by : Mike Singh

Bladder Cancer
What is this condition?
Bladder cancer is a tumor that develops on the surface of the bladder wall or that grows within the bladder wall and quickly invades underlying muscles. Bladder tumors are most common in men over age 50 and occur more often in densely populated industrial areas.
What causes it?
Certain carcinogenic substances can predispose a person to bladder cancer. These include 2-naphthylamine, benzidine, tobacco, and nitrates. So, workers in certain industries - rubber workers, weavers, leather finishers, aniline dye workers, hairdressers, petroleum workers, and spray painters - are at high risk.
What are its symptoms?
About 25% of people with bladder cancer have no symptoms during the early stages. Typically, the person first notices blood in the urine. Usually, this is painless, but people with invasive cancers may have pain above the pubic area after urinating. Other symptoms include bladder irritability, frequent urination, nighttime urination, and urine dribbling.
How is it diagnosed?
To confirm bladder cancer, the doctor will do a biopsy (in which he or she removes some bladder tissue) and will insert an instrument called a cystoscope into the urethra to visualize the urinary tract (this procedure is called cystoscopy).
The person should have cystoscopy when blood first appears in the urine. The doctor will try to determine if the tumor has invaded the prostate gland or nearby lymph nodes.
Other tests that provide important information about the tumor include urinalysis, X-rays of the urinary system, X-rays of the bladder and blood vessels in the pelvis using contrast dyes, computed tomography scan (commonly called CAT scan), and ultrasound.
How is it treated?
The surgeon will remove a superficial bladder tumor by a procedure called transurethral resection and fulguration (electrical destruction). This procedure is adequate if the tumor has not invaded the muscle.
To treat superficial tumors (especially those occurring in mall" sites) and to help prevent the cancer from recurring, the doctor may wash the bladder directly with anticancer drugs.
If more tumors develop, fulguration may have to be repeated every 3 months for years. But if the tumors invade the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Treating larger tumors
If the tumor is too large to be treated by means of a cystoscope, the surgeon will remove a section of the bladder - provided that the tumor isn't near the bladder neck or the openings of the ureters (the pair of tubes that carry urine from the kidneys into the bladder). To help control such tumors, the drug thiotepa may be instilled into the bladder after surgery.
Treating infiltrating tumors
Bladder removal (also called radical cystectomy) is the preferred treatment for an infiltrating bladder tumor. The week before the operation, the person may undergo external beam therapy to the bladder. Then, during surgery, the doctor removes the bladder along with adjacent fat, lymph nodes, the urethra, the prostate and seminal vesicles (pouches in the lower part of the bladder surface in males), and the uterus and some nearby structures (in females). The surgeon forms a channel for urine drainage, called a urinary diversion. The most common type of channel is called an ileal conduit. The person must then wear an external pouch at all times to collect and drain the urine.
Males are impotent after radical cystectomy and urethrectomy (removal of the urethra or a part of it) because these procedures damage the nerves that control erection and ejaculation. Later, they may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Treating advanced bladder cancer
Treatment for advanced bladder cancer includes surgical removal of the bladder, radiation therapy, and chemotherapy with such drugs as cyclophosphamide, fluorouracil, doxorubicin, and cisplatin. This combination sometimes can halt bladder cancer.
Experimental treatments
Researchers are investigating several treatments, including photodynamic therapy and administration of the drugs interferon alfa and tumor necrosis factor directly into the bladder. In photodynamic therapy, the person receives an intravenous injection of a photosensitizing agent, such as hematoporphyrin ether, which cancer cells readily absorb. Then a cystoscopic laser device delivers laser energy into the bladder, killing the cancer cells. This treatment also causes photosensitivity in normal cells, so the person must avoid all sunlight for about 30 days.