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Bladder Cancer Overview

Bladder Cancer

Cancer is a group of many different diseases that have some important things in common. They all affect cells, the bodys basic unit of life. To understand different types of cancer, such as Bladder Cancer , it is helpful to know about normal cells and what happens when they 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.

Benign tumors are not cancer. They often can be removed and, in most cases they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.

Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissues around them. Also, cancer cells can break away from a malignant tumor and enter the blood stream or the lymphatic system. This process is the way cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

Types of Bladder Cancer

Bladder tumors are grouped into several types by the way they appear under a microscope. The 4 main types of cancers that affect the bladder are:

Signs and symptoms

Bladder cancer often doesnt produce any signs or symptoms in its early stages. The first warning sign is usually blood in your urine (hematuria). The blood may show up on a urine test or your urine may appear reddish or darker than normal. You may also notice a change in bladder habits- having to urinate more often or feeling like you need to urinate but cant.

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 Staging

To find the cause of symptoms, the doctor asks about the patients medical history and does a physical exam. The physical may 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 use an instrument to look directly into the bladder, a procedure called cystoscopy. This procedure may be done with general or local 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 tissues through this tube. The sample is then examined 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. The 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.

Cause of the disease (Etiology)

Cancer of the bladder is the fourth most common cancer among men and the ninth most common cancer among women. About 40,000 men and 15,000 women will develop bladder cancer this year in the United States. There will be 250,00 new cases of bladder cancer world wide. Bladder cancer is the fourth leading cause of cancer and the seventh leading cause of cancer death. Cancer of the bladder may occur at any age, but it usually strikes those over 50 years old. What triggers this cancer isnt well understood. In cases, it occurs in people without known risk factors. The risk factors can include the following.

Smoking - Some cancer causing chemicals in tobacco smoke can collect in your urine, where they become concentrated and damage your bladder lining. Smoking is the leading cause of bladder cancer.

Industrial chemicals - Chemicals used by makers of dyes, rubber, leather, textiles and paint products have been associated with increased bladder cancer risk.

Chronic bladder inflammation - Chronic urinary infections or inflammations may increase your risk for a certain form of bladder cancer. But these conditions alone arent believed to cause cancer.

Researchers also arent certain why the incidence of bladder cancer is increasing. Some ways to prevent this disease are, if you use tobacco, stop. If you work with chemicals, follow all safety regulations. In addition, if you notice blood in your urine or it shows up on a urine test, be persistent in finding the cause.

Treatments

Treatment for bladder cancer depends on the stage of the disease (particularly if, or how deeply, the cancer has invaded the bladder wall), the grade of the cancer, the patients 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 patients needs. Depending on its stage and grade, bladder cancer may be treated with surgery, radiation therapy, chemotherapy,and immunotherapy.

Surgery - For superficial cancer, surgery to remove the cancer is performed through a cystoscope. The cancer may be cut away, burned or destroyed with a high-energy laser. More advanced cancer requires traditional surgery through an incision in your abdomen. Part of the bladder may be removed.

Radiation therapy - Radiation therapy uses high-energy radiation to kill cancer cells. Radiation is also sometimes used to shrink a tumor prior to surgery, or together in chemotherapy in place of surgery.

Chemotherapy - A combination of medications is used to kill the cancer. Chemotherapy may be used as a precautionary measure after surgery to ensure all of the cancer has been destroyed. Its also used to control more advanced cancer thats spread beyond the bladder.

Immunotherapy - This involves placing bacterial antigens into your body through a cystoscope. As your bodys immune system responds to the antigens, it attacks and kills cancer cells at the same time.

Follow up care

Follow up depends on the stage and type of disease that is being treated. For patients with superficial bladder cancers that are removed with telescopic surgery, urinalysis and cystoscopy should be done on a regular basis. Usually every three to four months for the first year and then less often, but at least once a year. Based on the results of cystoscopy and cytology, further tests may be ordered. For patients after total cystectomy for advanced disease, frequent follow-up exams are needed to see if the disease has recurred or spread to other parts of the body. These exams should be done every three to six months during the first three years after treatment. Most bladder cancers that recur do so during the first three years. Patients whose bladders have been removed will be examined to see if the rest of the urinary system is disease free and if the urinary diversion is working properly.

Prognosis

The outlook for patients for early-stage bladder cancer that has not invaded the bladder wall is very good. About 90% of those patients live for five or more years with localized diagnosis and treatment. For patients whose cancer has spread to areas near the bladder, the 5 year survival rate is 45%. For those with advanced disease that has spread far from the bladder, the 5 year survival rate is 10%.

Research advances in detection, treatment, rehabilitation, and pain control have improved the outlook and quality of life for people with bladder cancer. By using a combination of therapies, doctors can treat some bladder cancers without removing the patients bladder. However, when cystectomy is necessary, new surgical techniques allow doctors to create new ways of storing and passing urine, which improves patients recovery and long-term comfort. Researchers are also conducting studies to learn more about what causes the development of bladder cancer. Although there is still much more work to be done, there are many reasons to be optimistic about the future.