|
Diseases
and Conditions
Bladder cancer
From MayoClinic.com
Special to CNN.com
Overview
Bladder cancer typically begins in the lining of your bladder,
the balloonshaped organ in your pelvic area that stores
urine. Some bladder cancer remains confined to the lining,
while other cases may invade other areas.
Most people who develop bladder cancer are older adults
— more than 90 percent of cases occur in people older than
55, and 50 percent of cases occur in people older than 73.
Smoking is the greatest single risk factor for bladder cancer.
Exposure to certain toxic chemicals and drugs also makes
it more likely you'll develop bladder cancer.
Treating bladder cancer that has spread can be difficult
and involve extensive procedures. But if your bladder cancer
is detected early — before it has spread beyond the lining
of your bladder — you have a better chance of successful
treatment with minimal side effects.
Signs and symptoms
Bladder cancer often doesn't produce signs or symptoms in
its early stages. The first warning sign is usually blood
in your urine (hematuria). The blood may show up on a urine
test, or your urine may appear reddish or darker than normal.
This doesn't necessarily mean you have bladder cancer, however.
More common conditions — including a urinary tract infection,
kidney disease, kidney or bladder stones, and prostate problems
— can cause hematuria. These conditions can also cause other
symptoms similar to those of bladder cancer. If you develop
any of the signs and symptoms below, your doctor can help
determine the exact cause:
• Pelvic pain
• Pain during urination
• Frequent urination or feeling you need to urinate
without being able to do so
• Slowing of your urinary stream
• Urinary tract infection (UTI)
• Kidney stones
• Prostatitis
• Prostate gland enlargement
Causes
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 can get larger or smaller depending on the amount
of urine it holds. 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.
How cancer develops
Healthy cells grow and divide in an orderly way. This process
is controlled by DNA — the genetic material that contains
the instructions for every chemical process in your body.
When DNA is damaged, changes occur in these instructions.
One result is that cells may begin to grow out of control
and eventually form a tumor, a mass of malignant cells.
Most bladder cancers begin in the specialized cells that
line the walls of your bladder (transitional cells). The
same type of cells occurs in your kidneys, ureters and urethra
where they may also give rise to malignant tumors.
Some cancers remain confined to the bladder lining (carcinoma
in situ). But other cancers are invasive, growing into or
through the bladder wall, and eventually into nearby lymph
nodes and adjacent organs. In time, cancer may spread (metastasize)
to other organs, including your lungs, liver or bones.
Causes unclear
Just what causes the DNA damage that leads to bladder cancer
isn't entirely clear. A very few cases show signs of inherited
mutations — bladder cancer running in the family. More often,
it appears that bladder-cancer-causing mutations develop
during a person's lifetime. DNA damage may occur due to
exposure to certain toxic chemicals, such as those found
in cigarette smoke.
On the other hand, inherited factors such as how your body
metabolizes certain chemicals may play a role. People whose
bodies metabolize toxic chemicals quickly may be less susceptible
to bladder cancer than are people who metabolize the same
chemicals more slowly.
Risk factors
Although scientists aren't sure what causes bladder cancer,
they've identified a number of factors that may contribute
to its development, either by themselves or in combination
with other factors. Because chemicals often exit the body
through the bladder, many of these risk factors have to
do with chemical exposure.
Having one or more of the risk factors listed below doesn't
guarantee you'll develop bladder cancer, only that your
risk may be increased. Knowing about these factors may help
you make changes that could reduce your risk, such as quitting
smoking.
• Smoking. Smoking appears to be the single greatest risk
factor for bladder cancer. That's because cancer-causing
chemicals (carcinogens) in tobacco can become concentrated
in your urine and eventually damage the lining of your bladder.
This damage can increase the chances of a cancer-causing
genetic mutation. Smokers are at least twice as likely to
develop bladder cancer as nonsmokers are. The risk increases
with the number of cigarettes smoked a day and the number
of years you've smoked.
• Industrial chemicals. Repeated exposure to chemicals used
in the manufacture of dyes, rubber, leather, textiles and
paint products may increase your risk of developing bladder
cancer years later. Smokers who work with toxic chemicals
are at an especially high risk of bladder cancer.
