Urinary Bladder Cancer

The radical surgeries for bladder and prostate cancer can be performed by conventional open method or by laparoscopy (Laparoscopic Radical Cystectomy & Laparoscopic Radical Prostatectomy) with many benefits to the patients. Laparoscopic or Laproscopic cancer surgery has several advantages over conventional open surgery with same cure rate. Only surgery is curative in most of the cancers. Additional therapies (chemotherapy & radiotherapy) are mostly supportive. But, many patients and their relatives try to avoid surgery for the fear of the immense trauma for their loved ones, resulting in patient getting wrong or less effective treatment. With laparoscopy the trauma is much less and makes the treatment more acceptable. The Team MACS precisely addresses all these issues and works relentlessly for a better life

comparing the wounds - open surgery vs laparoscopic surgery
Dr. Sandeep Nayak

DR. SANDEEP NAYAK

MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),

Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.

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The Advantages Of Robotic & Laparoscopic Cancer Surgery Include

What Is Urinary Bladder Cancer ?

The urinary bladder or the bladder, is a hollow organ present in the pelvis that stores urine that drains form the kidney. Hollow tubes called ureters drain urine form both the kidneys into the urinary bladder. The bladder forms a low-pressure reservoir which gradually stretches out as urine fills into it. Bladder has inner lining (mucosa) under which there is a thin fibrous tissue (submucosa) which separates it from the muscle layer (detrusor). In males, the prostate gland is located just below the bladder where urethra joins the bladder. In order to urinate (micturate) the muscular wall of the bladder contracts.

Cancer of bladder arises from the inner lining. Transitional cell carcinoma is the most common type.

Symptoms And Diagnosis

Urinary Bladder Cancer. Blood in urine (hematuria) is the most common symptom of bladder cancer and may occur early in the disease. Even a single episode of blood in urine should be taken seriously and investigated. There may be no symptoms or bleeding for prolonged periods of time between episodes, making the patient have a false sense of security. Other symptoms include increased frequency, inability to hold the urine or burning sensation while passing urine. In an advanced disease, patient may have a distended bladder, pain in the flanks, bone pains, or cough/blood in the phlegm (due to spread to cancer cells to bones or lungs).

If urine analysis shows presence of blood in urine an ultrasound scan of abdomen or a CT scan and cystoscopy (looking into urinary bladder using a thin telescope) is needed. When the tumor is seen at cystoscopy, it is preferable to perform telescopic resection of the tumor (TURBT- trans urethral resection of bladder tumor) in the same or next sitting.

Prostate cancer patients most commonly develop blockage to urine flow or blood in urine. This cancer spreads mainly to back bones and can lead to pain. Diagnosis is reached based on ultrasound and biopsy. Prostate specific antigen (PSA) in blood can give good idea about the aggressiveness of the disease.

Urinary Bladder Cancer : Staging & Treatment

Treatment of bladder cancer predominantly depends on the microscopic examination report of TURBT (Trans Urethral Resection of Bladder Tumor) specimen. This is a diagnostic as well as treatment for early cancers of bladder. A CT or MRI scan would be required to further stage the disease

Stage 0

This is when the cancer has not spread beyond the innermost layer of bladder (mucosa) and are denoted as Ta & Tis. This is the most common form of bladder cancer.

curative. These patients may benefit from BCG treatment into the bladder. Rarely the entire bladder will have to be removed and reconstructed.

Stage II & III

Stage II is when the cancer has invaded the muscle layer of the bladder wall, as confirmed by microscopic examination of TURBT (Trans Urethral Resection of Bladder Tumor) tissue. Stage III cancers have reached the outside of the bladder and might have grown into nearby tissues or organs (uterus or rectum). Radical cytectomy (removal urinary bladder and lymph nodes with prostate among men) is recommended in these patients. Laparoscopic Radical Cystectomy is as effective as open surgery and is much better tolerated by the patients. The reconstruction of bladder can be done to drain through normal passage (orthotopic neo-bladder) or other methods (ileal conduit or thourh back passge) depending on various factors.

Stage I

Stage I bladder cancers have grown into the fiber tissue layer of the bladder wall but have not reached the muscle layer, as confirmed by microscopic examination of TURBT (Trans Urethral Resection of Bladder Tumor) tissue.

When tumor is of low grade, TURBT may itself be sufficient treatment. However, if the cancer is of high grade or if the tumor is extremely large, radical cystectomy (removal urinary bladder and lymph nodes with prostate among men) may be recommended. Laparoscopic Radical Cystectomy is as effective as open surgery and is much better tolerated by the patient. The reconstruction of bladder can be done to drain through normal passage (orthotopic neo-bladder) or other methods (ileal conduit or thourh back passge) depending on various factors. For people not fit radiation therapy (often along with chemotherapy) may be an option, however, the chances for cure may not be as good.

Stage IV

These cancers have reached the abdominal or pelvic wall (T4b tumors) or have spread to nearby lymph nodes or distant parts of the body. In most cases surgery cannot remove all of the cancer at this stage. In some cases where the disease is spread only to limited lymph nodes, surgery (removal of bladder along with lymph nodes) may be considered. Otherwise, the treatment is usually aimed at slowing the cancer’s growth and spread to help you feel better (chemotherapy with or without radiotherapy).