Bladder Cancer

Definition

The bladder is a hollow, balloon-like organ located behind the pelvic bone and hidden within the pelvis. Cancer is a disease characterized by the uncontrolled growth of abnormal cells (called a tumor). Bladder cancer is any type of malignant (cancerous) growth in the bladder.

Description

The bladder walls consist of muscle and the urinary epithelium. At the back of the bladder are the two ureters which carry urine to the bladder from the kidneys. The bottom of the bladder tapers down into a neck called the urethra, which carries the urine from the body.

The bladder's function is to collect and store urine until it can be expelled from the body.

There are two types of bladder cancer - superficial and invasive.

Superficial bladder tumors, also known as papillary tumors, papillomas or bladder warts, are found on the surface of the urinary epithelium.

Invasive bladder tumors are found deeper in urinary epithelium and have extended into the muscle layer or surrounding tissues, and in some cases, has spread through the bladder wall to nearby organs, such as the rectum, sigmoid colon, prostate gland (in men), the uterus (in women), and to the lymph glands and the bones of the pelvis.

Causes and Risk Factors

Bladder cancer occurs more commonly in men than women, and the average age at diagnosis is 65 years of age.

Cigarette smoking is a major risk factor, accounting for about 60 percent of all new cases.

Bladder cancer has been linked to the exposure to chemical carcinogens (cancer-inducing substances) used in synthetic dye, leather, rubber, cable, printing and chemical industries.

Symptoms

The symptoms of bladder cancer may include:

• blood in the urine (urine looks bright red or rusty)

• pain or burning when urinating

• passing urine often

• feeling the need to urinate but no urine comes out

• difficulty in passing urine

If the cancer is in a more advanced stage, additional symptoms such as the ones listed below may occur:

• loss of weight

• loss of appetite

• fever

• pain in the bones or the rectal, anal or pelvic area

Diagnosis

To diagnose bladder cancer, the doctor will take a medical history, do a physical examination and request a urine test. He or she may order an x-ray test and perform a cystoscopy (described below) and if needed, a biopsy.

The physical exam will include a vaginal exam for women and a digital rectal exam (DRE) for men. Since the bladder is located near the sexual organs of both the male and female, these internal exams enable the doctor to feel the bladder.

A urine sample is taken and then examined under a microscope for cancerous cells.

An x-ray procedure, called an intravenous pyelogram (IVP), is used to detect any abnormalities or growths in the bladder. For the IVP x-ray, a special dye containing iodine is given to the patient through a needle inserted in the vein. The dye goes into the bladder, making the bladder easier to see on the x-rays.

A cystoscopy is a procedure using a thin, lighted tube called a cystoscope that is inserted into the bladder through the urethra. If the doctor sees any abnormal areas or growths, he or she will remove some of that tissue (biopsy) for further examination under a microscope to see whether cancer cells are present.

Staging

Once bladder cancer has been diagnosed, the next step is to know where the cancer is located and whether it has spread from its original location.

The patient’s prognosis often depends on the extent of bladder wall penetration by the cancer and whether the cancer has metastasized (spread through the body). This step is called staging and may require additional tests, including a CT (computed tomography) scan.

The CT scan is a series of x-rays put together by a computer to form a detailed picture. The patient may need to drink a special dye that will outline the bladder and surrounding organs.

Treatment

There are four main types of treatment for bladder cancer: surgery, radiation therapy, chemotherapy and biological therapy. The type and staging of the cancer, age, and overall health, determine which treatment method(s) will be used.

Surgery

There are three (3) main types of surgeries for bladder cancer:

Transurethral resection (TUR) is an operation that uses a cystoscope inserted 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 the tumor away with high-energy electricity.

Cystectomy is an operation to remove the bladder. There are two types of cystectomy - segmental (partial), and radical (complete).

Segmental cystectomy is an operation to take out part of the bladder where the cancer is located. Radical cystectomy is the removal of the bladder and nearby organs. In women, this operation includes removing the uterus, fallopian tubes, ovaries and part of the vagina. In men, the prostate and seminal vesicles are removed.

Urinary diversion is an operation to make way for urine to pass out of the body so that it does not go through the bladder.

Radiation therapy

Radiation therapy (also called radiotherapy) may be needed when the cancer cannot be removed with TUR because it involves a larger area of the bladder.

X-rays destroy the ability of cancer cells to grow and multiply. Internal radiation therapy, with radioactive material placed in the bladder, may be combined with external radiation, which comes from a machine located outside the body.

For internal radiation therapy, radioactive material is inserted into the bladder through the cystoscope. This puts cancer-killing rays as close as possible to the site of the cancer while sparing most of the surrounding healthy tissues.

Chemotherapy

When cancer involves the pelvis or has spread to other parts of the body, the doctor may suggest chemotherapy.

Chemotherapy uses drugs to stop the growth of cancer cells. Chemotherapy may be given in different ways - by mouth or injection into a muscle or a vein, or by catheter into the bladder (intravesical chemotherapy).

Some of these drugs are given in cycles so that treatment periods alternate with rest periods.

Depending on the specific drugs, most patients take chemotherapy as an outpatient at the hospital, the doctor's office or at home. Sometimes, it may be necessary to stay in the hospital for a period of time to monitor the effects of the treatment.

Biological therapy

Often a form of intravesical chemotherapy, biological therapy uses materials made by the body or made in a laboratory to boost, direct or restore the body's natural defenses against the cancer.

When several tumors are present in the bladder or when there is a risk that the cancer will recur, TUR may be followed by treatment with drugs. The doctor may put a solution containing the bacteria bacillus Calmette-Guerin (BCG), a form of biological therapy, directly into the bladder via a catheter (intravesical biological therapy).

Questions to Ask Your Doctor

Do any tests need to be done for diagnosis or to determine if the cancer has spread?

Is the cancer invasive? Has it spread?

How serious is the condition?

What treatment will you recommend? What are the side effects or complications?

How successful is this treatment?

Will any medication be prescribed? What are the side effects?

Will surgery be required? What is the procedure? What can be expected after the surgery?

What is the prognosis?