Genitourinary Cancer – 17 – Bladder

Genitourinary Cancer PART – 17
(All the articles published in past are available at www.shyamhemoncclinic.com/blog/)
Question: Many many congratulations Chiragbhai on completing 12 years of continuous series, and for publication of so many books based on this series. I would also like to congratulate you for two of these books being recognized nationally. Many of our readers have also read these books, and have immensely benefitted from these books, written in very simple language, and yet comprehensive. Most important recognition for this series however is spread of the positive and yet balanced message related to cancer.
Also, I hope that our readers have started new year by asking questions you posed last time. Since these questions were really very important, I am going to post them again today, with your permission.
“This is where our readers can play a major role. Start New Year by asking yourself these questions: How many cancer screening tests have I ordered in last two years? How many families did I counsel about tobacco cessation, lifestyle changes, exercise, details of good diet, HPV vaccine? Can I diagnose an early oral cancer or breast cancer on examination? How many early cancers did I detect in last two years? How many patients did I send for genetic counseling where there was strong family history? Do I know basics of cancer, enough to guide my patient – surgery, radiotherapy, chemotherapy and other medicines, precautions during treatment, transplant? Do I know doctor or center (even if trust or government set up) in my region to send my patient for a PAP smear, and how frequently is this test to be done?
What are the Steps taken for cancer prevention for MYSELF and MY FAMILY?”
Answer: Thank you for reemphasizing the questions. Now let us move on to Bladder Cancer, last in the series of Genitourinary cancers.
As you may be aware, bladder cancer is also one of the cancers related to tobacco use. Same as lung cancer, risk is related to amount of exposure i.e. higher the smoking, higher the risk. And same as lung cancer, risk reduces after quitting tobacco, but remains higher than general population for many years, up to even 25 years.
Other less common risk factors include certain chemical exposure (mostly aromatic amines) in industries like rubber/aluminum/many others, chronic inflammation from stones, chronic infections like cystitis, chronic infestation with a work schistosoma hematobium, cyclophosphamide exposure. Phenacetin, is an old analgesic, with risk of bladder cancer. It is no longer available however.
A very peculiar aspect of bladder cancers is that so many of them are only superficial cancers. These cancers have a different behavior, evaluation and treatment.
Que: How do you diagnose bladder cancers?
Ans: Bladder cancers present with Hematuria – blood in urine, as the most common symptom. Other less common symptoms are similar to urine infection – pain, frequency etc. Hematuria can be gross or microscopic, later detected during urine examination for other purpose or routine check up. Microscopic hematuria is very common, and more likely associated with benign causes. Over age 40-50, however, a thorough evaluation for cancer should be done once, in absence of other obvious causes like stone, infection.
Urine cytology is frequently normal especially in low grade tumors, hence not used widely. However it can be used as an ancillary test to cystoscopy, more for detection of ureter or renal pelvis tumor detection.
Diagnosis is established by cystoscopy with biopsy from suscipious areas. Cystoscopy is now a widely available modality, similar to endoscopy from gastrointestinal tract. Flexible cystoscopy is also available which can be done in clinic, and is more comfortable for patient.
CT scan (preferred) or USG abdomen is important for staging. IVP is rarely used now, as CT scan gives more information and is widely available. Depending on patient symptoms, and suspicion of metastases, more imaging can be done, such as bone scan, chest CT scan, or a whole body PET-CT scan. Large majority of bladder and upper urinary tract cancers are of Transitional Cell Carcinoma histology. About 10% of other cases include squamous cell carcinoma (more common in some regions like Middle East due to schistosoma), adenocarcinoma, small cell carcinoma,poorly differentiated histology.
February 17th 2019. Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 079 26754001. Diplomate American Board of Oncology and Hematology. Ahmedabad. drchiragashah@gmail.com