Bladder Cancer

Bladder cancer is a type of cancer that begins in the bladder – the balloon shaped organ in your pelvic area which stores urine.

ABOUT
Bladder cancer usually begins in the cells that line the inside of the bladder and can progress to underlying muscle or spread to other parts of the body, such as the lymph nodes, lung, or liver.

SYMPTOMS
Symptoms of bladder cancer can include:

  • Blood in the urine
  • Frequent urination
  • Painful urination
  • Back or pelvic pain.

When there is blood in the urine, the urine may appear dark yellow (when there is only a very small amount of blood present), bright red (much more blood), or cola colored (older blood but not an active bleed). Sometimes, the urine may appear normal, but blood may be detected during a microscopic evaluation of the urine during a urine sample.
If you have any signs or symptoms which cause you concern, be sure to make an appointment with your primary care provider or Urologist as soon as possible.

CAUSES
It’s not always clear what causes bladder cancer. Some causes include:

  • Smoking (most commonly linked)
  • Radiation and exposure to certain chemicals
  • Abnormal growth of cells in the bladder – instead of growing and dividing in a normal way, the cells develop mutations, which cause them to grow out of control and not die. These abnormal cells then cause a tumor.

TYPES
There are 3 main types of bladder cancer named for the cell type that makes up the tumor:

  • Transitional cell carcinoma: This type of cancer occurs in the cells that line the bladder. It is the most common type of bladder cancer in the United States.
  • Squamous cell carcinoma: These cells appear in the bladder in response to an infection or irritation.
  • Adenocarcinoma: This is very rare in the United States and forms in the mucus-secreting glands in the bladder.

RISK FACTORS
Factors that can increase your chance of getting bladder cancer include

  •  Smoking
  • Increasing age – it is typically not found in people under the age of 40
  • Exposure to certain chemicals – chemicals used to manufacture dyes, rubber, leather, textiles, and paint products
  • Previous cancer treatment – including radiation to the pelvis
  • Taking certain diabetes medications
  • Chronic bladder inflammation
  • Personal or family history of cancer
  • Males develop bladder cancer twice as often as females
  • Caucasians develop bladder cancer more than other races

DIAGNOSIS
The tests a urologist will perform to evaluate you for the presence of bladder cancer include:

  • Urine analysis and cytology
  •  Cystoscopy – a look inside the bladder with a narrow telescope passed through the urethra
  • Biopsy – of a bladder tumor if one is seen
  • Urine cytology
  • Imaging tests to diagnose bladder cancer

Additional tests may include a CT scan to rule out any spread of the cancer and stage it more accurately.

STAGES
Once it is confirmed you have bladder cancer, additional tests may be performed. The stages of bladder cancer are I, II, III and IV – each stage affects more and more of the body and has more complications, side effects, and requirements more treatments.

TREATMENT
The treatment of bladder cancer depends on the stage (extent of the cancer) and the grade (aggressiveness of the cell mutations).

  • Stage TA: The majority of bladder cancer is stage TA, which is superficial to the lining of the bladder only. The treatment for Stage TA is removal of the tumor from the lining of the bladder with a cystoscope and cutting device. This is typically followed by instilling a chemical agent into the bladder to help reduce the risk of the tumor recurring.  Because bladder cancer has a high tendency to come back, frequent follow up monitoring is required with repeat cystoscopy examinations.
  • Carcinoma in situ: If a bladder cancer is found to be an aggressive cell type of a particular variant known as carcinoma in situ, then a series of several weekly treatments by an instillation through a catheter in the bladder of an immune stimulating medicine known as BCG is performed
  • Invasive bladder cancer: For invasive bladder cancer, the recommended treatment is surgical removal of the entire bladder and surrounding lymphatic nodes. The urinary storage is reconstructed using a segment of the intestinal tract. The segment is reconfigured into either an open system, which drains to a bag on the abdominal wall, or a closed system, which is reconnected to the urethra or to an opening in the abdominal wall that is catheterized on demand.
  • Progressed cancer: If cancer has progressed to the lymph nodes or other organs then chemotherapy is also given. Radiation may be used as an alternative to surgery in select cases but usually in cases where the patient is too frail to withstand surgery.

SUMMARY
The majority of bladder cancer cases are diagnosed at an early stage when bladder cancer is limited to the superficial lining of the bladder. Although it typically affects older adults, it can occur at younger ages. The treatment depends on the size and progression of the tumor and can include surgeries, chemo, and radiation. Bladder cancer survivors usually undergo fairly consistent follow-up tests to look for recurrence for years after treatment.

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