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Bladder cancer ( transitional cell carcinoma )

*Typically affects older males who smokes a lot
*Typically presents with passage of urine mixed with blood
*Usually diagnosed early
*If diagnosed early this cancer is curable
*High chance of recurrence ; so strict follow up is very essential

Bladder cancer ( transitional cell carcinoma ) falls into 2 categories
Urinary bladder wall has 4 layers ; inner lining is known as mucosa or mucous membrane. Underneath lies sub mucous layer. 3rd layer is muscle layer. 4th layer is known as adventitia. SUPERFICIAL CANCER is confined to mucosa and submucosa. To start with and all early stage cancers are superficial. Importance of this is if superficial tutors are removed endoscopically ( TUR – BT ) then patient gets a cure. Except follow up ( as superficial cancers may recur ) no further treatment is required. 

When superficial cancers are not diagnosed or patients default in taking treatment then they gradually penetrate into the muscle layer and become deep invasive cancer. All deep cancers require endoscopic removal of tumour and in addition will need bladder removal ( radical cystectomy ) or chemotherapy/ radiotherapy. 

How bladder cancers are diagnosed ?
Patients usually complains of hematuria that is blood in urine. Sometimes increased urinary frequency , urgency , burning sensation during urination may be the presenting symptoms. Diagnosis is easy ; simple SONOGRAPHY will clinch the diagnosis. Before surgery CT scan of whole abdomen is must. CT helps us to accurately diagnose bladder tumour and gives us some idea about stage of cancer.Confirmation of deep cancer or muscle invasion is made only from histopatholgical study. Even CT or MRI fails to tell us accurately about muscle invasion. After a bladder tumour is diagnosed on sonography or CT / MRI then patients are subjected to hospital admission for endoscopic removal of tumour ( TUR BT ). After resecting the tumour further tissues are taken from muscle layer ( deep muscle biopsy ). They are sent for histopathological examination.

What is BCG therapy ?
It’s only for superficial bladder cancer. Bladder cancer has predilection for recurrence over time. If initial tumour is high grade ( high grade tumour tends to grow faster ) then chance of recurrence is very high. When BCG vaccines are instilled into the bladder they are highly effective in preventing recurrence. Usually BCG vaccine is instilled into the bladder once a week for 6 weeks. Done as an outpatient procedure. Usually well tolerated with minimum side effects. Rarely serious side effects may occur. If BCG is not tolerated by the patient then another drug MITOMYCIN is instilled into the bladder. It has significantly less side effects but  less effective than BCG.

What are superficial bladder cancer follow up protocol ?
After main treatment is over then patients are advised to come 03 monthly for sonography and urine test for malignant cells. They are further subjected to check cystoscopy every 06 monthly for a period of at least 05 years.In check cystoscopy a fine endoscope ( telescope with a camera fitted ) is passed into the bladder to visualise bladder interior. It looks for any small tumour that might be missed by sonography or CT

All deep bladder tumour needs radical cystectomy ( removal of bladder ) or patients are not fit for surgery or not willing for surgery then chemotherapy or radiotherapy forms maistay of treatment.

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