Description

Bladder cancer is a common type of cancer that begins in the cells of the bladder. The bladder is a hollow muscular organ in your lower abdomen that stores urine.

Bladder cancer most often begins in the cells (urothelial cells) that line the inside of the bladder. Urothelial cells are also found in the kidneys and the tubes (ureters) that connect the kidneys to the bladder. Urothelial cancer may occur in the kidneys and ureters, as well, but it is much more common in the bladder.

The majority of bladder cancers are diagnosed at an early stage, when the cancer is highly treatable. But even early-stage bladder cancers can be return after successful treatment. For this reason, people with bladder cancer usually need follow-up tests for years after treatment to look for bladder cancer that is repeated.

Symptoms

Bladder cancer signs and symptoms may include:

  • Blood in the urine (hematuria), which can cause urine to appear bright red or cola-colored, although sometimes the urine appears normal and the blood is detected in a test lab
  • Frequent need to urinate
  • Pain when urinating
  • Back pain

When to see a doctor

If you notice that have discolored urine and are concerned that may contain blood, you make an appointment with your doctor to get a checkup. Also make an appointment with your doctor if you have other signs or symptoms that worry you.

Causes

Bladder cancer begins when cells of the bladder develop changes (mutations) in the DNA. A cell's DNA contains the instructions that tell the cell what to do. The changes that tell the cell to multiply rapidly and to continue living when healthy cells would die. The alteration of the cells form a tumor that can invade and destroy normal body tissue. At the time, the abnormal cells can break away and spread (metastasize) throughout the body.

Types of bladder cancer

Different types of cells in the bladder may become cancerous. The type of bladder cell where the cancer begins determines the type of bladder cancer. Doctors use this information to determine which treatments may work best for you.

Types of bladder cancer include:

  • Urothelial Carcinoma. Urothelial Carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when the bladder is empty. These same cells that line the inside of the ureters and the urethra, and cancers can form in those places as well. Urothelial Carcinoma is the most common type of bladder cancer in the united States.
  • The squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder, for example, of an infection or long-term use of a urinary catheter. Squamous cell cancer of the bladder is rare in the united States. It is more common in parts of the world where certain parasitic infections (schistosomiasis) is a common cause of infections of the bladder.
  • The Adenocarcinoma. Adenocarcinoma begins in cells that make mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is very rare.

Some types of bladder cancer include more than one type of cell.

Risk factors

Factors that may increase the risk of bladder cancer include:

  • The habit of smoking. Smoking cigarettes, cigars, or pipes, can increase the risk of bladder cancer-causing, harmful chemicals that accumulate in the urine. When you smoke, your body processes the chemicals in the smoke and excreted, some of them in your urine. These harmful chemicals which can damage the lining of the bladder, which can increase your risk of cancer.
  • The increase of the age. Risk of bladder cancer increases with age. Although it can occur at any age, the majority of people diagnosed with bladder cancer are over 55 years old.
  • The fact of being a man. Men are more likely to develop bladder cancer than women.
  • Exposure to certain chemicals. The kidneys play a key role in the filtration of harmful chemicals in the bloodstream and moving into your bladder. Because of this, it is believed to be close to certain chemicals may increase the risk of bladder cancer. Chemicals associated with the risk of bladder cancer include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
  • Previous cancer treatment. The treatment with the anticancer drug cyclophosphamide increases the risk of bladder cancer. The people who received the treatments of targeted radiation to the pelvis previous cancer have a higher risk of developing bladder cancer.
  • Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as could occur with prolonged use of a urinary catheter, may increase the risk of squamous cell cancer of the bladder. In some areas of the world, the squamous cell carcinoma is linked to chronic inflammation of the bladder caused by the parasitic infection known as schistosomiasis.
  • A personal or family history of cancer. If you have ever had bladder cancer, you are more likely to get it again. If one of your blood relatives — a father, brother or son — he has a history of bladder cancer, you may have an increased risk of the disease, although it is unlikely that the bladder cancer in families. A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), may increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries, and other organs.

Prevention

Although there is no guaranteed way to prevent cancer of the bladder, you can take steps to help reduce your risk. For example:

  • Do not smoke. If you don't smoke, don't start. If you smoke, talk with your doctor about a plan to help you quit. Support groups, medications, and other methods can help you to stop smoking.
  • Be careful around chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
  • Choose from a variety of fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.

