What is Invasive Bladder Cancer and Its Treatment Options .

BLADDER CANCER OVERVIEW   

Cancer of the urinary bladder is among the the most common cancers worldwide. urothelial carcinoma also called as transitional cell carcinoma is the most common type of cancer in united states and western Europe. The optimal treatment for urothelial bladder cancer depends on the cancer’s stage and grade (which describes how aggressive it appears). Here the optimal treatment also depends on the person’s health also.

  • Around 70 % of all new cases of bladder cancer are classified as non-muscle invasive. Initially the treatment for non-muscle-invasive bladder cancer is a procedure called “transurethral resection of bladder tumor,” or TURBT. This is sometimes followed by additional therapy, which minimizes the chances of the cancer recurring.
  • Approximately 30 percent are muscle-invasive bladder cancers, and they normally require surgical removal of the entire bladder. This is very often combined with preoperative and postoperative chemotherapy.

In some cases, the cancer can be successfully treated without removing the entire bladder.

WHAT IS INVASIVE BLADDER CANCER?  

The bladder tumors are staged using the TNM system. Here T stands for “tumor,” ; N for “node,” and M for “metastasis.” The information obtainedhere is then used to categorize the cancer into a “group stage” between O -which is least advanced up to IV – which is most advanced; this helps the doctor to decide on a treatment approach.

The stage indicates how deeply the tumor has penetrated the bladder wall (T stage), whether it has reached the lymph nodes (N stage) that drain the bladder or not , and whether it has metastasized or spread to other parts of the body (M stage). 

Invasive bladder cancer is stage T1 or greater, meaning that the tumor has invaded the lining of the bladder. T1 designates tumors that have invaded the surface lining of the bladder but not the muscle layer. In T2  stage, the tumor has invaded the muscle layer of the bladder but not deeper. In The stage T3 cancer has grown through the bladder muscle into the fat layer surrounding the bladder, while stage T4 cancer has grown directly into adjacent organs.

BLADDER CANCER TREATMENT OPTIONS 

The standard treatment used for muscle-invasive bladder cancer is called radical cystectomy, in which bladder is removed by surgery. This is a major operation. Radical cystectomy requires the creation of a new way to get rid of urine. For people with muscle-invasive bladder cancer who are able to tolerate more aggressive treatment, chemotherapy is often given before or after the surgery.

Which treatment is best? 

The best treatment for invasive bladder cancer depends on a number of factors

a) the stage of the cancer a

b) your age, health, other medical conditions, and personal preference.

Wherever possible, surgical removal of the bladder is preferred because it is associated with a lower chance of cancer recurrence . It has higher chances of survival compared with other treatments. However, preserving the bladder can be an option in some  cases.

Where will the urine go? 

After the bladder is removed, the surgeon will create a new place for urine to be collected inside the body. This is called a “urinary diversion.” All options involve using a segment of your intestines, which is removed from the small or large intestine. After removing a segment, the intestines are reattached so that they function normally. The section of intestine that is removed is cleaned and prepared for the procedure.

There are several possible options at this point:

  1. ILEAL CONDUIT: In this procedure urine can be diverted through a segment of bowel to the skin’s surface, where an opening , called a stoma, is created. A bag is attached to the stoma to collect the urine. The bag  sticks to the abdomen and collects the urine.  
  2. CONTINENT URINARY RESERVOIR : In this procedure you don’t have to wear a bag. A pouch like -reservoir may be created under the skin of the abdomen using tissue from the intestines. Urine collects in the pouch, and you use a thin tube called catheter to empty the pouch periodically. 
  3. NEOBLADDER RECONSTRUCTION: A new bladder may be created from a segment of bowel. The new bladder is connected to the tube through which urine exits the body  called -urethra, allowing the person to urinate normally. 

The “most suitable” type of urinary diversion depends on you and your surgeon’s preference as well as the extent of the cancer. The reservoir and neobladder may require learning how to self-catheterize, and hence may not be easy for those who find it difficult to handle the catheter.

Surgical complications :

Complications are quite possible after radical cystectomy and urinary diversion. The most common serious complications include wound opening, bleeding, infection and blood clots in the lungs.