WHAT YOU SHOULD
KNOW
Bladder cancer strikes over
50,000 Americans annually, favoring men over women by a 3 to 1
ratio. Like all forms of cancer, this variety is the result of
unrestrained multiplication of cells. Normal cells divide in a
planned way, creating more cells only when needed. Cancerous
cells reproduce without order or limits, often creating excess
tissue that becomes a tumor.
If bladder cancer is detected
while still limited to the surface of the bladder wall, a
variety of treatment options offer prospects of a cure. If the
cancer has invaded the underlying muscles, treatment is more
difficult. Left untreated, the cancer is likely to spread to
nearby organs and other parts of the body.
Causes
Some forms of bladder cancer are
the result of exposure to certain industrial chemicals, such as
benzidine, beta-napthylamine, aniline dyes, and organic
chemicals used or produced in rubber manufacture, leather
treatment, and paint production. Smoking and certain parasitic
infections of the bladder also increase the risk of bladder
cancer.
Signs/Symptoms
About 25 percent of those with
bladder cancer experience no symptoms at all in the early
stages. The first sign is typically blood in the urine. For
most people this is the only symptom, but some may also
experience bladder irritability, frequent urination, nighttime
urination, and a burning sensation during
urination.
Care
The doctor will start with a
series of diagnostic tests, typically including a urinalysis,
urine cytology (examination of cells suspended in the urine),
and x-rays of the bladder.
A technique called cystoscopy is
also common. In this procedure, a cystoscope---a slender,
flexible tube with a magnifying lens and light attached---is
advanced into the bladder through the urethra (the canal that
empties the bladder) to allow the doctor to examine the inner
wall.
To evaluate the size and location
of the tumor and determine whether it has spread to other
organs, the doctor may also order imaging procedures such as a
computed tomography (CT) scan, magnetic resonance imaging
(MRI), or ultrasound (a technique that builds an image by
bouncing sound waves off the organ).
The type of treatment recommended
will depend on the type of bladder cancer the doctor detects,
the extent of the disease, your overall health, and the
condition of the bladder.
-
Surgery: Depending upon the extent of the cancer,
the doctor may need to remove only the tumor or tumors or a
part of the bladder. If the cancer has penetrated deep
within the bladder wall, the entire bladder will have to be
removed. The most common operations are:
-
-
Transurethral resection: This procedure is done
with a cystoscope. Small instruments are passed through
the scope to destroy the cancer by either vaporizing it
with a laser or burning it with an electric
current.
-
Cystectomy: This surgery removes part or all of
the bladder. If the cancer has spread, the doctor may
need to perform a
radical cystectomy , in which nearby organs and
lymph nodes are removed along with the bladder. For
women this might include removal of the ovaries,
uterus, fallopian tubes, the urethra, and part of the
vagina. For men it could mean the removal of the
prostate, seminal vesicles, and sometimes the
urethra.
When the entire bladder must be
removed, the doctor creates another method for the body to
store and remove urine. Options include a
urostomy, in which a bag is worn outside of the body to
collect the urine, or a
continent diversion, in which the doctor creates a sac
and attaches it to the tubes (ureters) leading from the
kidneys. Urine is emptied by placing a drainage tube into a
hole in the sac. Doctors and researchers are now working to
develop new methods to route urine into the urethra, which will
make urination almost normal.
-
Chemotherapy: Often called "chemo," this type of
therapy uses drugs to kill or shrink new tumor cells. Chemo
for bladder cancer typically includes a combination of
drugs administered as pills or shots, or given through an
IV. You will probably need frequent blood tests to
determine how your body is doing and how much chemo you
need. The drugs can produce many side effects and may leave
you susceptible to infection for a while.
If the cancer is still restricted to the surface of the
bladder wall, you may be a candidate for a chemo treatment
called
intravesical chemotherapy . In this approach, drugs
are placed directly into the bladder through a tube
(catheter) advanced up the urethra. This keeps the potent
chemo drugs away from other parts of the body, and allows
them to remain in the bladder for several hours. Once the
treatment session is complete, the medication is drained
back out of the bladder through the catheter.
-
Radiation: X-rays or gamma rays can kill cancer and
help prevent it from spreading. They can also be effective
in reducing pain, controlling bleeding, and shrinking
cancerous tumors. For some bladder cancers, radiation alone
may yield a cure. However, radiation and chemotherapy are
often used together. Radiation is also used after surgery
to kill any cancer cells that might have been missed during
surgery.
Risks
No matter which form of treatment
is best, the therapy is likely to cause discomfort and, in many
cases, unpleasant side effects. Left untreated, however, the
cancer will eventually spread, involving additional organs
until it proves fatal.
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