HEALTH - CANCER OF THE BLADDER

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HEALTH - BLADDER CANCER (SYMPTOMS & TREATMENT)

What is Bladder Cancer?

Bladder cancer is a cancerous tumor that begins when cells in the bladder become abnormal and grow uncontrollably, forming a mass of tissue. It is described as either noninvasive or invasive. Noninvasive cancer does not spread through the lamina propria, and invasive cancer can spread through the lamina propria. Noninvasive cancer may also be called superficial cancer, although that term is being used less often because it may incorrectly imply that this type of cancer is not serious. Invasive cancer is subdivided as either cancer that only grows into the lamina propria or cancer that grows into the muscle layer.

Your bladder is a muscular, balloon-shaped organ located in your pelvis. It stores urine that your kidneys produce during the process of filtering your blood. Like a balloon, the bladder gets larger or smaller depending on the amount of urine it's holding. Urine passes from your kidneys into your bladder through thin tubes called ureters and is eliminated from your body through another narrow tube, the urethra.

The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage cancer of the bladder is likely to recur. For this reason, bladder cancer survivors often undergo follow-up screening tests for years after treatment.

How cancer of the bladder develops:

Cancer of the bladder occurs when healthy cells go awry. Rather than grow and divide in an orderly way, these cells develop mutations that cause them to grow out of control and not die. These abnormal cells form a tumor.

Types of bladder cancer
Different types of cells in your bladder can become cancerous. The type of cell involved in your cancer determines the type of treatments that may work best for you health wise. Types of bladder cancer include:

Transitional cell carcinoma - Transitional cell carcinoma occurs in the cells that line the inside of your bladder. Transitional cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of your ureters and your urethra, and tumors can form in those places as well. Transitional cell carcinoma is the most common type of bladder cancer in the United States.
Squamous cell carcinoma - Squamous cells appear in your bladder in response to infection and irritation. Over time they can become cancerous. Squamous cell bladder cancer is rare in the United States. It's a more common type of bladder cancer in areas of the world where a certain parasitic infection (schistosomiasis) is a more prevalent cause of bladder infections.
Adenocarcinoma - Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United States. Some bladder cancers include more than one type of cell.

Health: Risk Factors of Bladder Cancer

Age. The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.

Tobacco. The use of tobacco is a major health risk factor. Cigarette smokers are two to three times more likely than nonsmokers to get bladder cancer. Pipe and cigar smokers are also at increased risk.

Occupation. Some workers have a higher health risk of getting bladder cancer because of carcinogens in the workplace. Workers in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.

Infections. Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas but not in the United States.

Treatment with cyclophosphamide or arsenic. These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.

Race. Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.

Being a man. Men are two to three times more likely than women to get bladder cancer.

Family history. People with family members who have bladder cancer are more likely to get the disease. Researchers are studying changes in certain genes that may increase the health risk of bladder cancer.

Personal history of bladder cancer. People who have had bladder cancer have an increased chance of getting the disease again.

Chlorine is added to water to make it safe to drink. It kills deadly bacteria. However, chlorine by-products sometimes can form in chlorinated water. Researchers have been studying chlorine by-products for more than 25 years. So far, there is no proof that chlorinated water causes bladder cancer in people. Studies continue to look at this question.

Some studies have found that saccharin, an artificial sweetener, causes bladder cancer in animals. However, research does not show that saccharin causes cancer in people.

People who think they may be at risk for bladder cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the health risk and can plan an appropriate schedule for checkups.

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NATURAL CANCER TREATMENT

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Health: Symptoms of Bladder Cancer

People with bladder cancer may experience the following symptoms. Sometimes, people with bladder cancer do not show any of these symptoms. Or, these symptoms may be caused by a health condition that is not cancer. Bladder cancer usually does not cause symptoms that specifically indicate cancer. Most often, bladder cancer is diagnosed when a person tells his or her doctor about hematuria (blood in the urine). General urine tests are not used to make a specific diagnosis of bladder cancer, because hematuria can be a sign of several other conditions besides bladder cancer, such as an infection or kidney stones. One type of urine test that can indicate the presence of cancer is cytology, a test in which the urine is studied under a microscope to look for cancer cells

Blood in urine — blood may appear cola colored or bright red in your urine, or may appear in a microscopic examination of your urine
Frequent urination
Painful urination
Urinary tract infection
Abdominal pain
Back pain

Symptoms of advanced bladder cancer may include pain, a change in bowel habits, unexplained loss of appetite, and weight loss.

