Bladder Cancer
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Bladder cancer is a disease in which malignant (cancer) cells form
in the tissues of the bladder.
The bladder is a hollow organ in the lower part
of the abdomen. It is shaped like a small balloon and has a muscular wall
that allows it to get larger or smaller. The bladder stores urine until it
is passed out of the body. Urine is the liquid waste that is made by the
kidneys when they clean the blood. The urine passes from the two kidneys
into the bladder through two tubes called ureters. When the bladder is emptied
during urination, the urine goes from the bladder to the outside of the body
through another tube called the urethra.
There are three types of bladder cancer that
begin in cells in the lining of the bladder. These cancers are named for
the type of cells that become malignant (cancerous):
- Transitional cell carcinoma: Cancer that begins in cells in the innermost
tissue layer of the bladder. These cells are able to change shape depending
on whether the bladder is full or empty and may be stretched without breaking
apart. Most bladder cancers begin in the transitional cells.
- Squamous cell carcinoma: Cancer that begins in squamous cells, which are
thin, flat cells that may form in the bladder after long-term infection
or irritation.
- Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular
cells in the lining of the bladder produce and release fluids such as mucus.
Cancer that is confined to the lining of the
bladder is called superficial bladder cancer. Cancer that begins in the transitional
cells may spread through the lining of the bladder and invade the muscle
wall of the bladder or spread to nearby organs and lymph nodes; this is called
invasive bladder cancer.
Smoking, gender, and diet can affect the risk of developing bladder
cancer.
Risk factors include the following:
- Smoking.
- Being exposed to certain substances at work, such as rubber, certain dyes and
textiles, paint, and hairdressing supplies.
- A diet high in fried meats and fat.
- Being older, male, or white.
- Having an infection caused by a certain parasite.
Possible signs of bladder cancer include blood in the urine or pain
during urination.
These and other symptoms may be caused by
bladder cancer or by other conditions. A doctor should be consulted if any
of the following problems occur:
- Blood in the urine (slightly rusty to bright red in color).
- Frequent urination, or feeling the need to urinate without being able to do so.
- Pain during urination.
- Lower back pain.
Tests that examine the urine, vagina, or rectum are used to help detect
(find) and diagnose bladder cancer.
The following tests and procedures
may be used:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected into
a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- Urinalysis: A test to check the color of urine and its contents, such
as sugar, protein, blood, and bacteria.
- Internal exam: An exam of the vagina and/or rectum. The doctor inserts
gloved fingers into the vagina and/or rectum to feel for lumps.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters,
and bladder to find out if cancer has spread to these organs. A contrast
dye is injected into a vein. As the contrast dye moves through the kidneys,
ureters, and bladder, x-rays are taken to see if there are any blockages.
- Cystoscopy: A procedure to look inside the bladder and urethra to check
for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through
the urethra into the bladder. Tissue samples may be taken for biopsy.
- Biopsy: The removal of cells or tissues so they can be viewed under a
microscope to check for signs of cancer. A biopsy for bladder cancer is
usually done during cystoscopy. It may be possible to remove the entire
tumor during biopsy.
- Urine cytology: Examination of urine under a microscope to check for abnormal
cells.
Certain factors affect prognosis (chance of recovery) and treatment
options.
The prognosis (chance of recovery)
depends on the following:
- The stage of the cancer (whether it is superficial or invasive
bladder cancer, and whether it has spread to other places in the body).
Bladder cancer in the early stages can often be cured.
- The type of bladder cancer cells and how they look under a microscope.
- The patient’s age and general health.
Treatment options depend on the stage of bladder
cancer.
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After bladder cancer has been diagnosed, tests are done to find out
if cancer cells have spread within the bladder or to other parts of the body.
The process used to find out if cancer has
spread within the bladder lining and muscle or to other parts of the body
is called staging. The information gathered from the staging process determines
the stage of the disease. It is important to know the stage in order to plan
treatment. The following tests and procedures may be used in the staging
process:
- Cystoscopy: A procedure to look inside the bladder and urethra to check
for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through
the urethra into the bladder. Tissue samples may be taken for biopsy.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected into
a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio
waves, and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).
- Physical exam and history: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps or anything
else that seems unusual. A history of the patient’s health habits and past
illnesses and treatments will also be taken.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray
is a type of energy beam that can go through the body and onto film, making
a picture of areas inside the body.
- Bone scan: A procedure to check if there are rapidly dividing cells, such
as cancer cells, in the bone. A very small amount of radioactive material
is injected into a vein and travels through the bloodstream. The radioactive
material collects in the bones and is detected by a scanner.
Stage 0
In stage 0, the cancer is found on tissue
lining the inside of the bladder only. Stage 0 is divided into stage 0a and
stage 0is, depending on the type of the tumor:
- Stage 0a is also called papillary carcinoma, which may look
like tiny mushrooms growing from the lining of the bladder.
- Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue
lining the inside of the bladder.
Stage I
In stage I, the cancer has spread to the layer
below the inner lining of the bladder.
Stage II
In stage II, cancer has spread to either the
inner half or outer half of the muscle wall of the bladder.
Stage III
In stage III, cancer has spread from the bladder
to the fatty layer of tissue surrounding it, and may have spread to the reproductive
organs (prostate, uterus, vagina).
