In the last decades there has been an increase in the incidence of bladder tumors. However, there have been significant advances in bladder cancer treatment, leading to increased survival.
The bladder is an organ whose function is to store the urine produced by the kidneys, until it is eliminated by contraction of its muscles.
Internally, the bladder resembles the interior of the oral cavity, being covered by a thin film, or mucosa, called urothelium. This same urothelium also lines the inside of the ureters, the pelves and the renal chalices, which transport the urine produced in the kidneys to the bladder. Under the bladder mucosa is an even thinner layer, called the lamina propria, and below this, the bladder musculature. Externally, the bladder musculature is surrounded by fatty tissue.
Not yet known are all the changes that lead to the development of bladder cancer. However, a number of substances have already been identified that are associated with a higher incidence of this type of tumor, especially those related to cigarettes and some chemical substances, such as hair dyes. Smoking is associated with 50% of all bladder tumors diagnosed in India as an isolated factor. Prolonged exposure to paints and dyes appears to be the cause of these tumors in 20% to 25% of patients, says urologist in Hari Nagar.
More than 90% of malignant bladder tumors originate in the urothelium, most of which are confined to the mucosa and submucosa (superficial tumors), with no muscle involvement (infiltrative tumors).
According to the best urologist in Hari Nagar, the most frequent symptom is the presence of visible bleeding in the urine (hematuria), usually bright red and accompanied by coagulated blood. More rarely, this bleeding can only be seen through a urine test.
The exclusive presence of hematuria, microscopic or not, is insufficient for the diagnosis of bladder cancer, as it can be a symptom of other diseases, or even be considered “normal” for some individuals. Therefore, further tests are needed to diagnose bladder tumors.
Other symptoms associated with bladder cancer are very frequent urination and painful urination (dysuria). Again, these symptoms are also nonspecific and only suggest the possibility of a bladder tumor.
Through clinical history and physical examination, the urologist in Janakpuri may suspect this disease. As the presence of bleeding in the urine can result from other diseases in the kidneys, in the collecting systems (goblets and renal pelves), in the excretory pathways (ureters) and in the bladder, the best urologist in Janakpuri may order some imaging tests (computed tomography, ultrasound, resonance) magnetic, excretory urography) to assess these structures.
The analysis of urine may also include the analysis of urothelial cells that are released and carried by the passage of urine (urinary cytology), as well as some substances dissolved in it and that may be related to urothelial tumors.
The most important diagnostic test for bladder tumors is endoscopy (cystoscopy), which allows the urologist in Delhi to view the inside of the bladder. This examination can usually be performed without the need for hospitalization and under mild sedation, or even under local anesthesia through the introduction of an anesthetic jelly in the urine channel (urethra).
If the urologist in Dwarka diagnoses the presence of a tumor, or if they have already been diagnosed through imaging tests, there will be a need for hospitalization to perform an endoscopic surgery. This surgery takes place under general or epidural anesthesia / spinal anesthesia, in which we will try to “scrape” (transurethral resection – TURP) the entire visible tumor, which will allow the study of its microscopic characteristics (anatomopathological study), fundamental data for defining the prognosis and bladder cancer treatment.
The anatomopathological study will allow the pathologist to examine tumor cells and compare them with normal cells in the same tissue. With this, the best urologist in Dwarka will be able to conclude how much the tumor cells differ from the normal ones and classify the tumor in “low grade” and “high grade”. The tumor grade reflects the aggressiveness of the tumor, that is, the probability of becoming infiltrative, if it is a superficial tumor, or of spreading through the body (developing metastases).
The pathologist will also define how deep the tumor has invaded the bladder, whether it has compromised only the mucosa and submucosa (superficial tumors), or whether there has already been involvement of the bladder muscles (infiltrative tumors).
Through radiological exams, the urologist in Palam will check for possible involvement of other structures in the body, especially the lungs, liver and lymph nodes (lymph nodes) located inside the belly (abdominal cavity). All of this information constitutes tumor staging and it is this that will define the most appropriate form of treatment, as well as the prognosis.
Staged tumors such as Ta, Tis and T1 are considered superficial tumors. Most Ta tumors are low grade tumors and rarely progress to infiltrative tumors. However, they are often recurrent. T1 stage tumors, on the other hand, often evolve with involvement of the bladder muscles.
The Tis stage features a type of high-grade tumor called “in situ” carcinoma (CIS). These tumors are difficult to remove and are treated by bladder instillation of substances, such as BCG. When left untreated, they end up evolving to infiltrative tumors.
Removal of stage Ta and T1 tumors – Performed through endoscopic scraping (resection) by transurethral approach (RTU), which allows material to be obtained for anatomopathological study.
Chemotherapy and intravesical immunotherapy – After removal of the tumor by endoscopic route, depending on the case, and particularly in the CIS, the best urologist in Delhi may opt for intravesical instillation of immuno or chemotherapy in order to reduce the incidence of recurrences. Intravesical instillation is performed through a catheter (probe) inserted into the bladder through the urethra. The procedure is done on an outpatient basis, requiring only local anesthesia obtained with the introduction of an anesthetic jelly in the urethra.
The instilled substance is retained in the bladder for approximately 1 hour, and then eliminated through urination. After instillation, the patient is expected to experience a little burning sensation when urinating, which may persist for 24 to 48 hours. The most frequently used immunotherapeutic drug is BCG. Among chemotherapeutic agents, thiotepa, doxorubicin, and mitomycin-C may be used.
Cystectomy – Partial or complete removal of the bladder may be necessary in patients with CIS or high-grade T1 stage, who do not respond to intravesical chemotherapy and immunotherapy. In these situations, the risk of developing infiltrative disease is greater, which requires more aggressive treatments in order to reduce the possibility of metastasis.
Cystectomy is also the most appropriate way to treat infiltrative tumors (which affect the bladder muscles). It may be preceded by systemic chemotherapy (intravenous injection of chemotherapeutic drugs) in special situations. Exceptionally, infiltrative tumors can be treated only with endoscopic resection associated with chemotherapy and radiotherapy.
With the complete removal of the bladder, it becomes necessary to create an alternative for the elimination of urine produced by the kidneys (urinary diversion).
The preferred way, whenever it is possible to use it, is to make a “new” bladder with a segment of the intestine. This surgery allows the urine produced to be stored in this intestinal reservoir (neo-bladder ileal) to be eliminated by the urethra, allowing the patient to live with a very good quality of life. However, some tumors may make this form of urinary diversion impossible, requiring the use of urinary collection bags attached to the skin, or that a drainage of the urine into the intestine be created.