Diagnosis

The diagnosis of bladder cancer

Tests and procedures used to diagnose bladder cancer may include:

  • The use of an endoscope to examine the interior of the bladder (cystoscopy). To perform cystoscopy, your doctor inserts a small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens that allows your doctor to view the inside of the urethra and bladder, to examine these structures for signs of disease. Cystoscopy can be done in a doctor's office or in the hospital.
  • The removal of a sample of tissue for testing (biopsy). During cystoscopy, your doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for analysis. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat cancer of the bladder.
  • The examination of a urine sample (urine cytology). A sample of your urine is analyzed under a microscope to look for cancer cells in a procedure called urine cytology.
  • Imaging tests.Imaging tests, such as computed tomography (CT) urogram or pyelography, retrograde, it allows your doctor to examine the structures of your urinary tract. During aCTurogram, a contrast dye is injected into a vein in your hand, finally, ends up in the kidneys, ureters, and bladder. The X-ray images taken during the test to provide a detailed view of your urinary tract and help your doctor identify the areas in which it could be cancer. Pyelogram retrograde is an X-ray examination is used to get a detailed look of the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through the urethra into the bladder to inject a contrast dye into your ureters. The dye then flows into the kidneys, while the X-ray images are captured.

Imaging tests. Imaging tests, such as computed tomography (CT) urogram or pyelography, retrograde, it allows your doctor to examine the structures of your urinary tract.

During a ct urogram, a contrast dye is injected into a vein in your hand, finally, ends up in the kidneys, ureters, and bladder. The X-ray images taken during the test to provide a detailed view of your urinary tract and help your doctor identify the areas in which it could be cancer.

Pyelogram retrograde is an X-ray examination is used to get a detailed look of the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through the urethra into the bladder to inject a contrast dye into your ureters. The dye then flows into the kidneys, while the X-ray images are captured.

The determination of the extent of the cancer

After you confirm that you have bladder cancer, your doctor may recommend additional tests to determine if the cancer has spread to the lymph nodes or to other areas of your body.

Tests may include:

  • Computed tomography
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan
  • Chest X-ray

Your doctor uses the information from these procedures to assign the cancer a stage. The stages of bladder cancer are indicated using Roman numerals ranging from 0 to IV. The lower stages indicate a cancer that is confined to the inner layers of the bladder and has not grown to affect the muscle of the bladder wall. The highest of the stage — stage IV — indicates that the cancer has spread to the lymph nodes or organs in distant areas of the body

Bladder cancer grade

Bladder cancers are classified according to the mode in which the cancer cells appear when viewed through a microscope. This is known as the degree, and your doctor can describe cancer of the bladder, such as low grade or high grade:

  • Low-grade bladder cancer. This type of cancer has cells that are closer in appearance and organization of normal cells (well-differentiated). A low-grade tumor usually grows more slowly and is less likely to invade the muscle wall of the bladder, which is a high-grade tumor.
  • High-grade bladder cancer. This type of cancer has cells that are abnormal-looking and lacking any resemblance to the normal appearance of the tissues (poorly differentiated). A high-grade tumor tends to grow more aggressively than that of a low-grade tumor and may be more likely to spread into the muscle wall of the bladder and other organs and tissues.

Treatment

Treatment options for bladder cancer depends on a number of factors, including the type of cancer, the grade of the cancer and the stage of the cancer, which are taken into consideration along with your general state of health and their treatment preferences.

Bladder cancer treatment may include:

  • The surgery to remove the cancer cells
  • The chemotherapy into the bladder (intravesical chemotherapy), for the treatment of cancers that are confined to the mucosa of the bladder, but have a high risk of recurrence or progression to a higher stage
  • The chemotherapy for the whole body (systemic chemotherapy), to increase the likelihood of a cure in a person who has surgery to remove the bladder, or as a primary treatment when surgery is not an option
  • Radiation therapy to destroy cancer cells, often as a primary treatment when surgery is not an option or not desired
  • Immunotherapy, to activate the body's immune system to fight cancer cells, either in the bladder or in the whole body
  • Targeted therapy to treat advanced cancer when other treatments have not helped

A combination of treatment approaches may be recommended by your doctor and the members of your care team.

