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Bladder CancerEach year, nearly 55,000 people in the United States learn that they have bladder cancer. The BladderThe bladder is a hollow organ in the lower abdomen. It stores urine, the waste that is produced when the kidneys filter the blood. The bladder has a muscular wall that allows it to get larger and smaller as urine is stored or emptied. The wall of the bladder is lined with several layers of transitional cells. Urine passes from the two kidneys into the bladder through two tubes called ureters. Urine leaves the bladder through another tube, the urethra. The bladders also produce substances that help control blood pressure and regulate the formation of red blood cells. What is Cancer?Cancer is a group of many different diseases that have some important things in common. They all affect cells, the body’s basic unit of life. To understand cancer, such as bladder cancer, it is helpful to know about normal cells and about what happens when cells become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. These cells form a mass of extra tissue, called a growth or tumor. Tumors can be benign or malignant.
Bladder CancerMost cancers are named for the part of the body or type of cells in which they begin. About 90 percent of bladder cancers are transitional cell carcinomas, cancers that begin in the cells lining the bladder. After treatment, superficial bladder cancer can recur; if this happens, most often it recurs as another superficial cancer. In some cases, cancer that begins in the transitional cells spreads through the lining of the bladder and invades the muscular wall of the bladder. This is known as invasive bladder cancer. Invasive cancer may grow through the bladder wall and spread to nearby organs. Bladder cancer cells may also be found in the lymph nodes surrounding the bladder. If the cancer has reached these nodes, it may mean that the cancer cells have spread to other lymph nodes and to distant organs, such as the lungs. The cancer cells in the new tumor are still bladder cancer cells. The new tumor is called metastatic bladder cancer rather than lung cancer because it has the same kind of abnormal cells that were found in the bladder. SymptomsThe symptoms of bladder cancer include:
When symptoms occur, they are not sure signs of bladder cancer. They may also be caused by infections, benign tumors, bladder stones, or other problems. Only a doctor can make a diagnosis. (People with symptoms like these generally see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.) It is important to see a doctor so that any illness can be diagnosed and treated as early as possible. Diagnosis and StagingTo find the cause of symptoms, the doctor asks about the patient’s medical history and does a physical exam. The physical will include a rectal or vaginal exam that allows the doctor to check for tumors that can be felt. In addition, urine samples are sent to the laboratory for testing to check for blood and cancer cells. The doctor may look directly into the bladder, a procedure called cystoscopy. The procedure may be done with local or general anesthesia. The doctor inserts a thin, lighted tube (called a cystoscope) into the bladder through the urethra to examine the lining of the bladder. The doctor can remove samples of tissue through this tube. The sample is examined under a microscope by a pathologist. The removal of tissue to look for cancer cells is called a biopsy. In many cases, performing a biopsy is the only sure way to tell whether cancer is present. If the entire cancer is removed during the biopsy, bladder cancer can be diagnosed and treated in a single procedure. Once bladder cancer is diagnosed, the doctor will want to learn the grade of the cancer and the stage, or extent, of the disease. Grade is important, because it tells how closely the cancer resembles normal tissue and suggests how fast the cancer is likely to grow. Low-grade cancers more closely resemble normal tissue and are likely to grow and spread more slowly than high-grade cancers. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. This stage of bladder cancer may be determined at the time of diagnosis, or it may be necessary to perform additional tests. Such tests may include imaging tests—CT scan, MRI, sonogram, IVP, bone scan, or chest x-ray. TreatmentTreatment for bladder cancer depends on the stage of the disease (particularly if, or how deeply, the cancer has invade the bladder wall), the grade of the cancer, the patient’s general health, and other factors. People with bladder cancer are often treated by a team of specialists which may include a urologist, oncologist, and radiation oncologist. The doctors develop a treatment plan to fit each patient’s needs. Depending on the stage and the grade, bladder cancer may be treated with surgery, radiation therapy, chemotherapy, or biological therapy. Doctors may recommend one treatment or a combination of methods. It is important for patients to discuss the treatment plan with their doctors. Getting a Second OpinionBefore starting treatment, the patient may want to have a second specialist review the diagnosis and the treatment plan. It may take a week or two to arrange for a second opinion. A short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. There are a number of ways to find a doctor for a second opinion:
