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CANCER OF THE BLADDER
  • common disease

  • it is typically a transitional cell cancer has a high risk of lymphatic spread

  • penetration of the muscular wall predisposes the patient to a high risk of lymphatic spread

  • squamous cell carcinoma of the bladder is usually associated with chronic in-dwelling foley catheters and human papillomavirus infection

  • the malignant cells fail to express the ABH antigens

  • stoscopy and biopsy of the bladder are required to make a diagnosis

  1. smoking

  2. chemicals e.g. aniline dye, acrolein, benzidine

  3. ingestion of artificial sweeteners in analgesics calculi

  4. calculi

  5. parasitic infestations e.g. Schistosoma hematobium infection

  6. chronic bladder infections

  7. combustion gases


Signs and symptoms

  • may be asymptomatic

  • painless hematuria

  • urinary symptoms

  • lower abdominal (suprapubic) fullness

  • local spread to adjacent organs e.g. rectum, uterus

  • fistula formation.

  • pain as a terminal complain

 

TREATMENT

  • depends on the stage

  • intravesical chemotherapy with live BCG vaccine is used in patients with superficial disease

  • in patients with recurrence of carcinoma in situ , 2 cycles of intravesical chemotherapy is indicated. If there is progression of disease, cystectomy is necessary to ensure cure

  • In muscle invasive disease, radical cystectomy, neoadjuvant chemoradiation followed by surgery, segmental resection or deep TURBT are possible alternative treatment regimens

  • In metastatic disease, chemotherapy is the treatment of choice. Few drug combinations such as MVAC, Gemcitabine, Taxol ( plus or minus DDP or gemcitabine),ITP (ifosfamide, paclitaxel and cisplatin) and valrubicin have been found to be effective in some patients with BCG-refractory carcinoma in situ of the bladder and may offer a salvage therapy as an alternative to cystectomy (bladder removal) in these group of patients.