What Is Bladder Cancer

What Is Bladder Cancer 3

What Is Bladder Cancer 4

What Is Bladder Cancer 5

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 Bladder Cancer

The Bladder The bladder is a hollow organ in the lower abdomen. It stores urine, the waste that is produced when the kidneys filter the blood. The bladder has an elastic and muscular wall that allows it to get larger and smaller as urine is stored or emptied. Urine passes from the two kidneys into the bladder through two tubes called ureters. Urine leaves the bladder through another tube, the urethra. Urinary System About Cancer Cancer is a group of many different diseases that have some important things in common. Cancer affects cells, the body's basic unit of life. To understand different types of cancer, such as bladder cancer, it is helpful to know about normal cells and what happens when they become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. These cells form a mass of extra tissue, called a growth or tumor. Tumors can be benign or malignant. • Benign tumors are not cancer. They often can be removed and in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. • Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissues around them. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This process is the way cancer spreads from the original (primary) tumor to form new tumors in other parts of the body.

Bladder Cancer Bladder cancer is a disease in which malignant cells are found in the bladder. About 90 percent of bladder cancers are transitional cell carcinomas -- cancers that begin in the cells lining the bladder. Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Transitional cell cancers can also arise in other parts of the urinary system that are lined by transitional cells, such as the urethra, ureters and renal pelvis.

Who is at Most Risk of Bladder Cancer?

Smokers – People who smoke are at least twice as likely to be diagnosed with bladder cancer as nonsmokers. Toxins from cigarettes, pipes and cigars are absorbed into the lungs and blood and then filtered by the kidneys into the urine inside the bladder. The urine remains in contact with the bladder for a long time and those toxins then get absorbed into the lining of the bladder.
Workers with industrial occupations – Many carcinogens have been removed from the workforce. However, workers should use caution. I have had bladder cancer patients who worked in these industries, but they also smoked, so it is difficult to tell whether it was smoking or chemicals that were the cause. Possible high-risk industries involve:

• Textiles

• Rubber

• Leather

• Painting

• Printing

• Dye (aromatic amines known as benzidine and beta-naphthylamine)

People with chronic bladder inflammation – Frequent irritations of the bladder may have some connection to bladder cancer, but that does not necessarily mean they cause bladder cancer. Those conditions include:

• Urinary infections

• Kidney and bladder stones

• Other causes of chronic bladder irritation

• Indwelling catheters (such as those used by paraplegics)

• Schistosomiasis or bilharziasis – infection by a parasitic worm in Egypt

Cyclophosphamide (Cytoxan) and ifosfamide chemotherapy patients – High doses of these chemotherapy drugs can increase the risk of bladder cancer. However, the drug mesna is used with these drugs to help protect the bladder from irritation and decrease bladder cancer risk.
People exposed to arsenic – Arsenic in drinking water has been associated with a higher risk of bladder cancer, but the risk would depend on water system standards.
Whites, more than members of other races – Whites are twice as likely to develop bladder cancer than African-Americans or Hispanics. Asians have the lowest incidence of bladder cancer.
People with relatives who’ve had bladder cancer – Family members of bladder cancer patients are at an increased risk for developing the disease.

Children with rare birth defects – Two rare birth defects increase bladder cancer risk.
If the connection between a baby’s belly button and the bladder fails to disappear after birth, it could become cancerous. (According to the NCI, this happens in less than one-half of 1% of bladder cancers.)

Exstrophy, another rare defect, can greatly increase bladder cancer risk. The defect occurs when the skin, muscle and tissue in front of the bladder does not close completely causing a hole in the wall of the abdomen. This exposes the bladder to chronic infection, which could lead to cancer.

How is Superficial (Early-Stage) Bladder Cancer Treated?

The majority of bladder cancers are superficial, meaning they haven’t spread beyond the bladder muscle. Superficial bladder cancer is also the type most easily treated successfully. Superficial bladder cancer is not life threatening, but it comes back later most of the time.

Superficial Bladder Cancer

If the tumor is superficial, small, and of low-grade malignancy, a conservative treatment approach can be undertaken. This would include complete resection (surgical removal) of the tumor and close surveillance. The bladder would then be visually inspected by cystoscopy (a tiny camera threaded into the bladder) every three months initially, with later examinations being further apart once it is determined that the tumors are not returning.

