Bladder Cancer

Bladder Cancer is diagnosed and treated by the Urology Division at Premier Medical Group.

Bladder Cancer

The bladder is part of the urinary tract. The urinary tract which rids your body of liquid waste is made up of your kidneys, ureters (urine travels through these tubes through the kidneys) urethra, and bladder. Bladder cancer accounts for approximately 90% of cancers of the urinary system.

In bladder cancer certain cells in the urinary tract change in ways that are not normal. These cells can multiply out of control and form a lump of tissue (a tumor). Over time, the cancer cells destroy healthy tissue and they may travel to other parts of the body.

 

What are the causes of bladder cancer?

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The major risk factor for bladder cancer is cigarette smoking. Smokers are more than twice as likely to develop the disease as non-smokers. The longer a person smokes, the greater the chance of developing bladder cancer. Other risk factors include the following:

  • Chronic bladder inflammation (recurrent urinary tract infections, urinary stones)
  • Consumption of Aristolochia fangchi (herb used in some weight-loss formulas)
  • Diet high in saturated fat
  • Exposure to second-hand smoke
  • External beam radiation
  • Family history of bladder cancer (several genetic risk factors identified)
  • Male gender
  • Infection with Schistosoma haematobium (parasite found along the Nile river)
  • Race (Caucasian)
  • Treatment with certain drugs (e.g., cyclophosphamide–used to treat cancer)
Stage 0-V bladder cancer tumors
  • Exposure to carcinogens in the workplace also increases the risk for bladder cancer. Medical workers exposed during the preparation, storage, administration, or disposal of antineoplastic drugs (used in chemotherapy) are at increased risk. Occupational risk factors include recurrent and early exposure to hair dye, and exposure to dye containing aniline, a chemical used in medical and industrial dyes. Workers at increased risk include the following;
  • hairdressers
  • machinists
  • printers
  • painters
  • truck drivers
  • those in rubber, chemical, textile, metal, and leather industries.

What are the symptoms of bladder cancer?

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The primary symptom of bladder cancer is blood in the urine.This may be visible to the naked eye or visible only under a microscope and is usually painless. Bladder cancer must be ruled out in any patient who develops gross, painless blood in the urine. Other bladder cancer symptoms include frequent urination and pain upon urination.

How is bladder cancer diagnosed?

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Bladder cancer found in its early stages has an excellent chance to be cured. Diagnosis of bladder cancer includes urological tests and imaging tests. A complete medical history is used to identify potential risk factors (e.g., smoking, exposure to dyes). Diagnosis is can be made with several options:

Urine cytology

A urine sample is examined under microscope for cancer cells.

CT scan or intravenous pyelogram IVP

This is a series of special x-rays that are taken of your kidneys and bladder. One or both tests may be given. CAT scans are available at the Premier Medical Group Urology Division Poughkeepsie location.

Cystoscopy

The inside of your bladder is closely examined by the doctor with a special telescope called a cystoscope which is inserted through your urethra. During this procedure biopsy samples can be taken for later study.

What are the types of bladder cancer?

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Papillary tumors

Bladder cancer usually originates in the bladder lining, which consists of a mucosa layer of surface cells that expand and deflate (transitional epithelial cells), smooth muscle, and a fibrous layer. Tumors are broadly categorized as low-stage (superficial) or high-stage (muscle invasive). Common types of bladder cancer:

Papillary tumors

These tumors stick out from the bladder lining on a stalk and tend to grow into the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall (see the adjacent images).

Sessile tumors

This type of tumor lies flat against the bladder lining. They are more likely to grow deeper into the layers of bladder wall then papillary tumors.

Carcinoma in situ (CIS)

This is a cancerous patch of bladder lining. The patch may look almost normal or may look inflamed.

How is bladder cancer treated?

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The treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the patient’s age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy. In some cases, treatments are combined (e.g., surgery or radiation and chemotherapy, preoperative radiation). Bladder cancer cases are seen in all of our locations, Poughkeepsie, Fishkill, Kingston, Newburgh and Rhinebeck.

Surgery

There are two main surgeries for bladder cancer. Transurethral resection (TUR) removes cancerous growths from the bladder. Cystectomy removes all or part of the bladder if cancer has spread into the bladder muscle. The type of surgery depends on the stage of the disease. In early bladder cancer, the tumor may be removed (resected) using instruments inserted through the urethra (transurethral resection).

a: Bladder cancer
b: Resectoscope cutting loop cutting tumor

Transurethral resection (TUR)

This is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder.

Cystectomy

This is a surgical removal of all (total or radical cystectomy) or part (partial cystectomy) of the bladder. It is used to treat bladder cancer that has spread into the bladder wall as either a first occurrence or as a cancer that returns (recurs) following initial treatment. A radical cystectomy removes the whole bladder and the surrounding pelvic organs.