Sometimes when the first symptoms of bladder cancer appear, the cancer has already spread to another part of the body. In this situation, the symptoms depend on where the cancer has spread. For example, cancer that has spread to the lungs may cause a cough or shortness of breath, spread to the liver may cause abdominal pain or jaundice (yellowing of the skin and whites of the eyes), and spread to the bone may cause bone pain or fractures.

Health: Diagnosis of Bladder Cancer

The following tests may be used to diagnose bladder cancer:

Physical examination. A doctor can sometimes detect lumps in the wall of the bladder by examining the rectum and the pelvis. Areas where the cancer has spread may also be found during a physical examination.

Cystoscopy and biopsy. The doctor places a cystoscope (a small, hollow viewing tube) through the urethra (urinary opening) to look into the bladder. If abnormal tissue is detected, the doctor will do a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Urine tests. The doctor tests a urine sample to determine if it contains tumor cells. If a patient is undergoing a cystoscopy (see above), an additional test may be performed that involves rinsing the bladder and collecting the liquid through the cystoscope or through another small tube that is inserted into the urethra. The sample can be tested in a variety of ways. The most common way is to look at the cells under a microscope, called urinary cytology. Urine passed out of the body during normal urination can also be examined by cytology. There are other urine cancer tests using molecular analysis that can be done with or instead of urinary cytology.

Intravenous pyelogram (IVP), also called intravenous urogram (IVU). In this x-ray test, a dye containing iodine is injected into a patient’s vein and filtered through the kidneys. The dye enters the urine. This helps the bladder to appear more clearly on an x-ray and can provide an outline of a tumor in the bladder wall. The patient should tell the staff giving this test if he or she is allergic to iodine or other contrast mediums (special dyes).

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. Sometimes, a contrast medium is injected into a patient’s vein to provide better detail. The patient should tell the staff giving this test if he or she is allergic to iodine or other contrast mediums.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Health: Stages for Bladder Cancer

Stage 0 -- The cancer cells are found only on the surface of the inner lining of the bladder. The doctor may call this superficial cancer or carcinoma in situ.

Stage I -- The cancer cells are found deep in the inner lining of the bladder. They have not spread to the muscle of the bladder.

Stage II -- The cancer cells have spread to the muscle of the bladder.

Stage III -- The cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder. The cancer cells may have spread to the prostate (in men) or to the uterus or vagina (in women).

Stage IV -- The cancer extends to the wall of the abdomen or to the wall of the pelvis. The cancer cells may have spread to lymph nodes and other parts of the body far away from the bladder, such as the lungs.

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Natural Alternative Treatment: CANCER FREE
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Health: Conventional Cancer Treatment for Bladder Cancer

Your treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer, your overall health and your treatment preferences. Discuss your options with your doctor to determine what treatments are best for you.

Surgical procedures

Most people with bladder cancer undergo surgery to remove the cancerous cells. The types of surgical procedures available to you may be based on factors such as the stage of your bladder cancer, your overall health and your preferences.

Surgery for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:

Surgery to remove the tumor. Transurethral resection of bladder tumor (TURBT) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TURBT, your doctor passes a small wire loop through your urethra and into your bladder. The loop is used to burn away cancer cells with an electric current (fulguration). In some cases, a high-energy laser may be used instead of electric current.

TURBT may cause painful or bloody urination for a few days following the procedure.
Surgery to remove the tumor and a small portion of the bladder. During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy may be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function. To remove the tumor, the surgeon makes an incision in your abdomen. General anesthesia is used, and you usually stay in the hospital for a week to 10 days.

Surgery carries a risk of bleeding and infection. You may experience more frequent urination after segmental cystectomy, since the operation reduces the size of your bladder. Over time this may improve, though in some people it's permanent.

Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:

Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.

Cystectomy carries a risk of infection, bleeding, blood clots and bowel obstruction. In men, removal of the prostate and seminal vesicles will cause infertility. But in most cases your surgeon will take care to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause in women who haven't experienced menopause prior to this surgery.
Surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for your body to expel urine. Several options exist. Which option is best for you depends on your cancer, your health and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your kidneys to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen.