• Age. The chance of getting bladder cancer increases as
you grow older. The average age at diagnosis is 68 or 69.
People younger than 40 rarely get the disease.
• Race. Whites are twice as likely to develop bladder cancer
as blacks and Hispanics are. Asians have the lowest rates
of the disease.
• Sex. Men are about four times as likely to get bladder
cancer as women are.
• Chemotherapy and radiation therapy. Treatment with the
anti-cancer drugs cyclophosphamide (Cytoxan) and ifosfamide
(Ifex) increases your risk of bladder cancer. Studies of
women treated with radiation therapy for cervical cancer
have shown an elevated risk for subsequent development of
bladder cancer. But the same doesn't appear to be true for
men who receive primary radiation therapy for prostate cancer.
• Chronic bladder inflammation. Chronic or repeated urinary
infections or inflammations (cystitis), such as may happen
with long-term use of a urinary catheter, may increase your
risk of a certain type of bladder cancer called squamous
cell carcinoma. But doctors don't believe infection or inflammation
alone causes cancer. In some parts of the developing world,
especially North Africa, a chronic parasitic infection (schistosomiasis)
can contribute to squamous cell carcinoma. Both this infection
and squamous cell carcinoma are uncommon in the United States.
• Personal or family history. Having bladder cancer once
makes it more likely you'll get it again. Tumors may recur
in your ureters or urethra as well as in the bladder itself.
If one or more of your immediate relatives has a history
of bladder cancer, that also may increase your risk, although
it's rare for bladder cancer to run in families. A family
history of hereditary nonpolyposis colorectal cancer (HNPCC)
can increase the risk of cancer in your urinary system.
• Exposure to arsenic. Drinking water containing high levels
of arsenic has been associated with bladder cancer. Risk
of exposure to arsenic in drinking water usually depends
on where you live and the arsenic content standards for
your water system.
• Bladder birth defect. Rare birth defects of the bladder
may lead to an unusual form of bladder cancer called adenocarcinoma.
If you think you're at risk of bladder cancer, discuss your
concerns with your doctor. He or she may be able to suggest
ways to reduce your risk.
• Cystitis
Screening and diagnosis
See your doctor right away if you develop any of the signs
or symptoms of bladder cancer, including bloody, painful
or frequent urination.
Your doctor will ask you about your medical history and
perform a thorough physical exam. This may include an internal
examination during which your doctor gently inserts a gloved,
lubricated finger into your rectum or vagina. To help diagnose
bladder cancer, you may also have one or more of the following
tests:
• Urine cytology. A sample of your urine may be analyzed
under a microscope to check for cancer cells. Although common,
these tests can miss low-grade cancers.
• Cystoscopy. In this procedure, your doctor inserts a narrow
tube (cystoscope) through your urethra. The cystoscope has
a lens and fiber-optic lighting system, allowing your doctor
to see your urethra and bladder. Your doctor can also use
the cystoscope to remove a small sample of tissue (biopsy)
for analysis in the laboratory.
• Intravenous pyelogram (IVP). This X-ray allows your doctor
to see an image of your kidneys and lower urinary tract,
including your bladder. You'll receive an injection of a
contrast dye through a vein in your arm. Your bloodstream
delivers the dye to your kidneys, ureters and bladder. The
contrast agent makes it easier for your doctor to see any
abnormalities or tumors on a series of X-rays.
• Tumor marker test. Doctors are evaluating several newer
methods that may be more accurate than urine cytology, including
tests that check a sample of your urine for substances released
by tumors (tumor markers). The Food and Drug Administration
has approved two tumor marker tests — BTA and NMP22 — that
help diagnose recurrent bladder cancer. Both of these tests
involve checking a urine sample for proteins associated
with bladder tumors. Another marker under investigation
is the enzyme telomerase, which is active in malignant cells
but inactive in normal cells. These tests are promising,
but they're not recommended for routine use until further
studies are completed.