When the bladder is removed, another way to store and release urine is needed. Options include:

Orthotropic diversion

In most cases, a piece of intestine is formed into a new bladder. This is attached to the urethra allowing urine to follow the usual path out of the body. This procedure allows normal urinations during the day, although leakage may occur at night. Some people may need to use a catheter to release the urine.

Urostomy

This procedure uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. The urine passes from the ureters through the conduit and out the opening into a lightweight leak proof plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day. A larger bag that allows for longer storage can be worn overnight.

Abdominal diversion reservoir

In other cases, a piece of intestine may be formed inot a pouch, which can store urine. This is another form of urostomy. The opening is smaller than the opening for an ileal conduit. And because there is a pouch inside the abdomen, no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night.

Chemotherapy to Treat Bladder Cancer

Chemotherapy is a systemic treatment (i.e., affects the entire body) in which drugs are used to destroy cancer cells. Chemotherapy drugs are administered orally, intravenously (through a vein), or in early bladder cancer, may be infused into the bladder through the urethra (called intravesical chemotherapy). Chemotherapy can be administered before surgery or after surgery.

Side effects of chemotherapy drugs used to treat bladder cancer can be severe and include, abdominal pain, anemia, bladder irritation, blurred vision, excessive bleeding or bruising, fatigue, headache, infection, and/or loss of appetite.

Radiation Therapy

Radiation uses high-energy x-rays or other high-energy rays to destroy cancer cells. External beam radiation is emitted from a machine outside the body and is aimed at the bladder. This type of therapy be used after surgery to destroy cancer cells that may remain. Radiation therapy is also used to relieve symptoms (called palliative treatment) of advanced bladder cancer.

Side effects can include inflammation of the rectum, incontinence, skin irritation, blood in the urine, scar tissue formation, and impotence (erectile dysfunction).

Bacillus Calmette-Guérin (BCG) therapy

This therapy, which is also called biological therapy, uses medicines that cause your body’s immune system to attack bladder cancer cells. This treatment is used to enhance the immune system’s ability to fight disease. A vaccine derived from the bacteria that causes tuberculosis (BCG) is infused through the urethra into the bladder, once a week for 6 weeks to stimulate the immune system to destroy cancer cells. Sometimes BCG is used with interferon.

During treatment, you’re asked to hold the medication in your bladder for up to two hours, then urinate. If BCG is used, your doctor may advise you to pour bleach into your toilet after you urinate. This kills any leftover bacteria. Intravesical therapy is usually given weekly for 6 to 8 weeks. Depending on the medication used, you may be prescribed antibiotics to help prevent infection. If you have a fever at anytime during treatment, call your doctor.

Side effects can include inflammation of the bladder (cystitis), inflammation of the prostate (prostatitis), and flu-like symptom

s. High fever (over 101.5°F) may indicate that the bacteria have entered the bloodstream (called bacteremia). This condition is life threatening and requires antibiotic treatment. Immunotherapy is not used in patients with gross hematuria (blood in urine).

Photodynamic therapy

A new treatment for early bladder cancer. It involves administering drugs to make cancer cells more sensitive to light and then shining a special light onto the bladder.

Bladder Cancer Follow-Up

Bladder cancer has a high rate of recurrence. Urine cytology and cystoscopy are performed every 3 months for 2 years, every 6 months for the next 2 years, and then yearly.

Bladder Cancer Prognosis

Superficial bladder cancer has a 5-year survival rate of about 85%. Invasive bladder cancer has a less favorable prognosis. Approximately 5% of patients with metastasized bladder cancer live 2 years after diagnosis.

Bladder Cancer Prevention

The best way to lower the risk of bladder cancer is not to smoke. Studies have shown that drinking plenty of fluids daily also lowers the risk for bladder cancer.

Questions to Ask Your Doctor About Bladder Cancer

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  • Why do you suspect I have bladder cancer?
  • What other conditions may cause blood in the urine, frequent urination, and painful urination?
  • Does my history of smoking or secondhand smoke exposure or my family history increase my risk for bladder cancer?
  • Might I have been exposed to cancer-causing chemicals at work?
  • What types of tests will be performed to diagnose or rule out bladder cancer?
  • Might these tests involve a bladder biopsy? Why or why not?
  • What do these bladder cancer tests involve?
  • How should I prepare for these tests?
  • When will test results be available? Should I call for the results or will someone contact me?
  • Who will explain these results to me?
  • What is the type and stage of my bladder cancer?
  • How large is my bladder tumor?
  • Is the tumor superficial or invasive?
  • Have bladder cancer cells spread to my lymph nodes or to other organs?
  • Is my tumor fast or slow-growing?
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What You Need to Know about Bladder Cancer