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 What
is bladder? |
| What
is Bladder cancer? |
| What
are the causes? |
| What
are the symptoms? |
| How
is it Diagnosed? |
| What
are the treatment options? |
| Disadvantages
of the surgery |
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| What
is bladder? |
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| A bladder is a muscular hollow organ
that stores urine. It is located in the pelvic region.
Urine from both the kidneys passes through ureter and
reaches the bladder. When the bladder gets filled up to
a certain level, the nerves send signal to the brain and
we may feel the urge to urinate. |
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| What
is Bladder cancer? |
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Normally, cells grow and divide to form new cells as
the body needs them. Cancer merely indicates towards
a condition in which the cells start multiplying in
an abnormal way. These extra cells can form a mass of
tissue called a growth or tumor. Tumors can be benign
or malignant: Bladder cancer refers to any of several
types of malignant growths of the urinary bladder. The
process of invading and spreading to other organs is
called metastasis. Bladder cancers are most likely to
spread to neighboring organs and lymph nodes prior to
spreading through the blood stream to the lungs, liver,
bones, or other organs. Bladder cancer affects 3 times
as many men as women.
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| Types of bladder cancers: |
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| Urolithiasis is the medical term used
to describe stones occurring in the urinary tract. Other
frequently used terms are urinary tract stone disease
and nephrolithiasis. Doctors also use terms that describe
the location of the stone in the urinary tract. For example,
a ureteral stone (or ureterolithiasis) is a kidney stone
found in the ureter. To keep things simple, however, the
term "kidney stones" is used throughout this
fact sheet. |
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| Types of stones include: |
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The wall of the bladder is lined with cells called
transitional cells and squamous cells. More than 90
percent of bladder cancers begin in the transitional
cells. This type of bladder cancer is called transitional
cell carcinoma. About 8 percent of bladder cancer patients
have squamous cell carcinomas. All squamous cell carcinomas
are invasive. This means that they gradually spread
to deeper layers of the bladder wall if they are not
treated. By the time these cancers are detected, they
have usually already invaded the bladder wall. Many
transitional cell carcinomas are not invasive. This
means that they go no deeper than the transitional,
or urothelial, layer.
Bladder cancers are classified or staged based on their
aggressiveness and the degree that they are different
from the surrounding bladder tissue. There are several
different ways to stage tumors. Recently, the TNM staging
system has become common. This staging system contains
several sub stages, but it basically categorizes tumors
using the following scale:
Stage 0 - This is a Non-invasive tumor limited
to the bladder lining. Cancer that is only in cells
in the lining of the bladder is called superficial bladder
cancer. The doctor might call it carcinoma in situ.
This type of bladder cancer often comes back after treatment.
If this happens, the disease most often recurs as another
superficial cancer in the bladder.
Stage I -- Tumor extends through the lining,
but does not extend into the muscle layer. Cancer that
begins as a superficial tumor may grow through the lining
and into the muscular wall of the bladder. This is known
as invasive cancer. Invasive cancer may extend through
the bladder wall. It may grow into a nearby organ such
as the uterus or vagina (in women) or the prostate gland
(in men). It also may invade the wall of the abdomen.
Stage II - In this, the tumor invades the muscle
layer of the bladder.
Stage III -- Tumor extends past the muscle layer
into tissue surrounding the bladder.
Stage IV - In this, cancer has spread to regional
lymph nodes or to distant sites (metastatic disease).
When bladder cancer spreads outside the bladder, cancer
cells are often found in nearby lymph nodes. If the
cancer has reached these nodes, cancer cells may have
spread to other lymph nodes or other organs, such as
the lungs, liver, or bones.
When cancer spreads (metastasizes) from its original
place to another part of the body, the new tumor has
the same kind of abnormal cells and the same name as
the primary tumor. For example, if bladder cancer spreads
to the lungs, the cancer cells in the lungs are actually
bladder cancer cells. The disease is metastatic bladder
cancer, not lung cancer. It is treated as bladder cancer,
not as lung cancer.
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| What
are the causes? |
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There is no particular cause that has been found out.
But Studies have found the following risk factors for
bladder cancer:
Age- The chance of getting bladder cancer goes
up as people get older. People under 40 rarely get this
disease.
Tobacco- The use of tobacco is a major risk factor.
Cigarette smokers are two to three times more likely
than nonsmokers to get bladder cancer. Pipe and cigar
smokers are also at increased risk.
Occupation- Some workers have a higher risk of
getting bladder cancer because of carcinogens in the
workplace. Workers in the rubber, chemical, and leather
industries are at risk. So are hairdressers, machinists,
metal workers, printers, painters, textile workers,
and truck drivers.
Infections-Being infected with certain parasites
increases the risk of bladder cancer. These parasites
are common in tropical areas.
Medications- cyclophosphamide or arsenic are
used to treat cancer and some other conditions. They
raise the risk of bladder cancer.
Approximately 20% of bladder cancers occur in patients
without predisposing risk factors. Bladder cancer is
not currently believed to be heritable (i.e., does not
"run in families" as a consequence of a specific
genetic abnormality).
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| What
are the Symptoms? |
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| The symptoms described below are not
sure signs of bladder cancer. Infections, benign tumours,
bladder stones, or other problems also can cause these
symptoms. So incase of these symptoms, one must consult
an urologist or correct diagnosis. Moreover most of the
symptoms listed below can be associated with bladder cancer,
but they can also be associated with non-cancerous conditions.
Nevertheless, medical evaluation is critical. |
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- Blood in the urine
- increased Urinary frequency or Urinary incontinence
- Painful urination
- Urinary urgency
Additional symptoms that may be associated with this
disease are Bone pain or tenderness, abdominal pain,
Anaemia, Weight loss, Lethargy (tiredness).
