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Bladder Cancer

The bladder is a hollow organ that stores urine.

Types of Bladder Cancer

There are four main types of bladder cancer. They are grouped by the way the cancer cells look under a microscope.

Urothelial carcinoma: This is by far the most common type of bladder cancer. It starts in the urothelial cells. It is also called transitional cell carcinoma. Within this group are also several subtypes. They are named depending on the shape of the cells and whether they tend to spread and invade other organs (invasive).

Squamous cell carcinoma: This type is much less common and is usually invasive.

Adenocarcinoma: This type is also much less common and almost all are invasive.

Small cell: A very small number of bladder cancers are of this type.

Risk Factors:

The following risk factors have been linked to bladder cancer:

Smoking: Smoking is the greatest risk factor for bladder cancer. Smokers get bladder cancer twice as often as people who don't smoke. Certain chemicals in tobacco smoke are absorbed from the lungs and get into the blood. From the blood, they are filtered by the kidneys and collect in the urine. These chemicals in the urine damage the cells that line the inside of the bladder and increase the risk of cancer.

Work exposure: Some chemicals used in the making of dye have been linked to bladder cancer. Other types of industries use chemicals that may put workers at risk if good safety practices are not followed. Workers with a higher risk of bladder cancer include painters, hairdressers, machinists, printers, and truck drivers. Smoking can increase the risk among these workers. People who work with chemicals called aromatic amines may have higher risk. These chemicals are used in making rubber, leather, printing materials, textiles, and paint products.

Race: Whites are twice as likely to develop bladder cancer as are African Americans and Hispanics. Asians have the lowest rate of bladder cancer.

Age: The risk of bladder cancer goes up with age.

Gender: Men get bladder cancer four times as often as women.

Chronic bladder inflammation: While urinary infections, kidney stones, and bladder stones don’t cause bladder cancer, they have been linked to it.

Personal or family history of bladder cancer: People who have had bladder cancer have a higher chance of getting another tumor. People whose family members have had bladder cancer also have a higher risk.

Bladder birth defects: Rarely, the connection between the belly button and the bladder doesn’t disappear as it should before birth and can become cancerous. There is another, very rare, birth defect called exstrophy which can lead to bladder cancer.

Earlier treatment: Some drugs or radiation used to treat other cancers can increase the risk of bladder cancer.

Arsenic: Arsenic in drinking water has been linked to a higher risk of bladder cancer.

Not drinking enough liquids: People who drink lots of liquids each day have a lower rate of bladder cancer.

Prevention:

Early Detection: Signs and Symptoms

Blood in the urine or changes in bladder habits: These can be signs of bladder cancer. Other signs might include having to urinate more often, or feeling as if you need to go but not being able to do so. Although these problems can be caused by something other than cancer, do not ignore them. Be sure to talk to your doctor if you have any of these symptoms.

Medical history and physical exam: First your doctor will ask you about your medical history to check for risk factors and symptoms. The doctor might check the rectum and vagina (in women) to see how big the tumor is and how far it may have spread.

Cystoscopy: A cystoscope is a thin tube with a lens and a light. The doctor places it into the bladder through the urethra. The area is first numbed or drugs may be used to put you into a deep sleep. With the cystoscope the doctor can see the inside of the bladder. If there is anything suspicious, a small piece of tissue is removed and looked at under a microscope (a biopsy).

Urine cytology: In this test, urine or cells "washed" from the bladder are sent to the lab to see if cancer cells or pre-cancer cells are present. This is often done at the same time as the cystoscopy.

Urine culture: A sample of your urine is sent to the lab to see if you might have an infection. An infection can sometimes cause symptoms like those of bladder cancer. It may take 2 or 3 days to get the results of this test.

Biopsy: A sample of any suspicious tissue is removed during cystoscopy and looked at under a microscope. This test can tell if cancer is present, what type of bladder cancer it is, and how deep it has gone into the bladder wall. Bladder cancers are graded on a scale from 1 to 4 based on how they look under the microscope. The lower the number, the more the cells look like normal tissue. A higher grade means the cancer is more likely to have spread outside the bladder and the outlook is not as good.

Bladder tumor marker studies: These tests look for certain substances released by cancer cells into the urine. Some doctors use these tests, but most think that more research is needed to see how useful they are.

Imaging tests: Imaging tests are done to allow your doctor to "see" your bladder and other organs. A number of these tests, such as IVP (intravenous pyelogram), CT scans, MRI scans, x-rays, ultrasound, and bone scans may be done to give the doctor more information about the cancer and whether it has spread. Feel free to ask your doctor about any tests that you will have.

Treatment:

Transurethral surgery: This operation is used most often for early stage bladder cancer. It is done through a slender tube with a lens and a light that is placed into the bladder through the urethra. This tube is called a resectoscope. You will have either medicine to make the area numb or be put into a deep sleep using general anesthesia. With this approach there is no need to cut into the abdomen. After surgery, there may be other steps to get rid of any remaining cancer. These steps could include burning the base of the tumor using a cystoscope or treatment with a laser.
The side effects of this surgery are often mild and do not usually last long. There may be some bleeding or mild pain right after surgery. You can usually go home the same day or the next day. In less than 1 to 2 weeks you should be able to do your normal activities. If this surgery has to be done several times long-term side effects may become a problem. There is a chance that the bladder can become scarred and not able to hold much urine. This means having to urinate often and the chance of losing urine (incontinence).

Cystectomy: This surgery is used when the bladder cancer is invasive (cancer that has spread beyond the layer of cells where it started to nearby tissues.) In this case the surgeon has to cut through the abdomen to get to the bladder. When only part of the bladder is removed, it is called a partial cystectomy. If the entire bladder is removed it is a radical cystectomy.

If the entire bladder is removed, nearby lymph nodes are also removed. In men, the prostate is removed as well. In women, the womb (uterus), ovaries, fallopian tubes, and a small part of the vagina are often removed too.

For either operation, you will be asleep. You will need to stay in the hospital for about 7 to 10 days. After about 4 to 6 weeks you should be able to go back to your normal activities. It is important that the surgeon doing this operation have experience in treating bladder cancer. If the surgery is not done well, the cancer is more likely to come back.

Side effects of this surgery could include a lot of bleeding, urinary infections, urine leakage, and blockage of urine flow.

Intravesical Immunotherapy

Intravesical treatment is placed directly into the bladder rather than being given by mouth or injected into a vein. The most common form of this type of treatment for bladder cancer is immunotherapy.

BCG is an example of this type of treatment that is useful for treating low-stage bladder cancer. BCG is a type of bacteria that is sometimes used to vaccinate people against TB (tuberculosis). When used to treat bladder cancer, BCG is given directly into the bladder through a catheter. The body’s immune system responds to BCG. Immune system cells are drawn to the bladder and attack the cancer. It is usually given once a week for 6 weeks.

Chemotherapy:

Chemotherapy (chemo) refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Side effects might include:

Most of these side effects go away when treatment is over.

Radiation Therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells.

Treatment Centers in Georgia:

National Organizations and Web Sites that help are:

For Articles on bladder cancer:

http://health.mongabay.com/conditions/Bladder_Cancer.html

http://www.urotoday.com/37/browse_categories/bladder_cancer/1038/50/300/

Georgia Cancer Foundation—based in Atlanta—provides education, early detection, and support for Georgia residents affected by all types of cancer. Through its innovative programs and extensive support group network, the Foundation caters to newly diagnosed patients, those currently undergoing care, and survivors—as well as those in need of low-cost early detection.

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