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Cancer of the urinary bladder

There are two forms of bladder cancer: superficial (which tends to recur) and invasive. About 80% to 90% of all bladder cancers are transitional cell (which means they arise from the transitional cells of the bladder); the remaining types of tumors are squamous cell and adenocarcinoma.

Cancer of the urinary bladder

Cancer of the urinary bladder is more common in people aged 50 to 70 years. It affects men more than women (3:1). Bladder cancer is the fourth leading cause of cancer in American men, accounting for more than 12,000 deaths in the U.S. annually (American Cancer Society, 2002). Bladder tumors account for nearly 1 in 25 cancers diagnosed in the United States.
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Cancer of the urinary bladder

Research has demonstrated that many individuals with bladder cancer for which a total cystectomy is required go on to develop upper urinary tract tumors

Risk Factors
Cigarette smoking Environmental carcinogens: dyes, rubber, leather, ink, or paint Recurrent or chronic bacterial infection of the urinary tract Bladder stones High urinary pH High cholesterol intake
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Risk Factors
Pelvic radiation therapy Cancers arising from the prostate, colon, and rectum in males Chronic use indwelling Foley catheters Occupational hazards (aluminum workers, dry cleaners, manufacturers of preservatives, pesticide applicators)
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Clinical Manifestations
Painless hematuria Urinary frequency and nocturia Pain, when present, typically reflects the location of the bladder tumor. Lower abdominal pain may occur as a result of a bladder mass Rectal discomfort and perineal pain can result from tumors invading the prostate or pelvis.
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Clinical Manifestations
Tumors of the renal pelvis, ureter, or the ureteral orifice of the bladder can cause hydronephrosis, reduced renal function, and flank pain. Patients with more advanced disease may have anorexia, fatigue, weight loss, or pain from a metastatic bone lesion.

Diagnosis
Individuals older than 40 years in whom hematuria develops should undergo evaluation for the presence of urothelial cancer; studies should include urinary cytology and cystoscopy. In selected patients, additional imaging of the urinary tract may be required.

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Diagnosis
Screening asymptomatic subjects for hematuria increases the probability of diagnosing bladder cancer at an earlier stage but does not improve survival; thus, it is not routinely recommended.

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Diagnostic Procedures
Cytology Cystoscopy Biopsy Imaging Studies

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Treatment
Surgical Management Pharmacologic Therapy Radiation Therapy

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Surgical Management
The standard initial treatment of superficial bladder cancer is a complete transurethral resection with the cystoscope followed by surveillance flexible cystoscopy at threemonth intervals to monitor disease recurrence.

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Surgical Management
Transurethral resection or fulguration (cauterization) may be performed for simple papillomas (benign epithelial tumors). These procedures eradicate the tumors through surgical incision or electrical current with the use of instruments inserted through the urethra.

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Surgical Management
After this bladder sparing surgery, intravesical administration of bacillus Calmette-Gurin (BCG) is the treatment of choice. Valrubicin chemotherapy has been approved by the Food and Drug Administration for BCGrefractory patients.

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Surgical Management
A simple cystectomy (removal of the bladder) or a radical cystectomy is performed for invasive or multifocal bladder cancer. Radical cystectomy in men involves removal of the bladder, prostate, and seminal vesicles and immediate adjacent perivesical tissues.

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Surgical Management
In women, radical cystectomy involves removal of the bladder, lower ureter, uterus, fallopian tubes, ovaries, anterior vagina, and urethra. It may include removal of pelvic lymph nodes. Removal of the bladder requires a urinary diversion procedure.

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The Case
Patients Initials: Age: Sex: AAAQ 75 years Male

Nationality: Saudi

AAAQ was admitted under the care of Dr. Siddiqui with complaints of hematuria for more than forty-five days. It was associated with severe burning sensation in the lower abdomen. He had complaints of nocturia, weight loss and loss of appetite.
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The Case
Patients Initials: Age: Sex: AAAQ 75 years Male

He is a known hypertensive and diabetic on regular medication. He was posted for urethro-cystoscopy under general anesthesia.

