Bladder cancer
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):
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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.
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Squamous cell carcinoma: Cancer that
begins in squamous cells, which are thin, flat
cells that may form in the bladder after longterm infection or irritation.
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Adenocarcinoma: Cancer that begins
in glandular (secretory) cells that may form in
the bladder after long-term irritation
and inflammation.
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.
Anything that increases your chance of getting a
disease is called a risk factor. Risk factors for
bladder cancer include the following:
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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:
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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 xray 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.
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Urinalysis: A test to check the color of urine
and its contents, such as sugar, protein, red
blood cells, and white blood cells.
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 is inserted
through the urethra into the bladder. A
cystoscope is a thin, tube-like instrument with
a light and a lens for viewing. It may also have
a tool to remove tissue samples, which are
checked under a microscope for signs of
cancer.
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.
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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:
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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 patient’s age and general health.
Treatment options depend on the stage 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:
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Cystoscopy: A procedure to look inside the
bladder and urethra to check
for abnormal areas. A cystoscope is inserted
through the urethra into the bladder. A
cystoscope is a thin, tube-like instrument with
a light and a lens for viewing. It may also have
a tool to remove tissue samples, which are
checked under a microscope for signs of
cancer.
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 xray machine. A dyemay 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
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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 patient’s health habits and
past illnesses and treatments will also be
taken.
Chest x-ray CT Chest: 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.
There are three ways that cancer spreads in
the body.
The three ways that cancer spreads in the body
are:
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Through tissue. Cancer invades the
surrounding normal tissue.
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Through the lymph system. Cancer invades
the lymph system and travels through
the lymph vesselsto other places in the body.
Through the blood. Cancer invades
the veins and capillaries and travels through
the blood to other places in the body.
When cancer cells break away from
the primary (original) tumor and travel through
the lymph or blood to other places in the body,
another (secondary) tumor may form. This
process is called metastasis. The secondary
(metastatic) tumor is the same type of cancer as
the primary tumor. For example, if breast
cancer spreads to the bones, the cancer cells in
the bones are actually breast cancer cells. The
disease is metastatic breast cancer, not bone
cancer.
The following stages are used for bladder
cancer:
Stage 0 (Papillary Carcinoma and
Carcinoma in Situ)
In stage 0, abnormal cells are found
in tissue lining the inside of the bladder. These
abnormal cells may become cancer and spread
into nearby normal tissue. Stage 0 is divided into
stage 0a and stage 0is, depending on the type
of the tumor:
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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, cancer has formed and spread to the
layer of tissue under 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, seminal
vesicles, uterus, or 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.
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. 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. Patients may want to think about
taking part in a clinical trial. Some clinical trials
are open only to patients who have not started
treatment.
Four types of standard treatment are used:
Surgery
One of the following types of surgery may be
done:
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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 thevagina 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.
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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 lower the risk
that the cancer will come back, 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 or keep them from
growing. 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 them 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 cerebrospinal fluid, an organ, or a
bodycavity 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
patient’s 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 cancer. This
type of cancer treatment is also called
biotherapy or immunotherapy.
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
carry the laser light to the cancer cells, where the
drug becomes active and kills the cells.
Photodynamic therapy causes little damage to
healthy tissue.
Follow-up tests may be needed.
Some of the tests that were done
to diagnose the cancer or to find out
the stage of the cancer may be repeated. Some
tests will be repeated in order to see how well the
treatment is working. Decisions about whether to
continue, change, or stop treatment may be
based on the results of these tests. This is
sometimes called re-staging.
Some of the tests will continue to be done from
time to time after treatment has ended. The
results of these tests can show if your condition
has changed or if the cancer
has recurred (come back). These tests are
sometimes called follow-up tests or check-ups.
Treatment Options by Stage
For some types or stages of cancer, there may
not be any trials listed. Check with your doctor for
clinical trials that are not listed here but may be
right for you.
Stage 0 (Papillary Ca and Carcinoma in Situ)
Treatment of stage 0 may include the following:
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Transurethral resection with fulguration.
Transurethral resection with fulguration
followed by intravesical biologic therapy BCG
or chemotherapy.
Segmental Resection remove
Radical cystectomy.
A clinical trial of biologic therapy.
A clinical trial of chemoprevention therapy
Stage I Bladder Cancer
Treatment of stage I bladder cancer may include
the following:
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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.
Stage II Bladder Cancer
Treatment of stage II bladder cancer may
include the following:
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Radical cystectomy with or without surgery to
remove pelvic lymph nodes.
Combination chemotherapy followed by
radical cystectomy.
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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:
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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:
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Radical cystectomy with surgery to
remove pelvic lymph nodes.
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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).
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:
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Surgery.
Chemotherapy.
Radiation therapy.
A clinical trial of chemotherapy.