The bladder is located in the pelvis. It collects and stores urine and has a muscular wall that allows it to contract and expand.
About 90 percent of bladder cancers are transitional cell carcinoma. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma account for most of the rest. Treatment options vary depending on the type of bladder case.
Cancer that is only in the bladder lining is called non-muscle invasive bladder cancer (NMIBC). This type of cancer is sometimes called superficial bladder cancer. More than 75 percent of bladder cancer is diagnosed as a NMIBC and it has an excellent survival rate.
Muscle invasive bladder cancer penetrates the layers of muscles in the bladder and is more likely to spread to other parts of the body. About 90 percent of bladder cancers are transitional cell carcinoma. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma account for the rest
Bladder cancer is the result of cell changes in the mucous (inside) wall of the bladder. It is caused by changes in the cells' chromosomes or DNA (deoxyribonucleic acid).
This form of cancer develops most often in people between the ages of 60 and 79, with the average age being 67. The disease is three times more common in men than in women. It is one of the most common forms of cancer to strike men.
Symptoms
Generally the first sign is blood in the urine. It may be visible or the amount may be so small that it can only be discovered by chemical testing ('stix' test).
There does not need to be blood in the urine constantly. In fact, there are often periods in which there is no evidence of blood at all. So one should not be fooled by a symptom that seems to have gone away.
There may be frequent urination, stinging and pain across the pubic bone or exactly the same symptoms as in an ordinary bladder infection.
Types of bladder cancer
Transitional cell bladder cancer (TCC) is the most common type of bladder cancer. Nearly all cancers of the bladder start in the layer of cells (transitional cells) which form the lining of the bladder (transitional epithelium). These cancers are called transitional cell or urothelial cell cancers.
Bladder cancer may appear as a tumour which has grown into the muscle wall of the bladder. This is known as invasive bladder cancer.
Bladder cancer may also begin as a small growth only on the inner lining of the bladder (called papillary cancers). Sometimes these early cancers can start to grow into the muscle of the bladder and become invasive bladder cancer.
Carcinoma in situ (CIS) is a type of early bladder cancer which appears as a red, ulcerated area in the bladder. In CIS the cells are very abnormal or high-grade, so it can grow quickly. If it's not treated effectively, there's a high risk that CIS will become an invasive cancer.
Rarer types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancers start from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus. Both of these types are usually invasive.
Staging
The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment.
Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph glands or nodes that are linked by fine ducts containing lymph fluid. Doctors will usually look at the nearby lymph nodes to find the stage of the cancer.
There are four stages to cancer of the gall bladder : -
The cancer affects only the wall of the gall bladder. Approximately 1 in 4 cancers are at this stage when they are diagnosed.
: - The cancer has spread through the full thickness of the wall of the gall bladder, but has not spread to nearby lymph nodes or adjacent organs.
The cancer has spread to lymph nodes close to the gall bladder or has spread to the liver, stomach, colon or the small bowel.
The cancer has spread very deeply into two or more organs close to the gall bladder or has spread to distant lymph nodes or organs such as the liver or lungs. This is known as metastatic or secondary cancer.
A different system called the TNM staging system is sometimes used, in which : -
T describes the size of the tumour.
N describes whether the cancer has spread to the lymph nodes.
M describes whether the cancer has spread to another part of the body, such as the liver (secondary or metastatic cancer).
Treatment
The type of treatment you are given will depend on a number of factors, including your general health, the position and size of the cancer in the gall bladder and whether the cancer has spread to other areas of the body.
Consent
Before you have any treatment, your doctor will give you full information about what it involves and explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
a. Bladder Cancer
b. Resectoscope Cutting Loop cutting tumor
Surgery
Surgery is the main treatment for gall bladder cancer and may be used to remove all the cancer if it has not spread beyond the area of the gall bladder.
If the cancer has spread beyond the gall bladder, surgery may still be used to help improve a person's symptoms by removing as much of the cancer as possible.
Whether surgery is possible or not depends on the results of the investigations described above. You may be referred to a surgeon with a special interest in this rare cancer.
Radiotherapy : -
Radiotherapy treats cancer by using high-energy x-rays that destroy the cancer cells, while doing as little harm as possible to normal cells. It is occasionally used for cancer of the gall bladder. It may either be given externally from a radiotherapy machine, or internally by placing radioactive material close to the tumour.
Chemotherapy : -
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the cancer cells. They work by disrupting the growth of cancer cells. Chemotherapy has not been shown to be very effective for gall bladder cancer. However, it is thought that it may be helpful in controlling, for a while, gall bladder cancer that has spread elsewhere in the body.
Stent insertion : -
If cancer in the gall bladder is causing a blockage in the bile duct, it may be possible for the doctor to insert a small tube (stent) during the ERCP. This can help to relieve any jaundice without the need for a surgical operation.
The stent is about 5-10cm long and as thick as a ball-point pen refill. The stent clears a passage through the bile duct to allow the bile to drain away. The preparation and procedure is the same as for ERCP described above. By looking at the x-ray image the doctor will be able to see the narrowing in the bile duct. The narrowing can be stretched using inflatable balloons (dilators) and the stent can be inserted through the endoscope to enable the bile to drain.
The stent usually needs to be replaced every 3-4 months to prevent it becoming blocked. If it does block, jaundice and/or high temperatures will occur. It is important to tell your specialist about these symptoms as early as possible. Antibiotic treatment may be needed and your specialist may advise that the stent be exchanged for a new one. For most people this procedure can be done relatively easily
The list of of Gastroenterology Hospitals in India is as follows : -
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