In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.

In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your new bladder.

Biological therapy (immunotherapy)

Biological therapy, sometimes called immunotherapy, works by signaling your body's immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).

Biological therapy drugs commonly used to treat bladder cancer include:

An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is a bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
A synthetic version of immune system cell. An interferon is a type of cell your body uses to fight infections. A synthetic version of interferon, called interferon alfa, may be used to treat bladder cancer. Interferon alfa is sometimes used in combination with BCG. Interferon alfa can cause flu-like symptoms.

Biological therapy can be administered after TURBT to reduce the risk that cancer will recur. Biological therapy can also be given before surgery to shrink a tumor to a more manageable size.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. For bladder cancer, doctors may decide to use one of two types of chemotherapy: intravesical (local) or systemic (whole body) treatment. In general, earlier-stage cancer is more likely to be treated with local chemotherapy and more advanced cancer with systemic chemotherapy. Chemotherapy may be given before or after surgery. Chemotherapy before surgery is used most often for patients with very widespread or invasive cancer. However, some doctors may perform surgery first and then decided on whether treatment with chemotherapy will be beneficial based on an analysis of the tumor tissue. Patients should talk with their doctor about chemotherapy before surgery.

The types of chemotherapy most often used for bladder cancer are described below:

Intravesical therapy. In this type of therapy, drugs are placed into the bladder through a catheter inserted in the bladder through the urethra. Local treatment kills only noninvasive tumor cells. It cannot reach tumor cells in the bladder wall or that have spread to other organs. The most common drug that is given as intravesical treatment is an immunotherapy drug called BCG (see above). However, other types of drugs are also used. The most common is mitomycin C (Mutamycin). The drugs thiotepa (Thioplex) and doxorubicin (Adriamycin) have also been used.

Systemic chemotherapy. In this type of chemotherapy, patients receive drugs orally (by mouth) or intravenously (given through an IV). Intravenous chemotherapy is injected directly into a vein. Either way, the drugs enter the bloodstream and travel to all parts of the body.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

For bladder cancer, many of the available chemotherapy regimens are still being tested in clinical trials to help determine which drugs, or which drug combinations, work best to treat bladder cancer. Of the known drugs, usually a combination of drugs works better than one drug alone. The question of whether and in what situations it is best to give chemotherapy before or after surgery is also being tested in clinical trials.

A combination of drugs, called MVAC, has been used as the standard treatment for bladder cancer for many years, based on the results of clinical trials from the 1990s. MVAC has helped delay bladder cancer recurrence, and extend life and cure patients, but it has severe side effects. MVAC uses four drugs: methotrexate (multiple brand names), vinblastine (Velban), doxorubicin, and cisplatin (Platinol). This combination with the addition of other drugs, such as paclitaxel (Taxol), docetaxel (Taxotere), and ifosfamide (Ifex), is also being studied in clinical trials. The combination of gemcitabine (Gemzar) plus cisplatin is also used and has similar effects to the MVAC combination but with fewer side effects. Other drugs are now in clinical trials to determine if there is a combination of drugs that works better and has fewer side effects.

Chemotherapy for locally advanced bladder cancer

Locally advanced bladder cancer is invasive bladder cancer that has spread beyond the bladder to nearby organs or to the pelvic lymph nodes. Researchers are studying new combinations of chemotherapy that are more effective in managing bladder cancer. Treatments may include:

Combinations of different drugs
Known drugs tested in different doses
Drugs or drug combinations given before or after surgery
Drugs or drug combinations given with radiation therapy. If radiation therapy is combined with chemotherapy, it may make chemotherapy more effective through an effect called radiosensitizing.

Recently, an important clinical trial has shown that the use of intravenous chemotherapy (the MVAC regimen, mentioned above) before radical cystectomy improves survival for patients with invasive bladder cancer. This type of initial chemotherapy, termed neoadjuvant chemotherapy, may shrink the tumor in the bladder and may also kill small areas of cancer that have spread beyond the bladder. It is important to note that it does not appear that single-drug chemotherapy improves the survival of patients with locally advanced bladder cancer.

Chemotherapy for metastatic bladder cancer

Metastatic bladder cancer is cancer that is diagnosed after it has spread beyond the lymph nodes. The term advanced bladder cancer may be used; this can also refer to a cancer that has recurred after all local treatments (such as a cystectomy or radiation therapy) have failed and poses a serious threat to the patient’s survival.