If a tumor does come back, it can be removed and re-evaluated for invasiveness. If it is determined that the tumor is superficial and of low-grade malignancy, close surveillance with repeat cystoscopies can be continued. Close monitoring with cystoscopy and imaging studies is the key for adequate control of bladder cancer.

For persons with a large superficial tumor or who have multiple superficial tumors, or if the cancer is of high-grade malignancy, or if it recurs often, the use of an immunotherapeutic or chemotherapeutic agent instilled directly into the bladder (via a catheter) should be considered. These agents have proven to help reduce cancer recurrences and eradicate existing tumors. Cancer survivors in whom treatment with one agent fails may respond to another.

Persons with superficial bladder cancer who keep a close follow-up have a good chance that their disease can be well controlled. If there are any signs of worsening, a more aggressive approach can be undertaken to prevent the spreading of the cancer.

Treatment Options for Invasive (Late-Stage) Bladder Cancer

Treatment for more advanced may require removal of the bladder and aggressive chemotherapy.
Bladder cancers generally are divided into low-grade or high-grade—terms that help predict how rapidly the tumors will grow and spread. Even when the stage and grade have been determined, the challenge lies in choosing the treatment or combination of therapies that will give each patient the best possible outcome.

The most common type is the superficial, which is also the type most easily treated successfully. The treatment will depend on which type of tumor (superficial or invasive) is found at initial assessment. If the tumor is superficial, small, and of low-grade malignancy, a conservative treatment approach can be undertaken.

Invasive Bladder Cancer

In later-stage bladder cancer, when a tumor has spread into the muscle wall of the bladder, more aggressive treatment is required. The best treatment in these situations is removal of the bladder, sometimes with chemotherapy or radiotherapy as well. In very rare occasions, when there is no prior history of bladder cancer and the tumor is in an isolated portion of the bladder, removal of just the affected segment of the bladder may be enough. However, total bladder removal is generally necessary.

Surgical treatments include:

Radical cystectomy – a common surgery that involves removal of the bladder, nearby lymph nodes and part of the urethra and any nearby organs that may contain cancer cells. Once the bladder is removed some form of urinary diversion (or bladder reconstruction) is necessary to maintain normal kidney function.

Segmental cystectomy – removing only part of the bladder. The method might be used if a patient has a solitary tumor that has invaded a small area of the bladder wall.

Bladder Reconstruction

Once the bladder is removed, there are several options for reconstruction of the urinary tract, each has its own advantages and disadvantages. The method of reconstruction chosen will depend on location, grade and size of the tumor as well as the age, health, dexterity and motivation of the person being treated.

The three options for urinary reconstruction are:

Ileal Conduit

The ileal conduit procedure has been around for over 50 years and is still commonly used. In this surgical procedure, the normal flow of urine is diverted through a segment of the small bowel to a collection bag outside of the abdomen. The main advantage of this procedure is that it is less complex than other procedures to perform, which results in less surgery time. Its disadvantage is that it requires the use of an external collection bag on the abdominal wall.

Continent Urinary Diversion

The continent urinary diversion consists of a pouch made out of intestine. The pouch has a small opening in the skin through which a catheter is inserted to drain the urine. The advantage of this type of urinary reconstruction is that it does not require a collection bag attached to the abdominal wall. Its disadvantage is that it results in a small opening in the abdomen that requires self-catheterization to empty the pouch.

Orthotopic Neobladder

Orthotopic neobladder (also called neobladder reconstruction) involves constructing a new bladder from the patient's intestines. The neobladder is attached to the urethra so that individuals can void more normally, without the need for an external device to collect urine. The disadvantages are that poor emptying of bladder (which may require self-catheterization through the urethra) or nighttime leakage may occur.

Nonsurgical Options

Occasionally bladder cancer spreads to lymph nodes or other organs. In this setting, chemotherapy is advised. New chemotherapeutic agents are currently being investigated and have shown promise.

Bladder cancer is a very treatable disease that in the majority of cases can be well controlled with close surveillance and no major intervention. Odds are if you have bladder cancer, you will live a long and healthy life.