• Fluorescence in situ hybridization (FISH). This test for
bladder cancer can detect certain chromosomal abnormalities
often found in transitional cell cancer, the most common
type of bladder cancer. This test may help detect recurrent
cancer cells before a tumor becomes visually apparent. This
newer test isn't routinely available, and more studies are
needed before it can be considered standard.
Staging tests
If you're found to have bladder cancer, you're likely to
have tests to help determine whether the cancer has spread
(metastasized) — a process known as staging. The stage of
cancer helps your doctor determine the best course of treatment
and the outlook for your recovery. Staging tests may include
one or more of the following:
• Computerized tomography (CT). This is essentially a highly
detailed X-ray that allows your doctor to see your bladder
in two-dimensional "slices." Split-second computer
processing creates these images while a series of thin X-ray
beams pass through your body. In most cases, you will have
a contrast dye injected into a vein before the test. The
dye makes it easier for your doctor to see your organs and
to determine if anything abnormal is present that might
suggest cancer. Your greatest risk with this procedure is
a possible allergic reaction to the dye.
• Magnetic resonance imaging (MRI). Instead of X-rays, this
test uses a powerful magnetic field and radio waves to create
images of your urinary tract. During the test, you're enclosed
in a cylindrical tube that can seem confining to some people.
The machine also makes a loud thumping noise. In most cases
you'll be given earplugs to help block out the noise. If
you're claustrophobic, ask your doctor whether an open scan
or some mild sedation may be an option for you.
• Bone scan. This imaging test is used to determine whether
cancer has spread to your bones. During the procedure, a
small amount of a radioactive substance that collects in
bone is injected into a vein in your arm. A special scanner
then takes pictures of all your bones. The radioactive substance
highlights areas of abnormal bone.
• Chest X-ray. This test may help detect cancer that has
spread to your lungs.
How bladder cancer is staged
Bladder cancer is often staged using the numbers 0 to IV.
Most newly diagnosed bladder cancers fall into Stage 0 or
Stage I.
• Stage 0 cancer. Also called superficial or in situ cancer,
this occurs only on the surface of the inner lining of the
bladder. Finding cancer at this stage offers the best hope
for a full recovery. Stage 0 cancer can often be completely
removed while sparing the bladder, but the rate of recurrence
is high.
• Stage I cancer. Cancer at this stage occurs in the bladder's
inner lining, but hasn't invaded the muscular bladder wall.
• Stage II cancer. At this stage, cancer has invaded the
bladder wall.
• Stage III cancer. The cancer cells have spread through
the bladder wall to surrounding tissue. They may also have
spread to the prostate in men or the uterus or vagina in
women.
• Stage IV cancer. By this stage, cancer cells may have
spread to the lymph nodes and other organs, such as your
lungs, bones or liver.
• Recurrent. This refers to cancer that has returned after
having been treated. It may recur in the same place or in
another part of your body.
• Urine cytology
• CT scan
• MRI: Viewing the body's hidden structure
• Bone scan: Using nuclear medicine to find bone abnormalities
• Chest X-rays: Helping detect heart and lung conditions
Complications
Bladder cancer can lead to anemia, urinary incontinence
and a blockage of the ureters that prevents urine from draining
normally into your bladder (hydronephrosis). But the most
serious complication is the spread of cancer from the bladder
to other organs.
• Anemia
• Urinary incontinence
Treatment
Like many people with cancer, you may choose to take an
active role in the decisions affecting your medical care.
If so, try to learn as much as you can about bladder cancer
and the treatment options that exist. As part of this process,
you may want to consider getting a second opinion from a
bladder cancer specialist, such as a urologist, medical
oncologist or urologic oncologist.
In many cases, your primary care doctor may refer you to
one or more specialists. You can also get the names of specialists
from a nearby hospital or medical school. Or, contact the
Cancer Information Service at (800) 4-CANCER, or (800) 422-6237,
to find out information about cancer centers and programs
supported by the National Cancer Institute.
