What is Bladder Cancer?
A growth of malignant cancer cells in the inner lining of the bladder, forming a tumour which is the 8th commonest cancer in male. Commonly occur in male than female with ratio of 2:1 and more than 55 years old. Ninety percent of the bladder cell cancer is transitional cell cancer and the other is squamous cell cancer (associated with chronic infection and irritation) and adenocarcinoma (in urachus or chronic irritation).
Transurethral resection of bladder tumour (TURBT with EUA)
Transurethral resection of bladder tumour is performed when there is bladder tumour shown in flexible cystoscopy. The procedure is usually done under regional anaesthesia or general anaesthesia. The bladder tumour is resected with loop under continuous solution irrigation. If the tumour is papillary and superficial, then the whole tumour can be resected. However, if the tumour is deeply invaded into the bladder wall, the tumour may not be totally removed, especially when the biopsy of the tumour base showed still cancer, or the tumour is still palpable after resection.
This is the radical form of treatment when bladder cancer invades into the muscle without any distant spread to the lymph nodes, bone or lungs. The procedure usually occurred when TURBT and EUA with histology confirmed the present of cancer in the bladder muscle. The operation involves the removal of bladder, prostate and seminal vesicle, so the ureters will be connected to the exterior either by “new bladder” using the intestine to reconstruct or a conduit via an isolated small intestine to the abdominal wall. The operation required the patient to be put under general anaesthesia with bowel preparation done before the surgery. The operation will last 4 to 6 hours as it involves removal and reconstruction.
In bladder cancer, 2 key issues arise when the tumour is superficial and non-muscle invasive. One is recurrence and the other is progression into muscle invasive cancer. In order to prevent recurrence and progression, intravesical chemotherapy is given after the TURBT. Intravesical mitomycin C prevent recurrence after transurethral resection of superficial bladder cancer completely whereas intravesical BCG prevent recurrence and progression but may need several doses with some side effects especially in elderly patients.
Radiotherapy as in other a cancer is effective against transitional cell cancer of the bladder, but it is indicating only as adjuvant to TURBT when there is residual cancer in the bladder and patient is not fit or refuse radical treatment. The side effect is similar to other form of radiotherapy