Surgery of bladder cancer

Approaches to cancer of the bladder of the surgery can include:

  • Transurethral resection of bladder tumor (TURBT).TURBTis a procedure to diagnose bladder cancer and to remove the cancer is confined to the inner layers of the bladder — those who have non-muscle-invasive cancer. During the procedure, a surgeon passes an electrical wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut or burn the cancer. Alternatively, a high-energy laser can be used. Because doctors to perform the procedure through the urethra, you do not have cuts (incisions) in your belly. As part of theTURBTprocedure, your doctor may recommend a single injection of the cancer-killing drugs (chemotherapy) in the bladder to destroy any remaining cancer cells and prevent cancer from coming back. The drug remains in the bladder for a period of time and then drained.
  • Cystectomy.Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, your surgeon removes only the portion of the bladder that contains a single cancerous tumor. A radical cystectomy is surgery to remove the entire bladder and nearby lymph nodes. In men radical cystectomy typically includes removal of the prostate and the seminal vesicles. In women, radical cystectomy may involve the removal of the uterus, ovaries, and part of the vagina. Radical cystectomy can be performed through an incision in the lower part of the belly or several small incisions in the use of robotic surgery. During robotic surgery, the surgeon sits at a nearby console and uses hand controls, precisely, move robotic surgical instruments.
  • Neobladder reconstruction. After a radical cystectomy, the surgeon must create new way for urine to exit your body (urinary diversion). One option for urinary diversion is neobladder reconstruction. The surgeon creates a sphere-shaped deposit of a piece of intestine. This reservoir, often called a neobladder, is located on the inside of your body and joins the urethra. The neobladder allows most people to urinate normally. A small number of people difficulty to empty the neobladder and it may be necessary to use a probe periodically to drain any urine of the neobladder.
  • Ileal Conduit. For this type of urinary diversion, the surgeon creates a pipe (ileal conduit) the use of a part of your bowel. The tube that extends from the ureters, draining their kidneys, to the outside of your body where urine is emptied into a bag (bag, urostomy) that you use in your abdomen.
  • Continent urinary reservoir. During this type of urinary diversion procedure, the surgeon uses a section of the intestine to create a small pouch (deposit) to retain the urine, which is located on the inside of your body. You drain the urine from the reservoir through an opening in the abdomen through a catheter, a couple of times each day.

Transurethral resection of bladder tumor (TURBT). TURBT is a procedure to diagnose bladder cancer and to remove the cancer is confined to the inner layers of the bladder — those who have non-muscle-invasive cancer. During the procedure, a surgeon passes an electrical wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut or burn the cancer. Alternatively, a high-energy laser can be used.

Because doctors to perform the procedure through the urethra, you do not have cuts (incisions) in your belly.

As part of the TURBT procedure, the doctor may recommend a single injection of the cancer-killing drugs (chemotherapy) in the bladder to destroy any remaining cancer cells and prevent cancer from coming back. The drug remains in the bladder for a period of time and then drained.

Cystectomy. Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, your surgeon removes only the portion of the bladder that contains a single cancerous tumor.

A radical cystectomy is surgery to remove the entire bladder and nearby lymph nodes. In men radical cystectomy typically includes removal of the prostate and the seminal vesicles. In women, radical cystectomy may involve the removal of the uterus, ovaries, and part of the vagina.

Radical cystectomy can be performed through an incision in the lower part of the belly or several small incisions in the use of robotic surgery. During robotic surgery, the surgeon sits at a nearby console and uses hand controls, precisely, move robotic surgical instruments.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination.

Chemotherapy drugs can be given:

  • Through a vein (intravenously). Intravenous chemotherapy is often used before the removal of the surgery to increase the chances of curing the cancer. Chemotherapy can also be used to kill cancer cells that may remain after surgery. In certain situations, chemotherapy can be combined with radiation therapy.
  • Directly into the bladder (intravesical therapy). During the chemotherapy, intravesical, a tube that passes through the urethra directly to the bladder. Chemotherapy is placed in the bladder for a period of time before being drained. Can be used as the primary treatment for superficial bladder cancer, where the cancer cells only affect the wall of the bladder and not the deeper muscle tissue.

Radiation therapy

Radiation therapy uses beams of powerful energy, such as X-rays and protons, to kill cancer cells. Radiation therapy for bladder cancer is usually delivered from a machine that moves around your body, directing the energy beams at precise points.

Radiation therapy is sometimes combined with chemotherapy to treat cancer of the bladder in certain situations, such as when surgery is not an option or not desired.

Immunotherapy

Immunotherapy is a drug treatment that helps your immune system to fight cancer.