Ultimately, the best treatment for you will depend on a
number of factors, including the type and extent of bladder
cancer you have, as well as on your age, overall health
and personal preferences. Below are some of the treatment
options:
Surgical procedures
Surgical treatments are usually the best option for people
with bladder cancer. The most common procedures include:
• Transurethral resection (TUR). This is often used to treat
superficial bladder cancer. During TUR, your doctor inserts
a cystoscope — an instrument with a special lens and fiber-optic
lighting system — into your bladder through your urethra.
The cancer is removed with a small wire loop and any remaining
cells are burned away with an electric current. In some
cases, a high-energy laser may be used instead of the electric
current. TUR itself causes few problems. You're likely to
have some blood in your urine or pain when you urinate for
a few days following the procedure. But because superficial
bladder cancer commonly recurs, you'll need to see your
doctor for a cystoscopic exam every three to six months.
• Segmental cystectomy. This procedure may be an option
when a tumor has invaded just one part of the bladder wall.
It removes only the portion of the bladder that contains
cancer cells. 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.
The main side effect of this surgery is more frequent urination.
Although the problem is often temporary, it may become permanent
in some people.
• Radical cystectomy. Doctors may use this extensive operation
for invasive bladder cancer or for superficial cancer that
affects a large portion of the bladder. It involves removing
the entire bladder, as well as nearby lymph nodes and part
of the urethra. In men, the prostate gland, seminal vesicles
— which produce some of the fluid in semen — and a portion
of the vas deferens (a conduit for sperm) also are removed.
For women, radical cystectomy usually means removing the
ovaries, fallopian tubes and part of the vagina.
After a radical cystectomy, your surgeon may construct a
new bladder for you or attach a pouch — either internally
or externally — to collect urine.
Radical cystectomy can be life altering, affecting not only
your ability to urinate normally but also your sexuality.
Women who lose their ovaries and fallopian tubes are no
longer able to become pregnant and enter menopause immediately.
In addition, removing part of the vagina during surgery
can affect the ability to have sexual intercourse.
In the past, the vast majority of men became impotent after
a radical cystectomy. Now, new surgical procedures may prevent
this problem in a very select group of men. Still, removing
the prostate gland and seminal vesicles means that semen
is no longer produced and sperm aren't released during ejaculation.
Bladder cancer usually occurs in men after the years of
active reproduction, but some men who have a cystectomy
early in life choose to bank their sperm before surgery.
Others may later decide on a procedure in which sperm are
removed from their testicles.
Radiation therapy
This therapy uses high-energy X-rays to destroy cancer cells
and shrink tumors. It's most often used after an operation
to eliminate any remaining cancer cells. When surgical treatment
isn't an option, radiation may sometimes be used instead,
but it's much less effective than surgery.
In treating bladder cancer, radiation may either come from
outside your body (external radiation) or from radioactive
materials placed directly into your bladder (internal radiation).
External radiation is usually performed
as an outpatient procedure, with treatments occurring five
days a week for five to seven weeks.
You may find that you become tired during radiation therapy,
especially during the last weeks of treatment. External
radiation can also cause your skin to become red, tender
and itchy — just as if you had sunburn. Women may also experience
vaginal dryness, and men may have problems with impotence.
Radiation may also cause bladder or bowel incontinence,
impotence in men and irritation of the rectum, leading to
diarrhea. These side effects are usually temporary. In the
meantime, your doctor may be able to offer measures to make
them more manageable.
Chemotherapy
This treatment uses drugs to destroy cancer cells.
Your doctor may suggest having chemotherapy after an operation
to eliminate any remaining traces of cancer, but sometimes
you may have it before a surgical procedure in an effort
to spare your bladder.
In most cases, two or more drugs are used in combination.
They sometimes may be inserted directly into your bladder
through your urethra — a procedure known as intravesical
therapy. This treatment is commonly used after TUR to help
prevent a very superficial cancer from recurring. You are
likely to have intravesical therapy once a week for several
weeks.
This isn't an option if cancer cells have penetrated deep
into the bladder wall or spread to other organs. In that
case, chemotherapy drugs are given intravenously so that
they travel through your bloodstream to every part of your
body (systemic chemotherapy). This treatment is given in
several cycles, which gives your body a chance to recover
between sessions.
