It is a rare but a difficult cancer to treat because ofnthe important organ i.e. urinary bladder that is involved which is vital for control and evacuation of urine.
It usually presents as painless hematuroia –passing blood in the urine stream. It also laeds to pain in the lower abdomen and retention of urine in advanced cases.
The first sight of blood or blood tinged urine should aleretb the patient and physician to work up for the causew of the bleeding leading to adiagnosis of bladder cancer.
Once thers is a suspicion of bladder cancvert a cystocsopy is the first intervention.
This modality of direct visualization of the interior of the bladder will give access to biopsy and complete removal if the tumor is very small. If the Patient has a small and localised tumor that all is what is required.
Once a diagnosis is confirmed the next step is to stage the disease by C.T.scan and or an MRI scan of the abdomen.
TREATMENT
It is treated according to the extent of the disease (staging). Limited stage or volume disease are treated by some form of local excision guided by cystoscopy.
The vaccine BCG,which is usewd to treat PREVENT TUBERCULOSIS HAS SPECIAL PLACE IN THE TREATMENT OF BLADDER CANCER.
After removal of a localised tumor the bladder is instilled with this vaccine periodically over a period of three to six months.
Those tumors which are deeply invasive and large are usually treated by complete removal of the urinary bladder. after removal of the bladder the urinary stream is diverted via a intestinal conduit to the external collecting device .This form of diversion is now being replaced by a NEW FORM OF SURGICAL DIVERSION CALLED AS “ORTHOTOPIC NEOBLADDER”. Here a segment of patients own intestine is used to reconstruct a new bladder and is placed in place of his/her original urinary bladder so that the patient is able to allow the patient to pass urine by his/her natural passage through the external meatus.
We have done the largest number orthotopic neobladder reconstructions in Bangalore. The success rates are amazingly high and we continue to set high standards in the field of bladder surgeries.
The role of chemotherapy and radiotherapy in various combinations is being tested to avoid complete removal the bladder for large and deeply infiltrating tumors.
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