Immunotherapy can be given:

  • Directly into the bladder (intravesical therapy). Immunotherapy Intravesical may be recommended after TURBT for small cancers of the bladder who have not grown up in the deeper muscular layers of the bladder. This treatment uses bacillus Calmette-Guerin (BCG), which was developed as a vaccine used to protect against tuberculosis. BCG causes a reaction of the immune system that is directed against germs that the cells of the bladder.
  • Through a vein (intravenously). Immunotherapy can be given intravenously for the bladder cancer that is advanced or that comes back after initial treatment. Several immunotherapy medications are available. These drugs help the immune system identify and fight cancer cells.

Targeted therapy

Targeted therapy drugs are focused on specific weaknesses present within the cancer cells. By targeting these weaknesses, targeted drug treatments can cause cancer cells to die. The cancer cells can be tested to see if targeted therapy is unlikely to be effective.

Targeted therapy may be an option for the treatment of advanced bladder cancer when other treatments have not helped.

The preservation of the bladder

In certain situations, people with muscle-invasive bladder cancer who do not want to undergo surgery to remove the bladder can consider to try a combination of treatments in its place. Known as trimodality therapy, this approach combines TURBT , chemotherapy, and radiation therapy.

First, the surgeon makes a TURBT procedure to remove as much of the cancer as possible of the bladder, while the preservation of the function of the bladder. After TURBT , to submit to a regime of chemotherapy along with radiation therapy.

If, after attempting to trimodality therapy, not all the cancer is gone or has a recurrence of muscle-invasive cancer, your doctor may recommend a radical cystectomy.

After treatment of bladder cancer

Bladder cancer can recur even after successful treatment. Due to this, people with bladder cancer need of follow-up testing for years after successful treatment. What evidence is going to do and how often depends on your type of bladder cancer and how it was treated, among other factors.

In general, doctors recommend a test to examine the inside of the urethra and the bladder (cystoscopy) every three to six months for the first few years after treatment of bladder cancer. After a few years of surveillance without the detection of the recurrence of the cancer, you may need a cystoscopy exam only once a year. Your doctor may recommend other tests at regular intervals as well.

People with aggressive cancers may undergo more frequent screening. Those with less aggressive cancers can undergo the tests less often.

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Coping and support

Live with the concern that his bladder cancer may be repeated can leave you feeling as if you have little control over their future. But while there is no way to make sure that his bladder cancer does not recur, you can take steps to manage the stress.

With time you will find what works for you, but until then, you can:

  • Get a schedule of follow-up tests and go to each appointment. When you are finished bladder cancer treatment, ask your physician to create a personalized schedule of follow-up tests. Before each cystoscopy exam, expect to have a bit of anxiety. You may fear that the cancer has come back or worry about the uncomfortable examination. But don't let this stop you from going to your appointment. Instead, the plan ways to deal with your concerns. Write your thoughts in a journal, talking with a friend or using relaxation techniques, like meditation.
  • Take care of yourself, so that it is ready to fight against the cancer, if it comes back. Take care of yourself by adjusting your diet to include plenty of fruits, vegetables and whole grains. Exercise for at least 30 minutes most days of the week. Get enough sleep so that you wake up feeling rested.
  • Talk with other survivors of bladder cancer. To connect with bladder cancer patients who are experiencing the same fears that you are feeling. Contact your local chapter of the American Cancer Society to ask about support groups in your area.

Preparing for your appointment

Start by seeing your family doctor if you have any of the signs or symptoms that concern you, such as blood in your urine. Your doctor may suggest tests and procedures to investigate their signs and symptoms.

If your doctor suspects you may have cancer of the bladder, you may be referred to a doctor who specializes in the treatment of diseases and conditions of the urinary tract (urologist). In some cases, you may be referred to other specialists, such as doctors who treat cancer (oncologists).

Because there is often a large amount of information to discuss, it is a good idea to be well prepared. Here's some information to help you prepare, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking, along with the dose.
  • Consider the possibility of a family member or friend. Sometimes it is difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their doctor.

Prepare a list of questions can help you make the most of your time with your doctor. For bladder cancer, some basic questions to ask include:

  • Do I have bladder cancer or can my symptoms be caused by another condition?
  • What is the stage of my cancer?
  • Will I need additional tests?
  • What are my treatment options?
  • Can any of the treatments cure my cancer of the bladder?
  • What are the possible risks of each treatment?
  • There is a treatment that you feel is best for me?
  • You should see a specialist? What will that cost, and will my insurance cover it?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • What is going to determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Bladder cancer