Even so, the side effects of chemotherapy — hair loss, nausea,
vomiting and fatigue — can be severe. They occur because
chemotherapy affects healthy cells — especially fast-growing
cells in your digestive tract, hair and bone marrow — as
well as cancerous ones. Not everyone has these side effects,
however, and there are now better ways to control them if
you do.
Systemic chemotherapy may also reduce the number of white
and red blood cells in your body, making you temporarily
more prone to infections and bruising. In addition, some
drugs used to treat bladder cancer may cause kidney damage.
To help prevent kidney problems, you may be given intravenous
fluids during your treatment and advised to drink lots of
fluids.
Biological therapy
Biological therapy stimulates your body's own immune system
to fight cancer. It's usually used after TUR to help prevent
superficial bladder cancer from recurring. Bacille Calmette-Guerin
(BCG), a bacterium used in vaccines against tuberculosis,
is the most commonly used immune stimulant. It binds to
your bladder, where it triggers a response that inhibits
the formation and growth of tumors. BCG is administered
directly into your bladder using a small, flexible tube
(catheter) for two hours once a week. Treatment may last
six or more weeks.
During treatment with BCG, you may have some bladder irritation
or blood in your urine and feel as if you have the flu.
Your doctor may suggest a medication to help reduce some
of these signs and symptoms. If you have a persistent high
fever — greater than 101.5 F — that doesn't respond to pain
relievers, see your doctor promptly for treatment. This
may indicate widespread infection of BCG, which can be serious.
Other treatments
Standard therapies for bladder cancer may not always be
effective, or you may not be able to tolerate the side effects.
In that case, several other treatments may be an option.
One such option is photodynamic therapy (PDT).
This two-part treatment helps destroy bladder cancer cells.
Initially you receive an injection of a chemical that is
taken up by cancer cells but not by healthy ones. The cells
containing the chemical are then exposed to light from a
laser, which kills or severely damages them.
PDT may produce serious side effects, such as chronic bladder
infections, bladder shrinkage and long-term sensitivity
to sunlight. While promising, this therapy is only done
at a limited number of centers and needs further study before
it can be routinely recommended.
Bladder reconstruction
In radical cystectomy, your bladder is completely removed.
Immediately afterward, your surgeon reconstructs your urinary
system so that you can eliminate urine effectively. Several
options for bladder reconstruction exist. The best approach
for you depends on a number of factors, including your overall
health and the extent to which the cancer has spread. In
all cases, the goal is to maintain your quality of life
as much as possible. Some reconstructive procedures include:
• Urinary conduit. This is the simplest operation with the
least risk of complications. It involves isolating a segment
of your small intestine and attaching one end of it to your
ureters. The other end is connected to an opening (stoma)
in your lower abdomen through which urine drains into a
small bag. You wear the bag outside your body and empty
it three or four times a day. In the evening you can use
a larger bag that allows you to sleep through the night.
• Catheterizable stoma. This type of reconstruction eliminates
the need for a bag. Instead, your surgeon fashions an interior
pouch capable of holding 3 to 4 cups of urine. You drain
the urine from the pouch several times a day using a catheter.
Because the size of the pouch remains the same, you must
also drain your urine during the night.
• Neobladder. During this complex reconstructive procedure,
your surgeon literally recreates a bladder. This is accomplished
by connecting the same type of internal pouch used in a
catheterizable stoma to the tube that carries urine from
your body (urethra). As a result, you're able to eliminate
urine without having an external opening, although you may
need to use a catheter inserted through your urethra. Neobladder
reconstruction isn't an option if some or all of your urethra
has been removed, and it may lead to a number of complications,
including scarring, internal urine leakage and incontinence.
• Erectile dysfunction
• Urinary incontinence
• Fecal incontinence
• Diarrhea
Prevention
Although bladder cancer can't always be prevented, you can
take these steps to help reduce your risk:
• Don't smoke. Not smoking means that cancer-causing chemicals
in smoke can't collect in your bladder.
• Be careful with chemicals and private water sources. If
you work with chemicals, follow all safety instructions
to avoid exposure. If you have your own well, you may wish
to have it tested to check 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.