Bladder cancer occur s almost four times more often in men than women, and it is twice as common among whites as African-Americans and Hispanics.

Risk Factors
Tobacco use is the major risk factor for bladder cancer. Cigarette smokers are two to three times more likely than nonsmokers to develop bladder cancer, and both pipe and cigar smokers are at increased risk.

Other risk factors are:

• Age: Incidence increases in people 50 years and older.

• Occupation: Workers exposed to environmental agents in the rubber, chemical, leather, metal, printing, paint and several other industries are at risk.

• Personal history: Patients who have had bladder cancer have a greater chance of recurrence.

• Treatment with some drugs: Cancer patients treated with cyclophosphamide and people who have taken arsenic for various conditions appear to be at elevated risk.

However, many bladder cancer patients have no known risk factors.

Who is at Most Risk of Bladder Cancer?

Smokers – People who smoke are at least twice as likely to be diagnosed with bladder cancer as nonsmokers. Toxins from cigarettes, pipes and cigars are absorbed into the lungs and blood and then filtered by the kidneys into the urine inside the bladder. The urine remains in contact with the bladder for a long time and those toxins then get absorbed into the lining of the bladder.
Workers with industrial occupations – Many carcinogens have been removed from the workforce. However, workers should use caution. I have had bladder cancer patients who worked in these industries, but they also smoked, so it is difficult to tell whether it was smoking or chemicals that were the cause. Possible high-risk industries involve:

• Textiles

• Rubber

• Leather

• Painting

• Printing

• Dye (aromatic amines known as benzidine and beta-naphthylamine)

Hair stylists have been listed as possible high-risk professions for bladder cancer, but I’ve never had a hair dresser come in yet who had bladder cancer.
People in their late 60s – The risk of bladder cancer increases as people grow older. (According to the NCI, less than 1% of bladder cancer cases occur among people under the age of 40.)
Men and women, but men more commonly – Men are two to three times more likely to be diagnosed with bladder cancer than women. That’s probably related to workforce exposure and smoking patterns in the past.
People with chronic bladder inflammation – Frequent irritations of the bladder may have some connection to bladder cancer, but that does not necessarily mean they cause bladder cancer. Those conditions include:

• Urinary infections

• Kidney and bladder stones

• Other causes of chronic bladder irritation

• Indwelling catheters (such as those used by paraplegics)

• Schistosomiasis or bilharziasis – infection by a parasitic worm in Egypt

Cyclophosphamide (Cytoxan) and ifosfamide chemotherapy patients – High doses of these chemotherapy drugs can increase the risk of bladder cancer. However, the drug mesna is used with these drugs to help protect the bladder from irritation and decrease bladder cancer risk.
People exposed to arsenic – Arsenic in drinking water has been associated with a higher risk of bladder cancer, but the risk would depend on water system standards.

Whites, more than members of other races – Whites are twice as likely to develop bladder cancer than African-Americans or Hispanics. Asians have the lowest incidence of bladder cancer.
People with relatives who’ve had bladder cancer – Family members of bladder cancer patients are at an increased risk for developing the disease.

Children with rare birth defects – Two rare birth defects increase bladder cancer risk.
If the connection between a baby’s belly button and the bladder fails to disappear after birth, it could become cancerous. (According to the NCI, this happens in less than one-half of 1% of bladder cancers.)

Exstrophy, another rare defect, can greatly increase bladder cancer risk. The defect occurs when the skin, muscle and tissue in front of the bladder does not close completely causing a hole in the wall of the abdomen. This exposes the bladder to chronic infection, which could lead to cancer.
Symptoms

The most common symptoms for bladder cancer are:

• blood in the urine

• occasional pain while urinating

• frequent urination

• feeling the need to urinate without results

But these symptoms may suggest other problems, including infections or bladder stones. Anyone experiencing such symptoms should see a physician and have diagnostic tests as soon as possible.
Bladder cancer can range from wart-like growths that are not life-threatening to extensive and highly malignant disease, which, if it has spread to distant organs, can be rapidly fatal. The stage or extent of disease will help determine treat

Types of Bladder Cancer

Bladder cancers generally are divided into low-grade or high-grade—terms that help predict how rapidly the tumors will grow and spread. Even when the stage and grade have been determined, the challenge lies in choosing the treatment or combination of therapies that will give each patient the best possible outcome.