Preparing for TreatmentMany people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often it helps to make a list of questions. To help remember what the doctor says, people may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor—to take part in the discussion, to take notes, or just to listen. People do not need to ask all of their question or remember all of the answers at one time. Questions may arise throughout the treatment process. Patients may ask doctors, nurses, or other members of the health care team to explain things further or to provide more information. Methods of TreatmentSurgery is a common form of treatment for bladder cancer. Early (superficial) bladder cancer may be treated at the time of diagnosis through a procedure called transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer or to burn away cancer cells with an electric current (fulguration). TUR requires anesthesia and may be done in the hospital. Surgery to remove part or all of the bladder is called cystectomy. The most common form of surgery for invasive bladder cancer is radical cystectomy. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. Radical cystectomy removes the entire bladder, nearby lymph nodes, and any surrounding organs that contain cancerous cells. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to relieve urinary symptoms caused by the cancer. When the bladder must be removed, the doctor creates another way for urine to leave the body. In some cases, patients may have part of the bladder removed in an operation called segmental cystectomy. This type of surgery may be done when a patient has a low-grade cancer that has invaded the wall of the bladder but is limited to one area of the organ. Because most of the bladder remains intact, a patient urinates normally after recovering from this surgery. In radiation therapy (also called radiotherapy), high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy; it affects cancer cells only in the treated area. Sometimes, radiation is given before or after surgery or along with anticancer drugs. When bladder cancer has spread to other organs, radiation therapy may be used to relieve symptoms caused by the cancer. Chemotherapy is the use of drugs to kill cancer cells. The doctor may use one drug or a combination of drugs. Chemotherapy may be used alone or after TUR with fulguration to treat superficial bladder cancer. In a treatment called intravesical chemotherapy, anticancer drugs are placed in the bladder through a tube called a catheter, which is inserted through the urethra. When given in this way, the anticancer drugs, which remain in the bladder for several hours, affect mainly the cells of the bladder. The treatment is usually done once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year. Chemotherapy also may be used to help control the disease when cancer cells have deeply invaded the bladder or spread to lymph nodes or other organs. In this case, the anticancer drugs are usually given by injection into a vein (IV); some may be given by mouth. This form of chemotherapy is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Chemotherapy may be used alone or in combination with surgery or radiation therapy. Usually a patient has chemotherapy as an outpatient (at the hospital, at the doctor’s office, or at home). However, depending on which drugs are given and the patient’s general health, a short hospital stay may be needed. Biological therapy (also called immunotherapy) is a form of treatment that uses the body’s natural ability (immune system) to fight cancer. Biological therapy for bladder cancer is most often used when the disease is superficial. Like chemotherapy, biological therapy may be used alone to treat bladder cancer of after TUR with fulguration to help prevent the cancer from recurring. This form of treatment involves placing a solution of BCG, a substance that stimulates the immune system, into the bladder. The medicine stays in the bladder for about 2 hours before the patient is allowed to empty the bladder by urinating. This treatment is usually done once a week for 6 weeks and may need to be prolonged or repeated. Doctors are also studying the use of other forms of biological therapy for other stages of bladder cancer. Side Effects of TreatmentIt is hard to limit the effects of cancer therapy so that only the cancer cells, not healthy cells are removed or destroyed. Because treatment can damage healthy cells and tissues, it often causes side effects. These side effects depend mainly on the type and extent of the cancer treatment. Also, the effects may not be the same for each person, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment, and they can help relieve symptoms that may occur during and after treatment. SurgeryTUR causes few problems. Patients may have some blood in their urine and difficulty or pain when urinating for a few days afterward. After bladder surgery, particularly radical cystectomy, patients are often uncomfortable during the first few days. However, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies with each patient. After segmental cystectomy, patients may not be able to hold as much urine in hteir bladder. In most cases, this problem is temporary, but some patients may have long lasting changes in bladder capacity. When the bladder is removed, the patient needs a new way to store and pass urine. Various methods are used. In one common method, the surgeon uses a piece of the person’s small intestine to form a new tube through which the urine can pass. The ureters are attached to one end, and the other end is brought out through and opening in the wall of the abdomen. This new opening is called a stoma. A flat bag fits over the stoma to collect urine, and special adhesive holds it in place. The patient will be taught how to care for the stoma. The surgical procedure to create a stoma is called a urostomy or an ostomy. A newer method uses part of the small intestine to make a new storage pouch (called a continent reservoir) inside the body. Urine collects there instead of emptying into a bag. The pouch is connected either to a stoma or to the urethra. The patient learns to use a catheter to drain the urine through the stoma or the urethra. Women who have had a radical cystectomy are not able to have children because their uterus has been removed. In addition, the vagina may be narrower or shallower, which may make sexual intercourse difficult. In the past, nearly all men were impotent after radical cystectomy, but improvements in surgery have made it possible to prevent this side effect in some cases. However, men who have had their prostate and seminal vesicles removes no longer produce semen, so they do not ejaculate when they have an orgasm and are not able to father children. Radiation TherapyWith radiation therapy, the side effects depend mainly on the treatment dose and the part of the body that is treated. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can. With external radiation, there may be permanent darkening or "bronzing" of the skin in the treated area. In addition, it is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. These problems are temporary, and the doctor may be able to suggest ways to relieve them. Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Radiation therapy may also cause a decrease in the number of white blood cells, cells that help protect the body against infection. Usually, the doctor can suggest certain diet changes or medicine to ease these problems. For both men and women, radiation treatment for bladder cancer can affect sexuality. Women may experience vaginal dryness, and men may have difficulty with erections. ChemotherapyThe side effects of chemotherapy depend on the drugs and the doses the patient receives as well as how the drugs are given. In addition, as with other types of treatment, side effects vary from person to person. Anticancer drugs that are placed in the bladder may irritate the bladder for a few days after treatment, causing some discomfort or bleeding. Some drugs, if they come into contact with the skin or genitals, may cause a rash. Biological TherapyTreatment with BCG can irritate the bladder for a few days after treatment. This may cause pain, especially while urinating, and the feeling of an urgent need to urinate. Patients also may have some blood in their urine, have a low fever, or feel tired or nauseated. Other types of biological therapy may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a rash, or have swelling. These problems can be severe, but they go away after the treatment stops. Recovery and OutlookPeople with bladder cancer and their families are naturally concerned about recovery from cancer and their outlook for the future. Sometimes people use statistics to try to figure out their chances of being cured. It is important to remember, however, that statistics are averages based on large numbers of patients. They can not be used to predict what will happen to a particular patient because no two patients are alike; treatments and responses vary greatly. The patient’s doctor is in the best position to discuss the issue of prognosis, or chance of recovery. When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many cancer patients are cured, doctors use this term because cancer can return. (The return of cancer is called a recurrence.) Superficial bladder cancer tends to recur as another superficial cancer in the bladder. The disease can also recur in the bladder muscle or elsewhere in the body. Therefore, people who have had bladder cancer may wish to discuss the possibility of recurrence with the doctor. Follow-up CareIt is important for people who have had cancer to have regular follow-up examinations after their treatment is over. For people with bladder cancer who have not had their bladder removed, the doctor will check the bladder with a cystoscope and remove any superficial tumors that may have recurred. Patients also may have urine tests to check for cancer cells. Follow-up care may also include blood tests, a CT scan, a chest x-ray, or other tests. Follow-up care is an important part of the overall treatment process, and people with cancer should not hesitate to discuss it with the doctor. Regular follow-up care ensures that changes in health are noted so that recurrent cancer or other problems can be treated as soon as possible. Between checkups, people who have had bladder cancer should report any health problems as soon as they appear. Possible Causes and PreventionResearchers at hospitals and medical centers all across the country are studying bladder cancer. They are trying to learn what causes the disease and how to prevent it. At this time, the causes of bladder cancer are not fully understood. It is clear, however, that this disease is not contagious; no one can "catch" cancer from another person. Some researchers study patterns of cancer in the population. They look for factors that are more common in people who get bladder cancer than in people who don't get the disease. Studying such patterns helps researchers identify risk factors for bladder cancer. However, most people with the risk factors do not get cancer, and many people who do get bladder cancer have none of the known risk factors. Researchers have found that white people in the United States get bladder cancer twice as often as African-Americans, and men are affected about three times as often as women. People with family members who have bladder cancer may be more likely to get the disease as well. Most bladder cancers occur after the age of 55, but the disease can also develop in younger people. Known and possible risk factors for bladder cancer include:
People who think they may be at risk for developing bladder cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups. If you would like more information on this topic, please contact us. |
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