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22.8 Urinary Bladder Cancer

Table of Contents

Bladder cancer, as from 2005–2016, affected about 1,537 people in Tanzania. This is according to data available at ORCI. Risk factors for bladder cancer include smoking, family history, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals. The most common type is transitional cell carcinoma. Other types include squamous cell carcinoma and adenocarcinoma.

Diagnostic Criteria

  • Symptoms include blood in the urine, pain with urination, and low back pain.

Investigations

  • FBC, RFT, LFT, Alkaline phosphatase, urinalysis, culture and sensitivity, urine for cytology
  • CXR and /or CT chest, Bone scan, abdominal pelvic USS or CT scan
  • Cystoscopy with bladder mapping & Biopsy
  • EUA
  • Bimanual examination
  • TURBT with random biopsies of normal appearing mucosa to exclude CIS. (If trigone involved, biopsy prostatic urethra)

Staging: TNM

Management

Treatment of Urinary bladder cancer depends on how deeply the tumor invades into the bladder wall.

Surgery: Several modalities that may extend from bladder preserving surgery–TURB; to radical cystectomy with urine diversion depending bladder muscle invasion. Post operation patient may receive adjuvant chemo and/or radiotherapy

Chemotherapy: chemotherapy in bladder cancer may be offered before surgery or after surgery. It may also be given concurrent with radiotherapy or as palliative in inoperative tumor. Among chemotherapy regimens include Gemcitabine in combination with Cisplatin, commonly used in locally advanced and metastatic disease.

S: Gemcitabine 1000mg/m2 IV over 30mins day 1, 8 & 15 + Cisplatin 70mg/miv over 30mins day 2 given every 4 weeks for 6 cycles

Other drugs commonly given in combination include MVAC regimen;
o Methotrexate 30mg/miv day1, 15 & 22
o Vinblastine 3mg/m2 iv day2, 15 & 22
o Doxorubicin 30mg/m2 iv day2
o Cisplatin 70mg/m2 iv over 30mins day2

Radiotherapy

Radiotherapy may be given after bladder preserving surgery or alone in small lesions with a dose up to 65Gy/33fr concurrent with cisplatin. It is also commonly used as palliative therapy to control bleeding and or pain locally advanced and metastatic disease. Palliative dose 30Gy/10fr or 20Gy/5fr

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