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Treatment statement for Patients
Bladder Cancer
General Information About Bladder Cancer
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 stretch when the bladder is full and shrink
when it is emptied. 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 make
substances 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.
Refer to the following PDQ summaries for more information:
Screening for Bladder and Other Urothelial Cancers
Unusual Cancers of Childhood
Smoking, gender, and diet can affect the risk of developing
bladder cancer.
Anything that increases your chance of getting a disease
is called a risk factor. Risk factors for bladder cancer
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.
Other conditions may cause the same symptoms. 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 is present
in 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 by a pathologist 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 patients age and general health.
Treatment options depend on the stage of bladder
cancer.
Stages of Bladder Cancer
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 patients 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.
The following stages are used for bladder cancer:
Stage 0
In stage 0, the cancer is found only on tissue lining the
inside of the bladder. 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.
Recurrent Bladder Cancer
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.
Treatment Option Overview
There are different types of treatment for patients with
bladder cancer.
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.
Clinical trials are taking place in many
parts of the country. Information about ongoing clinical
trials is available from the NCI Web site. Choosing the
most appropriate cancer treatment is a decision that ideally
involves the patient, family, and health care team.
Four types of standard treatment are used:
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 only a part of the bladder
is removed, patients are 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, an organ, or a body cavity
such as the abdomen, the drugs mainly affect cancer cells
in those areas (regional chemotherapy). 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 patients
immune system to fight cancer. Substances made by the body
or made in a laboratory are used to boost, direct, or restore
the bodys natural defenses against cancer. This type of
cancer treatment is also called biotherapy or immunotherapy.
New 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 reduce the risk of developing cancer or to
reduce the risk that cancer will recur (come back).
Photodynamic therapy
Photodynamic therapy (PDT) is a cancer treatment that uses
a drug and a certain type of laser light to kill cancer
cells. A drug that is not active until it is exposed to
light is injected into a vein. The drug collects more in
cancer cells than in normal cells. Fiberoptic tubes are
then used to deliver the laser light to the cancer cells,
where the drug becomes active and kills the cells. Photodynamic
therapy causes little damage to healthy tissue.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
Treatment Options by Stage
Stage 0 Bladder Cancer (Carcinoma in Situ)
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).
This summary section refers to specific treatments
under study in clinical trials, but it may not mention every
new treatment being studied. Information
about ongoing clinical trials is available from the NCI
Web site.
Stage I Bladder Cancer
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.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
Stage II Bladder Cancer
Treatment of stage II bladder cancer may include the following:
Radical cystectomy with or without surgery to
remove pelvic lymph nodes.
Combination chemotherapy followed by radical cystectomy.
External radiation therapy combined with chemotherapy.
Radiation implants before or after external radiation
therapy.
Transurethral resection with fulguration.
Segmental cystectomy.
Stage III Bladder Cancer
Treatment of stage III bladder cancer may include the following:
Radical cystectomy with or without surgery to remove pelvic
lymph nodes.
Combination chemotherapy followed by radical cystectomy.
External radiation therapy combined with chemotherapy.
External radiation therapy with radiation implants.
Segmental cystectomy.
Stage IV Bladder Cancer
Treatment of stage IV bladder cancer may include the following:
Radical cystectomy with surgery to remove pelvic lymph
nodes.
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 alone or after local treatment (surgery or
radiation therapy).
A clinical trial of chemotherapy.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
Treatment Options for Recurrent Bladder Cancer
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.
This summary section refers to specific treatments under
study in clinical trials, but it may not mention every new
treatment being studied. Information about ongoing clinical
trials is available from the NCI Web site.
The PDQ cancer information summaries are reviewed regularly
and updated as new information becomes available. This section
describes the latest changes made to this summary as of
the date above.
Changes were made to this summary to match those made to
the health professional version.
To Learn More
Call
For more information, U.S. residents may call the National
Cancer Institute's (NCI's) Cancer Information Service toll-free
at 1-800-4-CANCER (1-800-422-6237) Monday through Friday
from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers
with TTY equipment may call 1-800-332-8615. The call is
free and a trained Cancer Information Specialist is available
to answer your questions.
Web sites and Organizations
The NCI Web site provides online access to information on
cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and
their families. There are also many other places where people
can get materials and information about cancer treatment
and services. Local hospitals may have information on local
and regional agencies that offer information about finances,
getting to and from treatment, receiving care at home, and
dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health
professionals, and the public. These publications discuss
types of cancer, methods of cancer treatment, coping with
cancer, and clinical trials. Some publications provide information
on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on
these and other topics may be ordered online or printed
directly from the NCI Publications Locator. These materials
can also be ordered by telephone from the Cancer Information
Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY
at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several
of the Institute's Web sites, provides Internet users with
the ability to chat online with an Information Specialist.
The service is available from 9:00 a.m. to 11:00 p.m. Eastern
time, Monday through Friday. Information Specialists can
help Internet users find information on NCI Web sites and
answer questions about cancer.
Write
For more information from the NCI, please write to this
address:
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on NCI's
Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive
cancer information database. Most of the information contained
in PDQ is available online at NCI's Web site. PDQ is provided
as a service of the NCI. The NCI is part of the National
Institutes of Health, the federal government's focal point
for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published
information on cancer prevention, detection, genetics, treatment,
supportive care, and complementary and alternative medicine.
Most summaries are available in two versions. The health
professional versions provide detailed information written
in technical language. The patient versions are written
in easy-to-understand, nontechnical language. Both versions
provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer
experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related
specialties are responsible for writing and maintaining
the cancer information summaries. The summaries are reviewed
regularly and changes are made as new information becomes
available. The date on each summary ("Date Last Modified")
indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about
taking part in a clinical trial. A clinical trial is a study
to answer a scientific question, such as whether one treatment
is better than another. Trials are based on past studies
and what has been learned in the laboratory. Each trial
answers certain scientific questions in order to find new
and better ways to help cancer patients. During treatment
clinical trials, information is collected about new treatments,
the risks involved, and how well they do or do not work.
If a clinical trial shows that a new treatment is better
than one currently being used, the new treatment may become
"standard."
Listings of clinical trials are included in PDQ and are
available online at NCI's Web site. Descriptions of the
trials are available in health professional and patient
versions. Many cancer doctors who take part in clinical
trials are also listed in PDQ. For more information, call
the Cancer Information Service 1-800-4-CANCER (1-800-422-6237);
TTY at 1-800-332-8615.
Physicians version: CDR0000062908
Date last modified: 2006-04-19
http://www.meb.uni-bonn.de/
cancer.gov/ CDR0000062705.html
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