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Urology

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Bladder Cancer

What is it?

Bladder cancer affects the bladder, the part of the body that holds and releases urine.  It is a chronic disease that affects both men and woman.  It is the fourth most common cancer among men and the ninth most common among women in the United States. Each year, more than 50,000 new cases of bladder cancer are diagnosed. Bladder cancer is caused by cells multiplying uncontrollably on the lining of the bladder wall.  Those cells can develop into tumors.  If the cancer develops through the lining it is considered to be invasive; otherwise if it is just on the inner liner it is considered superficial bladder cancer. 

There are a few different variants of bladder cancer that include Transitional cell carcinoma, Squamous cell carcinoma, and Adenocarcinoma.  Transitional cell carcinoma is the most common type of bladder cancer and consists of the cells that line the bladder, urethra, and ureters. Squamous cell carcinoma is a type of cancer that grows from the cells that appears in your bladder to help fight infection.  This type of cancer is rare and is more prevalent where parasitic infection of the bladder is common. Adenocarcinoma is a cancer of the mucus-secretion glands in the bladder.  This type of cancer is rare as well.

Symptoms

Bladder cancer symptoms can include:

  • Back pain
  • Pelvic pain
  • Blood in the urine
  • Pain during urination 
  • Frequent urination, or feeling the need to urinate without result

Other problems can mimic these symptoms like Infections, benign tumors, and bladder stones.

Make an appointment with your doctor if you experience any of these symptoms.

Causes
Bladder cancer does not have a clear cause but has been linked to:

  • Smoking
  • Parasitic infection
  • Radiation
  • Chemical Exposure (ex. Carcinogens)
  • Age
  • Race
  • Sex

As with all cancers it is recommended not to smoke or use tobacco products and to minimize exposure to certain chemicals.

Tests

Doctors will perform a combination of queries to determine the patient’s condition.  These could include:

  • A review of the patient’s medical and family history.
  • A physical examination of the abdomen and pelvis area for tumors and possibly a rectal or vaginal exam.
  • A blood test to determine if there are any abnormalities.

Other tests that a doctor may perform include a cystoscopy, biopsy, and urine cytology. 

  • A cystoscopy allows the doctor to see inside of your urethra and bladder by use of a small scope inserted through the urethra. 
  • In combination with the cystoscopy the doctor may also perform a biopsy, also called a transurethral resection (TUR).  The biopsy is used to gather cells to examine for cancer. 
  • A urine cytology (urine test) examines the urine for any present cancer cells.

If it is determined that you have bladder cancer additional tests may be performed to determine the severity like a chest X-ray, a bone scan, a CT scan, and magnetic resonance imaging (MRI).

Treatment

Treatments vary depending on the severity of the cancer.  All or part of the bladder may need to be removed or other therapies may be applied.

Surgical Treatments

Transurethral resection (TUR) may be used for cancer or the bladder lining.  TUR removes the cancer by burning away the bad cells.

A partial cystectomy may be performed to remove a portion of the bladder.  Some of the surrounding lymph nodes may be removed to check for cancer.  Immediately following the surgery most patients are able to urinate normally. Since the operation reduces the size of the bladder the patient may need to urinate more frequently.  This may improve over time.

If a radical cystectomy is performed the entire bladder will be removed and a urinary diversion will be fashioned.  A urinary diversion creates a new way for the body to pass urine. Some of the surrounding lymph nodes may be removed if the cancer has spread to them.

A type of cystectomy called a Robotic cystectomy offers patients’ potential benefits over open surgery, including lower risk of infection, reduced loss of blood, less pain and a quicker recovery of function.

Therapy Treatments

Radiation Therapy utilizes high power energy beams precisely directed at the affected cancer cells to kill them from outside the body.  This treatment is often used to kill any remaining cancer cells after surgery.

Immunotherapy uses biological therapy drugs to strengthen the immune system to help fight cancer cells.  The drugs are typically administered directly into the bladder by way of the urethra.  There are a few types of drugs that may be used including Bacille Calmette-Guerin (BCG) and Interferon.  Interferon, or the synthetic version, Interferon alfa-2b (Intron A) is a protein that helps your body fight infections.  Both drugs have been known to cause flu-like symptoms.

Chemotherapy uses powerful medication to kill cancer cells.  Chemotherapy can be applied intravenously (through a vein) or intravesical (directly through the urethra).  Chemotherapy is very effective against cancer cells but can have negative side effects because it kills both good and bad cells alike.  Some of the side effects include hair loss, nausea, vomiting, a weakened immune system, and fever.

Talk to your doctor about the best treatment options.