X-ray
Because haematuria can arise from any part of the urinary tract, the standard initial study is visual intravenous Urogram (IVU) control. Includes injection of a contrast medium that separates from the kidneys to outline the urinary tract. Bladder tumors may appear as "filling defects" if the tumor is large enough.
Sometimes, a bladder tumor can be seen on the ultrasound if it is> 1 cm.
Negative IVU or ultrasound does not exclude bladder cancer as small tumors <1 cm, and can not be obvious.
B) Cytoscopy
With local anesthetic in using a flexible range without causing much discomfort. The advantage is that even small tumors can be seen with a biopsy to confirm if a cancerous bladder tumor is actually present as about 5% of bladder tumors may actually be benign.
C) Cytology
Although urine may be sent for cytological examination for the presence of cancer cells, its accuracy is limited by low sensitivity (<50% pickup rate). Consequently, the result can not be relied upon when deciding whether or not the patient is cancerous.
Treatment
I) Early stage
A) Surgery
Once the diagnosis of bladder lesion is confirmed, endoscopic surgery is done using a resectoscope tumor reduction tool (called TURBT).
80% of bladder tumors are superficial. The remaining 20% are invasive (ie invaded in the muscle layer of the bladder). Surface tumors carry a good prognosis but tend to repeat often. If so, they have a real risk becoming aggressive in the future, especially if the pathological class is an aggressive species or if the CIS is present. Invasive tumors will eventually spread into the lymph nodes and other organs, especially the lungs, bones and liver.
B) Chemotherapy
Those at high risk of relapse, for example. Multiple tumors, high grade and those with MIS disease are further treated with the choice of cytotoxic agents or immune enhancement agent (BCG) in the bladder (intravesical therapy) to prevent recurrence. A typical treatment protocol will consist of weekly infusion for 6 weeks, followed by a booster for more than 3 weeks. The most common cytotoxic agent is Mitomycin C. BCG is considered to be higher for tumors that are likely to recur and with MIS disease.
Ii) Second phase
Surgery
Treatment of patients with invasive bladder cancer should be individualized according to overall health status, cancer grade, and personal preference. Total removal for muscle-invasive bladder cancer (radical cystectomy) provides the greatest chance of cure. Partial cystectomy is rarely done because most bladder tumors are of a transient cell type and can be repeated in the rest of the bladder. After radical cystectomy, urinary kidney and ureteral deviates into a small segment of the small intestine (called the ileal canal) that opens like a stomach on the abdominal wall. The urine is collected in an external collection bag (urostomy).
B) Radiotherapy
Although radiotherapy is a safer option and allows for bladder protection, the 5-year survival rate of bladder cancer with muscle invasion is only 20% -40%. The limitation of radiotherapy is that it can not kill the cancer cells completely and will not have cumulative side effects on the bladder and the intestines, causing irritation.
