The bladder is a hollow muscular organ in the lower part of the abdomen that stores urine made by the kidneys. Bladder holds the urine until it passes out through the urethra. Abnormal growth of cells or malignant cells that form in the tissues of the bladder is called bladder cancer. It can cause due to exposure to chemicals, smoking and tobacco abuse, radiation exposure, chronic inflammation of bladder, family history of cancer etc. Bladder cancer can be diagnosed at the early stages when it is easier to treat but early stage bladder cancer can recurs or advances to higher stage.
Some of the symptoms of bladder cancer include:
• Blood in urine (hematuria)
• Painful urination
• Pain in pelvic region
• Back pain
• Frequent urination
There are mainly three types of bladder cancer which starts in the cells in the lining of bladder. These three cancers are:
• Transitional cell carcinoma – malignant cells in the innermost tissue layer of the bladder. These cells can stretch when the bladder is full and shrink when it is emptied. These transitional cells can be of low or high grade. Low grade transitional cell carcinoma usually recurs after the treatment and can spread into the muscle layer of the bladder or to the other body parts whereas high grade transitional cell carcinoma can also recur and spread into the bladder muscle layer or the other body parts and to lymph nodes.
• Squamous cell carcinoma - is related to chronic inflammation of the bladder (from infection or from long term use of urinary catheter.
• Adenocarcinoma – cancer begins in glandular or secreatory cells found in the lining of the bladder is adenocarcinoma. This is a rare type of bladder cancer.
Bladder cancer can be diagnosed by doing several tests such as:
• Cystoscopy - this test is done by using a small narrow tube that has lens called cystoscope through urethra. The lens in the cystoscope allows the doctor to see inside the urethra and bladder to examine any sign of disease.
• Biopsy – during cystoscopy, a special tool is passed through the scope into the bladder to collect a cell sample for testing. This is sometimes called transurethral resection of bladder tumor (TURBT) that can also be used to treat bladder cancer.
• Urine cytology – urine sample is taken for analyzing under a microscope to check for cancer cells.
• Imaging tests – such as computerized tomography (CT scan) urogram in which a contrast dye is injected into a vein in the hand that eventually flows into the kidneys, ureters and bladder. Doctor will take x-ray images during the test which provide a detailed view of the urinary tract that allow the doctor to determine the area that might have cancer, retrograde pyelogram is x-ray exam that give the detailed look at the upper urinary tract. Doctor inserts a thin catheter through the urethra into the bladder to inject contrast dye into the ureters. This dye then flows into the kidneys while x-ray images are captured.
After confirming the presence of bladder cancer, doctor may perform some additional tests such as bone scan, MRI, chest X-ray to determine the stage and grade of the cancer.
The stages of bladder cancer are:
• Stage 1 – cancer occurs in inner lining of the bladder but has not spread to the muscular bladder wall.
• Stage 2 – cancer has spread to the muscular bladder wall but is still inside the bladder.
• Stage 3 – cancer spread through the bladder wall to near tissue
• Stage 4 – cancer cells spread to the lymph nodes and other organs of the body such as bones, liver or lungs
Bladder cancer tumors can be classified by the appearance of the cancerous cells under a microscope. This is called grading.
• Low –grade bladder tumor – low grade tumor typically grows slowly and is less likely to spread to the muscular wall of the bladder.
• High grade bladder tumor –these tumor cells looks abnormal and tends to grow more aggressively than a low grade tumor. They are more likely to spread to the muscular wall of the bladder and to the other body organs.
Treatment for bladder cancer depends on various factors like type of cancer, grade and stage of cancer. Bladder cancer treatment includes:
1. Surgery – can be done to remove the cancerous tissue or cells
2. Intravesical chemotherapy – can be done early stage to treat the tumor confined to the lining of the bladder but have higher risk of recurrence.
3. Reconstruction – in this, a new path is created for urine to pass out from the body after removal of the bladder.
4. Radiation therapy – radiation therapy is given to destroy the cancer cells in the bladder. This can be done at early stage or when the surgery is not an option for treating the cancer.
5. Immunotherapy- body’s immune system is triggered to fight cancer cells either in the bladder or throughout the body.
It is very important for patient to receive follow up care as bladder cancer often comes back. Regular doctor’s visits, checkups and tests are recommended.
There are some disadvantages associated with bladder cancer treatment such as:
• Sexual problems (less sexual pleasure)
• Lose of sex drive
• Women who have their bladder removed will also have their ovaries and uterus removed as a result cannot become pregnant
• Men may have erection problem or may not able to produce semen.
Kidneys are a pair of bean shaped vital organs located at the backside of the abdomen cavity. Its main function is to filter blood and remove excess water and waste from the body. When an abnormal growth of cells starts forming in the tissue of the kidney, it leads to kidney cancer.
Laparoscopic radical nephrectomy is a minimally invasive technique for complete removal of diseased kidney and larger tumor (larger than 4-5 cm). it is much preferred treatment option that provides patients with a safer, quicker recovery, reduced pain, blood loss, minimum hospital stay and improved cosmetic result as compared to the traditional open surgical method. Patients who have some serious medical conditions like a lung and heart disease that may not able to tolerate laparoscopic approach due to the need of undergoing a general anesthesia should consider different method of treating renal disease. The result rate of laparoscopic radical nephrectomy and open surgery are almost similar.
Doctor will perform some tests such as complete medical history of the patient, X-rays, CT scan, MRI scan, sonogram to evaluate the overall health of the patient at the time of consultation along with some pre-operative tests like electrocardiogram (EKG), complete blood count (CBC), blood coagulation profile (PT/PTT), urinalysis to determine whether the patient is eligible for surgery or not.
Patient will be asked to avoid some medicines such as steroidal anti-inflammatory drugs that can cause bleeding a week prior to the surgery day. Patient required not eating or drinking after midnight before the day of surgery.
During the surgery, patient will be given a general anesthesia and then surgeon will make 3-4 small incisions in the abdomen to allow him to insert a telescope connected to a camera and hand held surgical instrument which helps to have an enlarged and clear view inside the body to guide him through the procedure. The abdomen will be filled with carbon dioxide gas to create a larger working space that allow the surgeon to completely free and dissect the kidney. The blood supply to the kidney will be stopped for safe and efficient removal of the kidney with minimal blood loss during the surgery. In some cases, the adjacent adrenal gland may also be removed if the tumor is large or is very close to it. The kidney is then placed within a plastic bag and removed intact carefully. Incisions will be closed using plastic surgery techniques to minimize the scarring. The whole surgical procedure can take 2 to 3 hours. Patient will be shifted to the recovery room till the time patient is fully awake and his/her vital signs are stable. Some pain medications and antibiotics will be given to the patient through IV for few days. Hospital stay can vary from 2-3 days depending on the condition of the patient. Driving and sitting for long hours should be avoided for some time instead taking walks is advised. In laparoscopic radical nephrectomy, patient is often able to return to their regular activities within a few weeks.
Almost all surgeries have some risks and complications associated with them. Laparoscopic radical nephrectomy is less invasive surgery but there are still some complications involved with this that may include:
• Unexpected blood loss
• Injury to surrounding tissues or organ
• Incisional Hernia