Bladder cancer is the sixth most common cancer in India. In recent decades there has been a steady increase in the incidence of bladder cancer. However, doctors are making progress in treatment, and survival rates are improving. But what are its symptoms? How should it be treated? The following information should help you talk to the best urologist in Delhi about this condition.

 

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What happens under normal conditions?

The bladder is a hollow balloon-shaped mostly muscular organ that stores urine until ready for release. The urine is produced in the kidneys. It flows through tubes called the ureters into the bladder and is discharged through the urethra during urination. The bladder muscle aids urination by contracting (tightening) to help force out the urine.

A thin surface layer called the urothelium lines the inside of the bladder. Next is a layer of loose connective tissue called the lamina propria. Covering the lamina propria is the bladder muscle. Outside of the bladder is a layer of fat.

What causes bladder cancer?

The ways in which bladder cancers develop and progress are only partly understood. However, a number of substances that cause the cancers to develop have been identified. Chief among them are cancer-causing agents in cigarette smoke and various industrial chemicals. Cigarette smoking alone has been estimated to cause 50 percent of all bladder cancer cases in India. Long-term workplace exposure to chemical compounds such as paints and solvents has been estimated to cause another 20 to 25 percent of bladder cancer cases. Carcinogens in the bloodstream out by the kidneys to eliminate them from the body. However, these carcinogens remain in the bladder for a few hours interacting with the lining of the bladder before they are removed by urination. Through this process the bladder becomes a high risk organ for cancer, particularly in smokers.

More than 90 percent of all bladder cancers originate in the urothelium, the inner lining of the bladder. The majority of diagnosed bladder tumors are confined to the urothelium or the lamina propria and have not invaded the bladder muscle.

What are the symptoms of bladder cancer?

Blood in the urine (hematuria) is the most common symptom. It eventually occurs in nearly all cases of bladder cancer and is generally described as “painless”. Although the blood may be visible during urination, in most cases, it is invisible except under a microscope. In these, the blood is usually discovered when analyzing a urine sample as part of a routine examination. Blood in the urine, similar to blood in the stool or coughing up blood, is a potential warning sign of cancer, and should not be ignored.

Hematuria does not by itself indicate or confirm the presence of bladder cancer. Blood in the urine has many possible causes. For example, it may result from a urinary tract infection or kidney stones rather than from cancer. It is important to note that hematuria, particularly microscopic, might be entirely normal for some individuals. A diagnostic investigation is necessary to determine whether bladder cancer is present.

Other symptoms of bladder cancer may include frequent urination and pain upon urination (dysuria). Such “irritative” symptoms are less common. When present in the absence of a urinary infection (which may have similar or identical symptoms) exclusion of a bladder cancer as the possible cause is mandatory.

How is bladder cancer diagnosed?

The diagnostic investigation begins with a thorough medical history and a physical examination. The onco surgeon in Delhi will ask the patient about past exposure to known causes of bladder cancer, such as cigarette smoke (either through personal smoking or through “second-hand” smoke) or chemicals. Also, because hematuria can come from anywhere in the urinary tract, the cancer surgeon in Delhi typically order radiological imaging of the kidneys, ureter and bladder to check for problems in these organs. In this era, this is most often accomplished by a CT Urogram (CT scan focused on the urinary tract).

Diagnostic tools to check for bladder cancer include various types of urinalysis. In one type, the urine is examined under a microscope to look for cancer cells that may have been shed into the urine from the bladder lining (urinary cytology). Urine cytology is analogous to a Pap Smear, in this case looking for cancer cells that are sloughed off in the urine. Urine can also be tested for substances known to be closely associated with cancer cells (tumor markers).

The most important diagnostic tool for urologist in Delhi is cystoscopy, which is a procedure that allows direct viewing of the inside of the bladder. This is most commonly performed as an office procedure under local anesthesia or light sedation. First, a topical anesthetic gel is applied, so the patient will feel little or no discomfort. The doctor then inserts a viewing instrument called a cystoscope through the urethra and into the bladder. Looking through the cystoscope, the doctor is able to examine the bladder’s inner surfaces for signs of cancer. Modern cystoscopes are soft and flexible, and this procedure is generally well tolerated.

If tumors are present, the doctor notes their appearance, number, location and size. As removal (resection) of the tumors cannot usually be done under local anesthesia, the patient is then scheduled to return for a surgical procedure to remove the tumor under general anesthesia or spinal anesthesia. In a manner as before, the doctor inserts an instrument, called a resectoscope, into the bladder. This is a viewing instrument similar to the cystoscope, but contains a wire loop at the end for removing tissue. This procedure is done through the urethra and is called a transurethral resection of bladder tumors. The removed tissue is sent to a pathologist for examination. Pathologists are specialists who interpret changes in body tissues caused by disease. If cancer cells are found, doctor can suggest starting bladder cancer treatment in Delhi.