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Actos Bladder Cancer :There is a very close relationship between survival of an individual and the stage of bladder cancer at diagnosis. For superficial disease, five year survival rates are greater than 90%. Once the cancer has spread into the bladder muscle and beyond, survival is markedly reduced. Five year survival in those with T2 disease (tumor invading superficial bladder muscle) is 60-75%, T3 disease (tumor invading deep muscle) 36-58%, and for those with T4 disease (tumor invading surrounding organs) or with node positive disease, 4-35%.’ With distant (metastatic) spread, survival at five years is less than 5%.
Most individuals with bladder cancer will undergo an initial removal of their bladder tumor by biopsy or for larger tumors by resection of their tumor via a resectoscope. For complete details see Chapter 8. Once this tumor is removed, the pathologist will determine and report on the extent of tumor invasion into the wall of the bladder. If the tumor has grown into the prostate, tissue removal via the resectoscope from this location will also be reviewed and reported pathologically. This pathologic diagnosis determines the initial stage of the cancer.
When dealing with large tumors after the initial cancer resection, your urologist may do a manual exam under anesthesia. By pressing deeply on the pelvis, the urologist may be able to palpate the tumor and assess its possible spread beyond the bladder. With modern technology and the availability of the CT scan, the manual exam is now of less importance. The CT scan can often visualize a thickened or distorted bladder wall, indicating the possibility of tumor involvement or extension through the wall. More importantly, it can determine spread to adjacent organs or lymph node involvement. Distant spread into the abdomen or beyond may also be seen. Other studies, such as the Bone Scan or Chest X ray can assess the presence and extent of metastatic diseases, MRI can be used for those with limited kidney function that cannot have a CT scan. More recently, Positron Emission Tomography (PET) scan has become available. This study can sometimes locate small deposits of metastatic disease not visible on CT or MRI scan.
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A catheter is a plastic or rubber tube which is placed through the urethra into the bladder. It is kept in place by a fluid filled balloon, at the end of the catheter, which is inflated in the bladder. The tube allows for drainage of urine which may be mixed with blood after a TURBT. When small tumors are removed, a catheter is not usually required unless there is a concern that you may have difficulty urinating after the procedure because of an enlarged prostate, weak bladder or swelling of the urethra after instrumentation. After large tumors are resected, a catheter is often required. It serves the following purposes:
It allows one to monitor the amount of bleeding after surgery (although the urologist attempts to stop all bleeding, this is not always possible and bleeding may persist). It provides for bladder irrigation if required. If much bleeding is present after surgery, it is important to avoid the possibility of blood clots forming and blocking the flow of urine. Irrigation can be done intermittently with a syringe or continuously via a 3 way catheter, which has a port for inflow and outflow of irrigant.
It keeps the bladder decompressed, which may be important if the resection was deep and bladder integrity is in question. The bladder may have been thinned markedly in the area of resection or biopsies. Decompression provides for reduced risk of leakage through the wall of the thinned bladder.
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On occasion, a urologist may face an individual with a bladder tumor that cannot be reached. This is usually much more of an issue with male patients since the scope is required to pass through a much longer urethra to begin with, therefore reducing the amount of instrument available to work within the bladder. Contributing factors include: Tumor location: tumors loeated at the dome (the very top part of the bladder or those just inside the bladder neck) may be extremely difficult to remove. Body size: individuals who are markedly obese have distorted internal anatomy. Instruments may not be long enough to reach all bladder tumors.
Enlarged bladders: individuals with abnormally large bladders may have tumors beyond the reach of the resectoscope. Bladder diverticulum: some bladders have an abnormal cavity called a diverticulum. If the opening to the diverticulum is small or if the diverticulum is large, bladder tumor removal may be difficult. In addition, the walls of the diverticulum are quite thin, making tumor removal more hazardous, as perforation is more likely to occur.
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