• Learn to love broccoli. A 10-year study conducted by researchers
at the Harvard School of Public Health indicates that a
high intake of cruciferous vegetables, such as broccoli
and cabbage, may cut the risk of bladder cancer in men.
Although eating plenty of fresh vegetables and fruits is
important for overall health, only broccoli and cabbage
seem to affect bladder cancer risk. The Harvard doctors
studied only men, and it's not known if the results apply
to women.
• Seek medical attention early. If you notice blood in your
urine, see your doctor.
• Stop smoking: Strategies to help you quit
Coping skills
Living with cancer is never easy. But dealing with the physical
effects of bladder cancer and its treatment can be especially
difficult. This is particularly true if you have a stoma
or urostomy bag. You may wonder how the changes in your
body will affect your normal activities, your relationships
and your sexuality.
It may help to know that having a stoma or urostomy bag
doesn't mean you can't be active or live a normal life.
The bags are small, inconspicuous under clothing and shouldn't
leak. You can work, travel, exercise and even swim.
Even so, it may be difficult to come to terms psychologically
with the physical changes you've experienced. Although there
are no easy answers for coping with bladder cancer, the
following suggestions may help:
• Find ways to make your life easier. If you have problems
with incontinence or need to change a urostomy bag, try
to sit in the back of a movie theater, concert hall or meeting
room. That way you're less conspicuous if you need to leave
for the toilet. Sit in an aisle seat on an airplane or train.
Allow for breaks when planning long trips, seminars or excursions.
• Share your concerns with others. When you feel ready,
consider talking to someone you trust about your concerns.
This might be a friend, a family member, your doctor, a
social worker, a spiritual adviser or a counselor. You may
also find it helpful to talk to other people with bladder
cancer. They can tell you how they've coped with problems
similar to the ones you're facing.
One of the best ways to do that is to join a support group
for people with bladder cancer. Although support groups
aren't for everyone, they can sometimes be a good resource
for practical information about your disease. You may also
find strength and encouragement in being with people who
are facing the same challenges you are.
If you're interested in learning more about support groups,
talk to a doctor, nurse, social worker or psychologist.
They may be able to put you in touch with a group in your
area. Or check your local phone book, library or cancer
organization. The National Cancer Institute also can provide
a list of support groups. So can the American Cancer Society
at (800) ACS-2345, or (800) 227-2345, or Cancer Care at
(800) 813-HOPE, or (800) 813-4673.
After deciding to participate in a group, try it out a few
times. If it doesn't seem useful or comfortable, you don't
have to continue.
• Don't be afraid of intimacy. Your natural reaction to
changes in your body may be to avoid intimacy. Although
it may not be easy, it's vitally important to discuss these
feelings with your partner. You may also find it helpful
to talk to a therapist, either on your own or together.
Remember that you can express your sexuality in many ways.
Touching, holding, hugging and caressing may become far
more important to you and your partner. In fact, the closeness
you develop may produce greater intimacy than you've ever
had.
Intimacy issues may be even harder to address if you're
not currently in a committed relationship. You may worry
that no one will ever find you attractive or desirable.
In that case, the advice and understanding of a medical
social worker or other therapist who understands bladder
cancer can be a tremendous help. Your doctor may be able
to recommend a qualified counselor. Or call the National
Cancer Institute's toll-free information line, called the
Cancer Information Service. It provides access to trained
counselors and accurate, up-to-date information on all aspects
of living with cancer. You can reach the Cancer Information
Service 24 hours a day at (800) 4-CANCER, or (800) 422-6237.
• You've been diagnosed with cancer: What happens next
http://www.cnn.com/
HEALTH/library/DS/00177.html
| 
High Grade Liquid
Discount Brand Name
Vitamins And
Cancer Nutrition Packages!
ORDER NOW!
LOWEST PRICES
ONLINE ON ALL LIQUID
SUPPLEMENTS GUARANTEED!Only at www.SharpWebLabs.com!
Put Some Nutrition
In Your Life Today!
Guaranteed Satisfaction! Thousands Of Customers! Cancer And Nutrition Go Hand In Hand!
|
