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The reasons why Bladder tumor still recur after the completion of resection

Bladder cancer
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

There have been many patients at my clinic presented a bloody urination symptom and end up with the diagnosis of a “Bladder tumor”.  After a definite endoscopic surgery, I was always educated and explained patients that we still need to do the regular repetition on the endoscopic checkup for any possibly recurrence bladder tumor happens. The questions came up like; why do we need to do the surveillance, even the completion of the bladder tumor removal though? As I have mentioned though, so we will split to the reasons that why a regular bladder checkup program after the surgery is necessarily.

flexible cystoscopy
Flexible cystoscopy is the tool for surveillance bladder tumor recurrence Ref : http://www.ccmurology.com

In this topic, I’m going to focus only on a low-grade bladder tumor! The “Low-grade bladder tumor” means a low chance turning to a life-threatening by malignancy, and we can get this answer from the tissue diagnosis once finished endoscopic surgery. First reason, there were a confirmation etiology stating that, smoking, petroleum-related occupied are number one trigger that caused bladder tumor. Now you can notice that all risk factors are mentioned about the inhalation toxic agents, after we inhaled those things, the toxic agents will mix with our blood go through the lung then travelling throughout our body and finally excreted via urine by the kidney.

Still carcinogen, all toxic agents are mixing with urine and spending longest-contact period inside the bladder –the urine-storage organ before urination. They spent time up to decades to trigger out the bladder’s mucosal cells turning into a tumor cells, so these mean every single bladder mucosal cell can possibly turn into tumor cell in the coming future. That’s why even we have completed resect all visible tumor cells from the bladder; it still has chance that the recurrence tumor will be back in any area of bladder mucosa.

Second reason is the seeding theory. When I did endoscopic resection of the tumor, there will be a small molecule of tumor cells that are floating in the bladder even I have done a lot of water irrigation. They act like dropping seeds; they are floating around, implant in any area of bladder area and growing up again like planting the field. Don’t be panic for this, we have a solution. Once we finished the operation, we flush the medical agent which has effect on eradicating these tumor seeds cell, we killed them before they growing seeds like they used to grow.

Counselling
Good mutual understanding between patients and doctors are very important for maximizing clinical outcome

However, we strictly performed the best practice but recurrence rate still reported as 15% – 61% during 1 year after the operation, and 31% – 78% during 5 years after the operation. The rate of the recurrence depends on individuals. With good mutual understanding between patients and doctors along with the regular bladder checkup program, the early detection for the recurrence bladder tumor will beneficial and it help us to manage the complication. Better sage then sorry!

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