Tumor of the bladder is a fairly common occurrence, and it is more likely in males, 75 percent occurring in men aged 50 or more. The cause is unknown, although there is increasing evidence that carcinogens (cancer-producing chemicals or other substances) may play a large part.
In recent years it has been found much more commonly in persons who smoke than in nonsmokers (two to five times the risk). It is also found more often with persons working in synthetic rubber and other chemical factories. Several years of exposure are necessary for the cancerous effect to be manifest. In industries where the link is suspected, efforts to reduce this are usually being made.
Any bladder disorder that prevents complete emptying of the bladder at urination, allowing residual urine to remain, gives the carcinogen a greater length of time to contact the bladder wall and exert its influence. Several predisposing causes have become well-established. These include encrusting cystitis, vesical calculus (stones in the bladder), leukoplakia (a precancerous condition) and certain other less-common disorders.
Kidney Cancer Symptoms
The cardinal symptom is hematuria – that means blood in the urine. It usually occurs at the end of urination (called terminal), and may be accompanied with some small clots. Only in the final, severe states does blood come with urination each time and throughout the act. An old description was. “The bleeding is profuse, painless and periodic.” Often a patient will notice the bleeding over a period of several days. It then tends to disappear. It is often incorrectly put down to “a chill in the bladder,” or a cold or some other innocuous diagnosis after it suddenly quietly disappears.
Often, only after several recurring attacks, will the patient decide to visit the doctor, probably many months later. This is foolish, for valuable time is lost, and this may be life-endangering. “If there is hematuria [blood in the urine] there is almost certainly a lesion of the urinary tract, for it is rare for systemic diseases and blood dyscrasias [i.e. other non-renal diseases] to manifest themselves initially by blood in the urine,” Dr I. Cosbie Ross, Consultant Urologist at the Liverpool Regional Urological Centre, in Liverpool, has written in the British Medical Journal.
It is mandatory for the patient to seek immediate medical treatment at the first sign of blood in the urine.
Don’t put it off. Do not shrug your shoulders and imagine you are seeing something that doesn’t exist. Do not attribute it to a chill, getting wet, the grippe or anything else. Do not start taking your wife’s cystitis medicine or leftover medication from a previous infection. Go and see the doctor, and take a sample of urine with you in a clean bottle. The sooner investigations are started and treatment commenced (in the event of its being a cancer), the better.
Kidney Cancer Treatment
Once hematuria has been established (and in mild cases this may require microscopic examination of the urine), further investigation to establish the diagnosis is essential. Most family doctors will refer their patients either to the urologist, a doctor specializing in disorders of the urinary system, or to the urology clinic of a large hospital where full facilities are available for diagnosis and treatment.
The specialists are emphatic about what should follow. “The only safe and inflexible rule is that a full investigation, especially a cystoscopic examination, must be carried out in every patient with hematuria,” Cosbie Ross says.
This is an operation in which the cystoscope, a metal tube with lights, is inserted into the bladder. It allows the surgeon to see first-hand the entire inner lining of the bladder. The nature of the bleeding site can be discovered and it may be assessed. Moreover, it may be removed (biopsied) for further pathological examination under the microscope by the pathologist. This will give an exact diagnosis.
The disorder is then treated on the spot. Various methods are available, and it will depend on what is found at operation as to the next step in treatment. In suitable cases, cystoscopic diathermy is often performed, provided the tumor is not deep-seated. Often the growth is found in an X-ray image featuring both kidneys (green) and ureters (red), and the vessels connecting the kidneys to the bladder (red circular mass).
In certain cases, if the tumor is much larger, other methods are available. Irradiation with gold grains or external irradiation may be done, but usually for lesions that are obviously more extensive. Sometimes the operation may extend to cystectomy, in which the whole bladder is removed. In this case, the ureters conveying urine from the kidneys to the bladder are implanted into the colon, the terminal part of the large bowel, for urinary elimination.
In very advanced stages, the surgeon may be able to offer the patient only palliative relief. This means some form of relief from the inevitable pain, until death occurs.
After surgery, it is essential that the patient keep in regular touch with the surgeon. At first, regular inspections of the site of operation will be carried out every few months, later, six- to 12-monthly. Recurrences may take place.
“Cystoscopic follow-up must be maintained for the rest of the patient’s life,” Cosbie Ross says. “There is a tendency for cancers in this region to recur, and there is also a tendency for multiple lesions.” There is an old saying, “Once a papilloma of the bladder, always a papilloma.” “This old phrase was well illustrated by one of my patients,” Cosbie Ross wrote in the British Medical Journal. “This man had a fairly large papillary tumor treated by diathermy, and subsequently attended for regular cystoscopy – at first six-monthly, and later at yearly intervals. The bladder remained clear for 12 years. But on the 13th, a bun-shaped tumor, which proved to be malignant [cancerous] was found.”
Enough said? Heed the warning symptoms. Do not put them off. Waiting until other symptoms appear could be courting disaster. See the doctor at once if you have are experiencing any symptoms.