Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
What is transurethral surgery or "TURBT" for bladder cancer?
The initial surgical procedure that a patient undergoes after the diagnosis
of bladder cancer is established is usually a transurethral resection of
bladder tumor or "TURBT." It is done with the help of special instruments
attached to a cystoscope (mentioned earlier in the section on investigations)
and involves cutting out the tumor and removing it from the bladder with the
help of an electrical cautery device. This surgery is done through the normal
urinary passage and does not involve an external cut on the body. It is the
initial treatment of bladder cancer as well as a staging procedure since the
specimen retrieved from the surgery is sent to a pathologist who gives his/her
inference on the depth of invasion of the tumor in the bladder wall (T stage) as
well as the grade (high/low). Further treatment depends to a large extent on the
findings of this initial surgery as well as the other staging investigations and
is covered in the sections to follow.
What is the treatment of superficial bladder cancer?
Superficial bladder cancer is a cancer which has not invaded the muscle wall
of the bladder and is confined to the inner lining of the bladder. The T stage
is Ta, T1, or Tis (also known as carcinoma in situ or "CIS"). After the initial
TURBT or biopsy in case of CIS, the subsequent treatment in these cases may
involve observation with regular follow-up with cystoscopy examinations of the
bladder, instillation of medications in the bladder, or in certain cases,
surgical removal of the bladder (radical cystectomy).
Small low-grade, superficial bladder cancers may not require aggressive
management after the initial TURBT and may be simply followed up by doing
repeated cystoscopy examinations at regular intervals (usually every three months
for the initial two years and then at increasing intervals). Recurrent tumors may
be surgically removed or fulgurated (burnt out) with special instruments
passed through the cystoscope. It is very important to note that 30%-40% of these
tumors tend to recur and these recurrences may not be associated with any
symptoms. Hence, it is imperative to stick to a regular follow-up protocol to
ensure that the disease does not go out of control. It has also been shown that
a single dose of a chemotherapy medication (for example, mitomycin C [Mutamycin]) put inside the
bladder immediately after a TURBT can decrease the chances of recurrence within
the first two years after surgery.
High-grade, larger, multiple, or recurrent superficial bladder cancers may
require additional treatment after the initial TURBT. One of the most effective
and widely used medications is called the
Bacille Calmette Guerin, commonly
referred to as BCG. It is a modified form of a bacterium that causes
tuberculosis in cattle (Mycobacterium bovis). It is instilled into the bladder
in the form of a solution using a catheter placed in the urinary passage. It
acts by stimulating the immune system of the body to act against the cancerous
bladder cells and prevent their growth and development. It has been shown to
decrease the chances of recurrence of bladder cancer as well as its invasion
into the muscle layer of the bladder. However, it is only partially effective in
achieving these objectives and its use does not obviate the need for a regular
follow-up. It is usually administered in six initial doses at weekly intervals
followed by a "maintenance" schedule which is usually recommended for at least
once per year but may be needed for as long as three years.
Patients, who do not respond to BCG treatment, recur in spite of treatment or
those who have medical issues which preclude the use of BCG, may require other
forms of treatment. These include bladder instillation of immunotherapy agents
such as Interferon or chemotherapy medicines like valrubicin (Valstar),
mitomycin C, epirubicin (Ellence), or doxorubicin (Adriamycin). In general, these medications are not as effective as
BCG and help only a small minority of patients who have not responded to BCG.
In patients who have an aggressive form of high-grade superficial bladder
cancer and those who have not responded or recurred in spite of treatments
mentioned above, a more aggressive form of treatment may be warranted. This is
usually in the form of a major surgical procedure called radical cystectomy.
It entails removal of the bladder and the prostate and diverting the urinary
stream using parts of the intestine. This surgery will be described in the
subsequent section on treatment of invasive bladder cancer.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Hydronephrosis is a condition in which the kidney swells, due to a backup of urine. Hydronephrosis generally occurs with another disease.Symptoms of hydronephrosis include nausea, vomiting, urinary tract infection, fever, painful urination, increased urinary frequency and urgency, flank pain, and swelling of the abdomen. Treatment of hydronephrosis depends on the cause.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Schistosomiasis (snail fever), a disease caused by parasites, causes a variety of symptoms and signs, such as cough, rash and bloody diarrhea. Praziquantel is used in the treatment of schistosomiasis.
Tumor grade is a system used to classify cancer cells in how likely the tumor is to grow, and how abnormal they look under a microscope. Tumor grade is not the same as tumor stage. A biopsy is taken to determine if the tumor is benign (non cancerous) or malignant (cancerous).
Urethral cancer is a rare form of cancer that primarily affects white females, people over 60 years of age, and those who have stds or who experience frequent urinary tract infections. Symptoms and signs of urethral cancer include blood in the urine, interrupted urine flow and discharge from the urethra. Treatment involves surgery, radiation therapy, and chemotherapy.
Smokeless tobacco can have negative health effects such as cancers, poor oral health (gum disease and tooth decay), infertility, pregnancy complications, and nicotine addiction.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
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