Bladder Cancer


General Information

What is 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 the cells lining 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 change shape depending on whether the bladder is full or empty and may be stretched without breaking apart. Most bladder cancers begin in the transitional cells.

Squamous cell carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the bladder.

Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the bladder produce and release fluids 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.

Smoking, gender, and diet can affect the risk of developing bladder cancer. Risk factors 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 Caucasian.
-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 or by other conditions. 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 created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Urinalysis: A test that examines a sample of urine to check for anything abnormal.

Internal examination: The doctor will insert 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. The x-rays are taken after a dye is injected into a blood vessel. The dye concentrates in the urine and outlines the kidneys, ureters, and bladder on the x-rays.

Cystoscopy: An examination of the bladder and urethra using a cystoscope (a thin, lighted instrument) inserted into the urethra. Tissue samples may be removed and examined under a microscope to check for cancer cells.

Biopsy: Cells, tissues, or fluid are removed and viewed under a microscope to see if cancer cells are present. 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 for the presence of abnormal cells.

Certain factors affect prognosis (chance of recovery) and treatment options. Prognosis (chance of recovery) depends on the stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body), the type of bladder cancer cells and how they look under a microscope, and the patient's age and general health. Treatment options depend on the stage of bladder cancer. Bladder cancer in the early stages can often be cured.

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 the best treatment. The following tests and procedures may be used in the staging process:

Cystoscopy: An examination of the bladder and urethra using a cystoscope (a thin, lighted instrument) inserted into the urethra. Tissue samples may be removed and examined under a microscope to check for cancer cells.

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 created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

Physical examination: A check of general signs of health, including looking for anything unusual, such as swollen or tender lymph nodes.

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it 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 on tissue lining the inside of the bladder only. 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 cells have spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III
In stage III, cancer cells have 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. 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. 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 most of the bladder remains intact, a patient is 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 the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Bladder cancer is treated with internal and external radiation.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy.

Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Other types of treatment are being tested in clinical trials. These include the following:

Chemoprevention
Chemoprevention is the use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer.

Photodynamic therapy
Photodynamic therapy is treatment with drugs that become active when exposed to light. These drugs kill cancer cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options By Stage

Stage 0 Bladder Cancer (Carcinoma in Situ)
Treatment of stage 0 bladder cancer may include the following:

1.Transurethral resection with fulguration.
2.Transurethral resection with fulguration followed by intravesical biological therapy or chemotherapy.
3.Segmental cystectomy
4.Radical cystectomy
5.A clinical trial of photodynamic therapy
6.A clinical trial of biological therapy.
7.A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).

Stage I Bladder Cancer
Treatment of stage I bladder cancer may include the following:

1.Transurethral resection with fulguration.
2.Transurethral resection with fulguration followed by intravesical biological therapy or chemotherapy.
3.Segmental or radical cystectomy.
4.Radiation implants with or without external radiation therapy.
5.A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).
6.A clinical trial of intravesical therapy.

Stage II Bladder Cancer
Treatment of stage II bladder cancer may include the following:

1.Radical cystectomy with or without surgery to remove pelvic lymph nodes.
2.External radiation therapy.
3.Radiation implants before or after external radiation therapy.
4.Transurethral resection with fulguration.
5.Segmental cystectomy.
6.A clinical trial of chemotherapy before or after surgery.
7.A clinical trial of chemotherapy combined with external radiation therapy.

Stage III Bladder Cancer
Treatment of stage III bladder cancer may include the following:

1.Radical cystectomy.
2.External radiation therapy with or without radiation implants.
3.Segmental cystectomy.
4.External radiation therapy combined with chemotherapy.
5.A clinical trial of chemotherapy before or after surgery.
6.A clinical trial of chemotherapy combined with external radiation therapy.

Stage IV Bladder Cancer
Treatment of stage IV bladder cancer may include the following:

1.Radical cystectomy.
2.External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life.
3.Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.
4.Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
5.Chemotherapy.
6.A clinical trial of chemotherapy before or after surgery.
7.A clinical trial of chemotherapy combined with external radiation therapy.

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:

1.Surgery
2.Chemotherapy
3.Radiation therapy
4.A clinical trial of chemotherapy






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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