There are no methods to permanently cure metastatic bladder cancer for most people. For these patients, the goals of treatment are to slow the spread of cancer, shrink the tumor (temporary remission), relieve symptoms, and extend life as long as possible. With advances in treatment, most patients with advanced bladder cancer can expect to live many months or even years—longer than they could just a few years ago. As explained above, the MVAC and gemcitabine-cisplatin regimens are the current standard approaches in treatment. Changes to these regimens or the use of new treatment regimens that improve survival rates, quality of life, and duration of life are being studied in clinical trials. Since there are relatively few treatment options for metastatic bladder cancer, clinical trials are often the best option for treatment. Clinical trials compare the best treatments available (standard treatments) with newer treatments that may be more effective. Investigating new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track progress.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy.

Doctors may use radiation therapy to treat bladder cancer that has invaded the bladder muscle in several ways:

After surgery, to destroy any remaining tumor
To relieve symptoms caused by a tumor, such as pain, bleeding, or blockage
To treat a metastasis located in one area, such as the brain or bone.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. For bladder cancer, side effects most commonly occur in the pelvic or abdominal area and may include bladder irritation, with the need to pass urine frequently during the treatment period, and bleeding from the bladder or rectum. Most side effects go away soon after treatment is finished.

Health: Complications of Bladder Cancer

Bladder cancer often recurs. Because of this, bladder cancer survivors often undergo follow-up testing for years after successful treatment. What tests you'll undergo and how often will depend on your type of bladder cancer and your treatment, among other factors.

What types of tests are used to screen for bladder cancer recurrence?
Tests and procedures commonly used to screen for recurrent bladder cancer include:

Looking for abnormal growths in your bladder. Cystoscopy is a common screening test for bladder cancer recurrence.
Looking for cancer cells in your urine. Your doctor may recommend urine cytology testing every few months for the first few years after cancer treatment.
Taking random samples of bladder tissue. If you have a high risk of bladder cancer recurrence, your doctor may recommend that samples of your bladder tissue be analyzed periodically. This may help doctors diagnose a bladder cancer recurrence before it can be seen with cystoscopy.

How often should you undergo screening for bladder cancer recurrence?
Ask your doctor to create a follow-up plan for you. In general, doctors recommend cystoscopy screening every three months for the first two years after bladder cancer treatment. For the next two years, you may undergo cystoscopy every six months. Then you may undergo cystoscopy every year. Your doctor may recommend other tests at various intervals as well.

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

How can you prevent a bladder cancer recurrence?
Doctors don't yet know a reliable way to prevent bladder cancer recurrence. Talk to your doctor about ways to reduce your risk, such as:

Stopping smoking. Ask your doctor about strategies to help you quit smoking. Support programs and medications can help.
Increasing your intake of antioxidant vitamins. Some studies suggest that large amounts of certain vitamins may reduce the risk of recurrent bladder cancer in some people. But not enough study has been done to recommend taking big doses of antioxidants in pill form. In fact, large doses of vitamin supplements could be harmful. A safe way to increase your antioxidant intake is to increase fruits and vegetables in your diet. Talk to your doctor about other ways to get more vitamins.
Joining a clinical trial. Consider joining a clinical trial that's studying a new way of preventing bladder cancer recurrence. These studies can't guarantee that you won't have a bladder cancer recurrence. But joining a clinical trial may help doctors discover ways to reduce the risk of bladder cancer recurrence for people in the future.

Health: Prevention for Bladder Cancer

Although there's no guaranteed way to prevent bladder cancer, you can take steps to help reduce your health risk. For instance:

Don't smoke. Not smoking means that cancer-causing chemicals in smoke can't collect in your bladder. If you don't smoke, don't start. If you smoke, talk to your doctor about a plan to help you quit. Support groups, medications and other methods may help you quit.

Take caution with chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.

Have your well tested for arsenic. If you have your own well, consider having it tested for high levels of arsenic in the water.

Drink plenty of fluids. Drinking liquids, especially water, dilutes toxic substances that may be concentrated in your urine and flushes them out of your bladder more quickly.

Eat your 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.

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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.

Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services

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HEALTH: BLADDER CANCER (SYMPTOMS & TREATMENT)