Overview

What is bladder cancer ?

The bladder is located in the pelvis. It collects and stores urine and has a muscular wall that allows it to contract and expand. About 90 percent of bladder cancers are transitional cell carcinoma. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma account for most of the rest. Treatment options vary depending on the type of bladder case.

Cancer that is only in the bladder lining is called non-muscle invasive bladder cancer (NMIBC). This type of cancer is sometimes called superficial bladder cancer. More than 75 percent of bladder cancer is diagnosed as a NMIBC and it has an excellent survival rate.

Muscle invasive bladder cancer penetrates the layers of muscles in the bladder and is more likely to spread to other parts of the body. About 90 percent of bladder cancers are transitional cell carcinoma. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma account for the rest Bladder cancer is the result of cell changes in the mucous (inside) wall of the bladder. It is caused by changes in the cells' chromosomes or DNA (deoxyribonucleic acid).

This form of cancer develops most often in people between the ages of 60 and 79, with the average age being 67. The disease is three times more common in men than in women. It is one of the most common forms of cancer to strike men.


What causes cholecystitis?

A gallstone stuck in the cystic duct , a tube that carries bile from the gallbladder, is most often the cause of sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis.

Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes, cause the swelling.

Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains swollen over time, causing the walls of the gallbladder to become thick and hard.

Symptoms

Generally the first sign is blood in the urine. It may be visible or the amount may be so small that it can only be discovered by chemical testing ('stix' test).
There does not need to be blood in the urine constantly. In fact, there are often periods in which there is no evidence of blood at all. So one should not be fooled by a symptom that seems to have gone away. There may be frequent urination, stinging and pain across the pubic bone or exactly the same symptoms as in an ordinary bladder infection.

Types of bladder cancer

Transitional cell bladder cancer (TCC) is the most common type of bladder cancer. Nearly all cancers of the bladder start in the layer of cells (transitional cells) which form the lining of the bladder (transitional epithelium). These cancers are called transitional cell or urothelial cell cancers.

Bladder cancer may appear as a tumour which has grown into the muscle wall of the bladder. This is known as invasive bladder cancer.

Bladder cancer may also begin as a small growth only on the inner lining of the bladder (called papillary cancers). Sometimes these early cancers can start to grow into the muscle of the bladder and become invasive bladder cancer. Carcinoma in situ (CIS) is a type of early bladder cancer which appears as a red, ulcerated area in the bladder. In CIS the cells are very abnormal or high-grade, so it can grow quickly. If it's not treated effectively, there's a high risk that CIS will become an invasive cancer.

Rarer types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancers start from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus. Both of these types are usually invasive.

Staging

The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment.

Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph glands or nodes that are linked by fine ducts containing lymph fluid. Doctors will usually look at the nearby lymph nodes to find the stage of the cancer.


How is it treated?

Treatment for cholecystitis will depend on your symptoms and your general health. People who have gallstones but don't have any symptoms may need no treatment. For mild cases, treatment includes bowel rest, fluids and antibiotics given through a vein, and pain medicine.

The main treatment for acute cholecystitis is surgery to remove the gallbladder (cholecystectomy). Often this surgery can be done through small incisions in the abdomen (laparoscopic cholecystectomy), but sometimes it requires a more extensive operation. Your doctor may try to reduce swelling and irritation in the gallbladder before removing it. Sometimes acute cholecystitis is caused by one or more gallstones getting stuck in the main tube leading to the intestine, called the common bile duct. Treatment may involve an endoscopic procedure (endoscopic retrograde cholangiopancreatography, or ERCP) to remove the stones in the common bile duct before the gallbladder is removed.

In rare cases of chronic cholecystitis, you may also receive medicine that dissolves gallstones over a period of time.

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