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Bladder Cancer

Bladder Cancer

Bladder cancer is generally noticed in people over the age of 50. Quite often it is curable especially when it is found superficially on the surface of the bladder. At its more invasive and deeper stage, Bladder Cancer can be fatal. More instances of bladder cancer have been found in smokers, in particular those who have worked with PCB plastics or commercial dye industry.

This cancer occurs almost uniformly within the transitional cells of the bladder (the type of cell which lines the bladder wall). Transitional cell cancer is also found in the kidney and the ureter (the tube which connects the kidney to the bladder) although with much less frequency.

A urinalysis that shows an increased number of white blood cells without evidence of bacterial infection can lead to suspicion of bladder cancer. Urinalysis may also be remarkable for microscopic haematuria (blood in minute quantities). A cystoscopy allows the Urologist to look inside the bladder. This procedure is done under I.V. sedation or general anaesthesia. Cancer is detected with a biopsy or tissue sample. This is where a Pathologist can help in determining the extent of invasion of the cancer.

Chemotherapy agents are injected into the bladder through a catheter. These agents could include Adriamycin, BCG and other types of chemotherapy. If the bladder cancer is in an invasive stage, radical cystectomy may be required. This means a total surgical removal of the bladder. Radiation therapy which involves high doses of x-rays to localised body parts along with chemotherapy can be succesfully used to treat patients suffering from bladder cancer. When the bladder cancer has reached an advanced stage, it is generally incurable. A nutritious cancer diet is used to supplement the treatment.

Prostrate Biopsy

Some doctors opine that prostrate cancer begins with a condition called 'prostatic intraepithelial neoplasia' (PIN). Almost 50% of men have PIN by the time they reach the age of 50 years. There occur changes in the microscopic appearance of the prostrate gland cells in this condition. These changes can be either normal or abnormal. If a person had an abnormal high-grade PIN, then there is 30 to 50 % of cancer. Men diagnosed with such high-grade PIN are asked to undergo repeated Prostrate Biopsies. Other reasons for prostrate biopsy are:

An elevated PSA level in a blood test.

Significant change in the standard PSA level over time.

Standard PSA level but a low free/total PSA ratio as indicated by the PSA II test.

Suspicious feeling prostrate on digital rectal examination.

Normally for a prostrate biopsy, the tissue is taken using a fine needle from ten or more places in the prostrate. Nowadays, specialists recommend the biopsies of the prostrate to be carried out only under ultrasound guidance. Several samples from the prostrate are taken using a method called 'sextant biopsy'. Biopsies are taken using 'Trans-Rectal Ultrasound' (TRUS) to guide the precise placement of the biopsy needle. The patient is administered an enema prior to carrying out the biopsy. There is no need for anesthesia but an antibiotic is given in order to prevent possible infection. The biopsy specimens ('cores') are sent to a pathologist for evaluation.

Histopathology

Histopathology involves study of diseased tissues thereby aiding diagnosis of tumors. Histopathological examination of tissues involves three stages - surgery, biopsy or autopsy.

After collecting the diseased tissues, they are first stabilized by placing in a fixative, to prevent decay. Formalin (10% formaldehyde in water) is the fixative used normally.

The stabilized sample tissues are first transferred to a container where permitted reagents are allowed to act on the tissues.

Concentrated ethanol helps to dehydrate the tissues. Toluene or Xylene is used after the above procedure to immerse the tissues followed by hot liquid paraffin wax. This process takes 12 to 16 hours, during which paraffin replaces the water in the tissue turning it soft and moist. Now the sample is ready for embedding.

The tissue is transferred and set in a mold. During this process of embedding, additional paraffin is added to prepare a hard paraffin block.

Microtome is used to section the embedded tissues into very thin sections of about 3-7 micrometer in thickness. These thin layers or sections are now ready for microscopic study.

One or more pigments are used to stain the sections to view the details clearly. A combination of hematoxylin and eosin is used to stain the tissues. The cytoplasm pink is got by using eosin and nuclei blue by hematoxylin. Saffron, silver salts and some artificial dyes are the other compounds used to color tissue sections. For staining specific proteins, carbohydrates and liquids, antibodies are also used. The technique known as immunohistochemistry has helped scientists in the microscopic studies to identify different categories of cells specifically.

A medically qualified expert or pathologist examines the histological slides microscopically.