Nationality: Saudi
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The Case
Patients Initials:
Age: Sex:

Nationality: Saudi

Upon admission of AAAQ at the MDH Surgical ward, vital AAAQ signs were checked: afebrile, 75 years eupneic, normocardic, hypertensive with blood pressure of 180/90 mmHg. Male Pre-operative investigations were done.

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The Case
Hgb = 14.0, WBC = 4.9, BUN = 19, S. Creatinine = 1.0, PSA = 2.72, Total Protein = 5.8 g/dl, S. Albumin = 3.1 g/dl, Prothrombin Time = 14.3 s
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The Case
Urine Analysis, Chest X-ray, ECG was done. Urine Culture was negative. Ultrasound of abdomen and pelvis indicates vesical calculus (query), enlarged prostate, splenomegaly with prominent portal vein. IVP was normal.

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The Case
Urethro-cystoscopy, resectoscopic biopsy, insertion of No. 20 hematuria catheter was done on December 24, 2009 under spinal anesthesia. Vital signs and blood sugar was monitored and sliding scale was followed for high blood sugar. Continuous bladder irrigation was done.

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The Case
He was on non per orem for six hours post operatively. Tramal 100 mg IM every four to six hours was administered for pain. Cefizox 1 g IV and Zantac 50 mg IV every eight hours for antibiotics.

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The Case
At midnight, He had bleeding and clot retention. Cystoscopy, evacuation of clots, suprapubic cystostomy, removal of residual bladder tumor was done on the early morning of December 25.

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The Case
On the same day, two units of O-positive blood were transfused. Vital signs and blood sugar was monitored. Sliding scale was followed for high blood sugar every six hours. Seen and examined by Dr. Siddiqui, he was given 30 mL of water every hour, then increased to 60 mL, then 90 mL as tolerated.

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The Case
Two glycerine suppositories per rectum was administered, yielded good result. Bladder irrigation was continued. Blood stained fluid was drained. Started on fluids, tolerated. By evening, low salt, diabetic light diet was given, tolerated. IV fluids discontinued.

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The Case
On December 26, he was seen and examined by Dr. Siddiqui. CBC, BUN, S. Creatinine, S. Electrolytes, PT, RBS, Total Protein, S. Albumin, S. Globulin were requested. Glucophage 500 mg 1 tab per orem was admistered for high blood sugar.

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The Case
On December 27, he was seen and examined by Dr. Siddiqui. Vital signs checked: afebrile, normocardic, eupneic, normotensive. Suprapubic catheter was removed. Dressing was changed. Porta vac is still intact. Diet was progressed to low-salt, diabetic diet and was tolerated well by the patient. Ambulated.

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The Case
On December 28, he was seen and examined by Dr. Siddiqui. Vital signs checked with normal values. Dressing with porta vac and three-way Foleys catheter were intact. Intake and output monitored and recorded.

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The Case
On December 29, he was seen and examined by Dr. Siddiqui. Vital signs checked with normal values. Urine sample was sent to the laboratory for culture and sensitivity analysis. Same diet was given and tolerated well. Dressing was changed. His general condition is satisfactory.

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The Case
On December 30, he was seen and examined by Dr. Siddiqui. Total Protein=5.8 g/dl, S. Albumin=3.1 g/dl. He was administered with 100 mL 20% Human Albumin daily for three days. Intake and output monitored and recorded.

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The Case
On December 31, porta vac was removed. On January 1, no significant findings. On January 2, CBC and LFT were carried out. Three-way Foleys catheter was removed and voided freely to a blood stained urine. Urine sample was sent to the laboratory for culture and sensitivity analysis.

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The Case
On January 3, he was seen and examined by Dr. Siddiqui. Orders were made to discharge the patient. Discharge papers and home teachings about diet and follow-up at the out-patient department were given. He went home, ambulatory, on improved condition.

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