Stage IV
In stage IV, cancer has spread from the bladder
to the wall of the abdomen or pelvis. Cancer may have spread to one or more
lymph nodes or to other parts of the body.
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Recurrent bladder cancer is cancer that has
recurred (come back) after it has been treated. The cancer may come back
in the bladder or in other parts of the body.
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Different types of treatment are available
for patients with bladder cancer. Some treatments are standard (the currently
used treatment), and some are being tested in clinical trials. Before starting
treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the “standard”
treatment, the new treatment may become the standard treatment.
Surgery
One of the following types of surgery may
be done:
- Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope
(a thin lighted tube) is inserted into the bladder through the urethra.
A tool with a small wire loop on the end is then used to remove the cancer
or to burn the tumor away with high-energy electricity. This is known as
fulguration.
- Radical cystectomy: Surgery to remove the bladder and any lymph nodes
and nearby organs that contain cancer. This surgery may be done when the
bladder cancer invades the muscle wall, or when superficial cancer involves
a large part of the bladder. 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 reduce urinary symptoms caused by the cancer.
When the bladder must be removed, the surgeon creates another way for urine
to leave the body.
- Segmental cystectomy: Surgery to remove part of the bladder. This surgery
may be done for patients who have a low-grade tumor that has invaded the
wall of the bladder but is limited to one area of the bladder. Because most
of the bladder remains intact, a patient is able to urinate normally after
recovering from this surgery.
- Urinary diversion: Surgery to make a new way for the body to store and
pass urine.
Even if the doctor removes all the cancer
that can be seen at the time of the surgery, some patients may be given chemotherapy
after surgery to kill any cancer cells that are left. Treatment given after
surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that
uses high-energy x-rays or other types of radiation to kill cancer cells.
There are two types of radiation therapy. External radiation therapy uses
a machine outside the body to send radiation toward the cancer. Internal
radiation therapy uses a radioactive substance sealed in needles, seeds,
wires, or catheters that are placed directly into or near the cancer. The
way the radiation therapy is given depends on the type and stage of the cancer
being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses
drugs to stop the growth of cancer cells, either by killing the cells or
by stopping the cells from dividing. When chemotherapy is taken by mouth
or injected into a vein or muscle, the drugs enter the bloodstream and can
reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy
is placed directly into the spinal column, a body cavity such as the abdomen,
or an organ, the drugs mainly affect cancer cells in those areas. Bladder
cancer may be treated with intravesical (into the bladder through a tube
inserted into the urethra) chemotherapy. The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses
the patient’s immune system to fight cancer. Substances made by the body
or made in a laboratory are used to boost, direct, or restore the body’s
natural defenses against cancer. This type of cancer treatment is also called
biotherapy or immunotherapy.
Other types of treatment are being tested in clinical trials. These
include the following:
Chemoprevention
Chemoprevention is the use of drugs, vitamins,
or other substances to try to reduce the risk of developing cancer or reduce
the risk cancer will recur (come back).
Photodynamic therapy
Photodynamic therapy (PDT) is a cancer treatment
that uses a drug that is not active until it is exposed to light. When exposed
to light, the cancer cells are killed.
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Treatment of stage 0 bladder cancer may include
the following:
- Transurethral resection with fulguration.
- Transurethral resection with fulguration followed by intravesical biologic therapy
or chemotherapy.
- Segmental cystectomy.
- Radical cystectomy.
- A clinical trial of photodynamic therapy.
- A clinical trial of biologic therapy.
- A clinical trial of chemoprevention therapy given after treatment to stop cancer
from recurring (coming back).
Treatment of stage I bladder cancer may include
the following:
- Transurethral resection with fulguration.
- Transurethral resection with fulguration followed by intravesical biologic therapy
or chemotherapy.
- Segmental or radical cystectomy.
- Radiation implants with or without external radiation therapy.
- A clinical trial of chemoprevention therapy given after treatment to stop cancer
from recurring (coming back).
- A clinical trial of intravesical therapy.
Treatment of stage II bladder cancer may include
the following:
- Radical cystectomy with or without surgery to remove pelvic
lymph nodes.
- External radiation therapy combined with chemotherapy.
- Radiation implants before or after external radiation therapy.
- Transurethral resection with fulguration.
- Segmental cystectomy.
- A clinical trial of chemotherapy before or after surgery.
- A clinical trial of chemotherapy combined with external radiation therapy.
Treatment of stage III bladder cancer may
include the following:
- Radical cystectomy.
- External radiation therapy with or without radiation implants.
- Segmental cystectomy.
- External radiation therapy combined with chemotherapy.
- A clinical trial of chemotherapy before or after surgery.
- A clinical trial of chemotherapy combined with external radiation therapy.
Treatment of stage IV bladder cancer may include
the following:
- Radical cystectomy.
- External radiation therapy (may be as palliative therapy to relieve symptoms
and improve quality of life).
- Urinary diversion as palliative therapy to relieve symptoms and improve quality
of life.
- Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
- Chemotherapy.
- A clinical trial of chemotherapy before or after surgery.
- A clinical trial of chemotherapy combined with external radiation therapy.
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Treatment of recurrent bladder cancer depends
on previous treatment and where the cancer has recurred. Treatment for recurrent
bladder cancer may include the following:
- Surgery.
- Chemotherapy.
- Radiation therapy.
- A clinical trial of chemotherapy.
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Bladder Cancer
