Bladder Tumour

The tumour that develops in the bladder is termed a bladder tumour. When cells of the urinary bladder start to divide without any control, lead to the development of tumours. Almost 90 per cent of cases of bladder tumours begin in the cells of the innermost lining of the bladder wall. It can develop in both females and males. 

Some of the signs and symptoms of bladder tumour:-

1. Persistent feeling that you need to urinate even if your bladder is not full
2. Pain while urinating
3. Blood in the urine
4. Pain in the lower back of one side of the body
5. Appetite loss and sudden loss of weight
6. In rare cases, the person affected with a bladder tumour may also experience pain in the pelvic bone.

1. The exact cause of bladder tumours is unknown. However, many experts believe alteration in bladder cell genetics causes bladder tumours.
2. Smokers are at three times increased risk for bladder cancer than non-smokers. 
3. People who are highly exposed to harmful chemicals for a long time are at a higher risk of getting bladder tumours. 
4. Patients taking pioglitazone, a diabetes drug, for more than 2 years are at a higher risk of getting bladder tumours. 

Factors increasing the risk of bladder tumour are as follows:-

1. People who are highly exposed to harmful chemicals, like persons working in the paint industry, for long, are at increased risk of getting bladder tumours.
2. People who have taken radiation therapy of the pelvic region are at a higher risk of bladder tumours. 
3. Several recent studies have revealed that ingesting a high amount of arsenic with drinking water may increase the risk of getting a bladder tumour.
4. The person who smokes at least thrice a day is more vulnerable to bladder tumours than the person who does not smoke.
5. If you have gone through tumour treatment before, you are more likely to develop a bladder tumour.
6. Certain medications, such as pioglitazone, increase the risk for bladder tumours if taken for a long time.

The doctor performs the following tests to determine the presence and stage of bladder cancer:

1. Urine cytology: Abnormal or tumour cells in the urine are detected by performing this test. Urine is collected and checked under the microscope for abnormal cells.
2. CT Urogram: The presence of any tumour is determined by evaluating the detailed images of the flow of contrast dye injected into the veins of the arms. The dye flows into the complete urinary system, and the X-ray images are captured, which are sent to a computer for their conversion to detailed 2D images.
3. Retrograde pyelogram: In Retrograde Pyelogram, the upper urinary tract is studied by inserting a catheter into the bladder and injecting the contrast dye. Then the photograph of the flow of contrast dye is studied by X-ray to detect any presence of tumour cells.
4. Cystoscopy: In cystoscopy, a small tube is inserted into the bladder through the urethra to examine any signs of a tumour. The doctor performs this procedure with a cystoscope with a lens at the end.
5. Biopsy: While performing the cystoscopy, the doctor may also remove the tissue sample and send it to the laboratory for testing. This procedure is known as a biopsy. It is also sometimes called transurethral resection of bladder tumour, which is also a treatment procedure for bladder cancer.

Bladder tumour is treated based on various factors like stage of the tumour, age of the patient, and overall health condition. Following are some of the treatment options for bladder tumours:

1. Radiotherapy: Also called radiation therapy, radiotherapy is a type of treatment that beams high radiation at the bladder to kill cancer cells. It is given for about 10 to 15 minutes per session. This treatment lasts for 4 to 7 weeks.
2. Chemotherapy: In this type of treatment, cancer cells are killed by drugs. The doctor may inject the drug directly into the bladder, also known as intravesical chemotherapy. The doctor may also prescribe systemic chemotherapy in which the patient may be given oral medicines or injections.
3. Immunotherapy: Also known as biologic therapy, it is designed to trigger the defences of the body to fight against cancer. Other than immunotherapy, targeted therapy is performed in an advanced bladder tumour.

Surgical procedures:- 

1. Segmental cystectomy: This is done in the early stages when the cancer is restricted to only one area. Doctors remove the affected section of the bladder without interfering with the bladder function.
2. Radical cystectomy:- It is used when cancer becomes invasive and widespread. The doctor removes the entire bladder and surrounding lymph nodes in this process. In the case of males, prostate and seminal vesicles are also removed. Immediately after radical cystectomy, a new path for urine is created using the tube connecting to an external pouch.

If not realised and treated at early stages, bladder tumour can spread to other parts of the body resulting in various complications such as:

1. Swelling of the uterus (in women)
2. Sexual dysfunction (in women)
3. Erectile dysfunction in men
4. Stricture of the urethra 
5. Anaemia
6. The bladder may need to be reconstructed in some conditions, also called a neobladder.

Disease Progression

Following are the stages through which bladder tumour progresses:

Stage 0: The tumour has developed only in the centre of the bladder. At this stage, the tumour hasn’t spread to lymph nodes or tissues of the bladder wall.

Stage 1: At this stage, the lining of the bladder has uncontrolled cell division, but it hasn't spread to other organs.

Stage 2: Tumour has now spread through the connective tissue and muscle layer of the bladder. 

Stage 3: The tumour spreads through the fatty tissues surrounding the bladder at this stage. The prostate, vagina, and uterus might also have developed cancer. The tumour has not spread to distant organs or nearby lymph nodes at this stage.

Stage 4: This is the last and the most advanced stage of bladder tumour. Cancer spreads to lymph nodes and organs, such as the liver, lungs or bones.