Superficial Bladder Cancer

The most common type of bladder cancer is the superficial, which is also the most easily treated. The earliest stages involve cancer on the surface of the bladder lining or cancer cells within the inner lining. These superficial tumors can be treated while preserving the bladder. If the tumor is superficial, small and of low-grade malignancy, a conservative treatment approach can be undertaken.

Invasive Bladder Cancer

In later-stage disease, when a tumor has spread into the muscle wall of the bladder, more aggressive treatment is required. The cancer has spread outside the bladder to nearby lymph nodes and possibly to other organs, such as the liver, lung or bone.

The best treatment in these situations is removal of the bladder, sometimes with chemotherapy or radiotherapy as well. In very rare occasions, when there is no prior history of bladder cancer and the tumor is in an isolated portion of the bladder, removal of just the affected segment of the bladder may be enough. However, total bladder removal is generally necessary.

How is Superficial (Early-Stage) Bladder Cancer Treated?

The majority of bladder cancers are superficial, meaning they haven’t spread beyond the bladder muscle. Superficial bladder cancer is also the type most easily treated successfully. Superficial bladder cancer is not life threatening, but it comes back later most of the time.

Superficial Bladder Cancer

If the tumor is superficial, small, and of low-grade malignancy, a conservative treatment approach can be undertaken. This would include complete resection (surgical removal) of the tumor and close surveillance. The bladder would then be visually inspected by cystoscopy (a tiny camera threaded into the bladder) every three months initially, with later examinations being further apart once it is determined that the tumors are not returning.

If a tumor does come back, it can be removed and re-evaluated for invasiveness. If it is determined that the tumor is superficial and of low-grade malignancy, close surveillance with repeat cystoscopies can be continued. Close monitoring with cystoscopy and imaging studies is the key for adequate control of bladder cancer.

For persons with a large superficial tumor or who have multiple superficial tumors, or if the cancer is of high-grade malignancy, or if it recurs often, the use of an immunotherapeutic or chemotherapeutic agent instilled directly into the bladder (via a catheter) should be considered. These agents have proven to help reduce cancer recurrences and eradicate existing tumors. Cancer survivors in whom treatment with one agent fails may respond to another.
Persons with superficial bladder cancer who keep a close follow-up have a good chance that their disease can be well controlled. If there are any signs of worsening, a more aggressive approach can be undertaken to prevent the spreading of the cancer.

Smoking Cessation
.
The most important risk factor for bladder cancer is cigarette smoking1. Continued use of tobacco following cancer diagnosis may increase the likelihood that tumors will recur2. For this reason, quitting smoking is an important part of the patient's overall health care plan following diagnosis of bladder cancer.

The U.S. Department of Health and Human Services has published guidelines on the most effective treatments for helping people quit smoking3. These guidelines provide recommendations based on a review of all randomized clinical trials of smoking cessation treatments published through December 1998.

Together, these studies show that the combination of counseling and medications for smoking cessation is more effective in helping people quit smoking than no treatment at all. Even counseling sessions as brief as 3 minutes or less, in combination with medication, are more effective than no counseling at all. It's effectiveness increases with the amount of time spent in counseling. For this reason, the guidelines recommend 4 or more counseling sessions of 10 minutes or more.

Effective counseling helps people develop the skills to:

• Recognize high-risk situations

• Cope with temptations to smoke

• Obtain support from others during the quit attempt.

The guidelines recommend that all smokers use medication to help them quit, except in special circumstances such as pregnancy.

The most effective medications include:

• Nicotine patch

• Nicotine gum

• Nicotine inhaler

• Nicotine nasal spray

• Bupropion

The nicotine patch and nicotine gum can be obtained without a prescription. Bupropion, also known as Zyban, may be especially helpful for people who have had problems with depression. The patient's doctor may be able to assist in making decisions about the best medication to use.
For many people, the hardest part of quitting is remaining abstinent after the quit date. For this reason, the guidelines recommend continued in-person or telephone contact with a smoking cessation counselor or healthcare professional following the quit date to help prevent relapse.
Smoking cessation counseling and medication services are available to M. D. Anderson Cancer
Center patients and their families.

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