Treatment of Superficial Bladder Tumors with Endoscopy and Laser

Treatment of Superficial Bladder Tumors with Endoscopy and Laser

Bladder cancer is cancer that begins in the bladder and is the second most common type of cancer in the urinary tract. Superficial bladder cancer means the cancer cells are found only in the inner lining of the bladder and have not spread to the outside and have not reached the muscle tissue. It is the most common type of bladder cancer, accounting for about 75% of all patients with bladder cancer. 
Superficial bladder cancer can affect both men and women. Its symptoms are sometimes mistaken for those of urinary tract infections, which can delay the diagnosis of bladder cancer. Bladder cancer is often linked to a history of smoking and occupational or environmental exposure.
Patients are commonly diagnosed with this type of bladder cancer after experiencing blood in the urine, urinary problems, or irritation during urination.

What are the symptoms of bladder cancer?

The most noticeable sign of bladder cancer is blood in the urine. However, many other conditions can also cause blood in the urine.
In some cases, the amount of blood may be so small that the patient doesn’t notice it. It may only be detected during a routine urine test. In other cases, the amount of blood is large enough to be visible. Blood in the urine may appear and then disappear for weeks or even months.
Here are some other common symptoms of superficial bladder cancer:
• Frequent urination.
• A strong, urgent need to urinate even when the bladder isn't full.
• Pain or burning during urination.
• Difficulty urinating.

Who is at risk of developing bladder cancer?

The incidence of bladder cancer in males compared to females is approximately 3 to 1, and the risk increases with age. Studies have shown that the likelihood of developing bladder cancer is higher if you are between the ages of 45 and 60. 
Factors that may increase the risk of developing a disease are called risk factors. These risk factors vary depending on the type of cancer. Having one or more of these risk factors does not mean that you will develop bladder cancer; it just means you may have a higher chance than others.

Risk factors for bladder cancer:

• Smoking: The most common risk factor is smoking. Tobacco smoking is the leading cause of bladder cancer, accounting for at least half of all cases. Your risk of developing bladder cancer if you smoke is up to four times that of someone who has never smoked. People at the highest risk are those who:
- Are heavy smokers.
- Started smoking at a young age and have continued for a long time.
- Smoke other types of tobacco products, such as cigars.
The chemicals in cigarette smoke enter the bloodstream and are filtered out by the kidneys, eventually ending up in the urine. When urine is stored in the bladder, these chemicals encounter the bladder lining, increasing the risk of bladder cancer. These harmful substances found in cigarette smoke are the main reason for the increased risk of bladder cancer.
• Certain medications: The use of some medications may increase the risk of developing bladder cancer, such as the painkiller phenacetin and the long-term use of cyclophosphamide, a chemotherapy drug and immunosuppressant.
• Infection: Schistosomiasis increases the risk of bladder cancer. It is caused by a parasitic worm that lives in freshwater in some parts of the world, including Africa and Asia.
• Urinary catheterization: Having a urinary catheter for a long time may increase the risk of bladder cancer.
• Industrial chemicals: Exposure to certain industrial chemicals (such as carbon and crude oil) may increase the risk of developing bladder cancer. This includes chemicals used in industries such as dyes, rubber, electricity, cables, painting, and textiles.
• Radiation therapy: You're more likely to develop bladder cancer if you've had radiation therapy for previous pelvic cancers, such as prostate cancer.
• Family history: You may have a slightly increased risk of bladder cancer if you have a first-degree relative with bladder cancer.
• Excess weight: You may be at increased risk of developing bladder cancer if you are obese and overweight.

Treatment of superficial bladder cancer:

Fortunately, superficial bladder cancer is highly treatable with the expertise of Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada. The first step in treatment is to identify the cancer. Diagnosing superficial bladder cancer typically involves several tests:
• When cancer is suspected, patients undergo a CT scan to look for abnormalities in the kidneys, ureters (the tube between the kidneys and bladder), and the bladder, which provides a detailed view of the urinary system to check for signs of cancer. During this procedure, a contrast dye is injected, and X-ray images are taken when the dye reaches the kidneys, ureters, and bladder.
• Then, Dr. Enmar Mohamed Habib performs a cystoscopy, during which a narrow tube called a cystoscope is inserted through the urethra into the bladder. The tube contains a lens to examine the inner part of the urethra (the tube through which urine exits the bladder) and the bladder itself, allowing for careful and precise inspection.

Cystoscopy with holmium laser for destroying superficial bladder tumors:

Cystoscopy is performed by passing a thin tube equipped with lighting and a camera through the urethra into the bladder, allowing Dr. Enmar Mohamed Habib to view the inner part of the bladder, as mentioned earlier. The modern cystoscope used by Dr. Enmar Mohamed Habib is equipped with channels that allow small instruments to be passed into the bladder. It also enables the application of a holmium laser to eliminate superficial cancerous cells. The holmium laser separates tissue layers by tearing them apart while simultaneously coagulating small to medium-sized blood vessels, resulting in rapid tissue healing and effectively stopping bleeding.

Advantages of the holmium laser over other treatment techniques:

Holmium laser treatment, as a minimally invasive procedure, offers several advantages over traditional surgical methods for removing superficial bladder cancer. Some of the key benefits include:
• Safe procedure with minimal surgical intervention.
• Reduced urinary catheterization time, usually less than 12 hours.
• Shorter hospital stays, typically not exceeding 24 hours.
• Reduced pain and bleeding, as the holmium laser works without deep penetration.
• Adjustable laser power according to the size of the tumor.

The holmium laser treatment also has several advantages over electrosurgical methods, which are associated with the following complications:
• Risk of bladder perforation: When electrical current-based techniques are used to remove tumors, the flow of current through the obturator nerve can lead to sudden muscle contractions, increasing the risk of bladder perforation. In contrast, when a holmium laser is applied to remove tumor tissue, there is no current flow during the procedure, thus not stimulating the obturator nerve. Therefore, bladder perforation can be avoided using holmium laser technology.
• Thermal injury: With holmium laser treatment, thermal injury at the treatment site is reduced, as the temperature ranges from 40 to 75 degrees Celsius. This contrasts with the high temperatures associated with strong electrical fields, which can range from 100 to 300 degrees Celsius at the treatment site, leading to thermal injury.

Positive results in cases of superficial bladder cancer can be achieved with minimal surgical intervention, thanks to the expertise of Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, ensuring the best therapeutic outcomes.