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| How
is it Diagnosed? |
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If a patient has symptoms that suggest bladder cancer,
the doctor may check general signs of health and may
order lab tests. The person may have one or more of
the following procedures:
Physical examination
This includes a rectal and pelvic exam. The doctor may
feel for the tumour by palpating.
Urinalysis
The laboratory checks the urine for blood, cancer cells,
and other signs of disease. It is also screened for
cancerous cells.
Cystoscopy
The doctor uses a thin, lighted tube (cystoscope) to
look directly into the bladder. The doctor inserts the
cystoscope into the bladder through the urethra to examine
the lining of the bladder. The patient may need anesthesia
for this procedure. Bladder biopsy (usually performed
during cystoscopy)
Intravenous pyelogram - IVP
The doctor injects dye into a blood vessel. The dye
collects in the urine, making the bladder show up on
x-rays.
Blood Tests
This will give the doctor an indication of the general
health of the patient and how well the kidneys are working.
A Chest-X-ray
This will examine the heart and lungs to check that
they are healthy.
CT or CAT SCAN
This is a type of X-ray during which a large number
of cross-section pictures of the body are taken to build
up a three dimensional image of the issues and organs
inside.
Radioactive Bone Scans
This may be performed to check if any cancer has spread
from the bladder to the bones. A tiny amount of radioactive
liquid is injected into a vein, and then the scan is
done two to three hours later.
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| What
are the Treatment options? |
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| The choice of an appropriate treatment
is based on the stage of the tumor, the severity of the
symptoms, and the presence of other medical conditions.
The treatment for patients with stage II and stage III
disease is changing. While the accepted treatment has
been removing the entire bladder but there is growing
interest in conserving the bladder. |
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| Conservative treatment |
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| Some patients may be treated by removing
only part of the bladder, and that procedure is followed
by radiation and chemotherapy. However, many people with
stage II and stage III tumors still require bladder removal.
Most patients with stage IV tumors cannot be cured and
surgery is not indicated. In these patients, chemotherapy
is often considered. |
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| Chemotherapy for bladder cancer
can be administered through a vein or into the bladder.
For early disease (stages 0 and I), it is usually given
directly into the bladder. For more advanced stages (II-IV),
treatment is usually given by vein. Chemotherapy may be
given to patients with stage II and III disease either
before or after surgery in an attempt to prevent the tumor
from returning. It is given as a single drug or in different
combinations of drugs. |
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| Radiation therapy may also
be given. Radiation is a high-energy ray that kills cancer
cells. It can be either given externally or internally.
External radiation is produced by a machine outside the
body. The machine targets a concentrated beam of radiation
directly at the tumor. Internal radiation is given by
placing a small pellet of radioactive material inside
the bladder. The pellet can be inserted through the urethra
or by making a tiny incision in the lower abdominal wall. |
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| Immunotherapy or biological therapy
takes advantage of the body's natural ability to fight
cancer. A fluid containing BCG, an attenuated vaccine
(altered Mycobacterium), is introduced into the bladder
through a thin catheter that has been passed through the
urethra. The Mycobacterium in the fluid stimulates the
immune system to produce cancer-fighting substances. The
solution is held in the bladder for a few hours, and then
drained. This treatment is repeated every week for 6 weeks. |
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| Surgical methods |
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| Trans Urethral Resection of Bladder
Tumour (TURBT) |
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| People with stage 0 or I bladder cancer
are usually treated with Trans Urethral Resection of Bladder
Tumour (TURBT). This surgical procedure is performed under
general or spinal anesthesia. A cutting instrument is
then inserted through the urethra. A small wire loop on
the end of the instrument then removes the tumor by cutting
it or burning it with electrical current (fulguration).
Generally, stage 0 and I tumors are treated with this
method. They sometimes may also be treated by administering
chemotherapy or immunotherapy directly into the bladder.
Because the risk of the cancer returning is so high, people
with bladder cancer require constant follow-up for the
rest of their lives. |
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| Partial Cystectomy |
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| In this operation, part of the bladder
is removed. If the tumour is confined to the bladder wall,
it may be possible to remove the tumour and just the section
of the bladder involved. 'This may be done either as a
telescopic procedure (Cystoscopic Resection) or as a cutting
operation through the abdomen (Partial Cystectomy). After
the operation the patient will be able to pass urine normally. |
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| Complete Cystectomy or Bladder
Removal |
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In this operation, the entire bladder
is removed, as well as its surrounding lymph nodes and
other structures that may contain cancer. This is usually
performed for cancers that have invaded through the bladder
wall or for superficial cancers that extend over much
of the bladder. In women this involves the removal of
the whole bladder, the urethra, and the lower end of the
ureters, the front wall of the vagina, the womb (hysterectomy),
fallopian tubes and ovaries. In younger women the ovaries
may be preserved. As a result the vagina will be shorter
and narrower following the operation. In men the whole
of the bladder, the prostate gland, the lower ends of
the ureters and sometimes the urethra is removed.
Many people with stage II or III bladder cancer may require
bladder removal. This surgical procedure is also called
complete or radical cystectomy. Radical cystectomy in
men usually involves removal of the bladder, prostate,
and seminal vesicles. In women, the urethra, uterus, and
the front wall of the vagina are removed along with the
bladder. Often, the pelvic lymph nodes are also removed
during the surgery for examination in the laboratory.
About half of the people treated with radical cystectomy
will be completely cured; the other half shows signs of
metastasis at the time of the surgery.
A urinary diversion surgery is usually performed with
the radical cystectomy procedure. In this, an alternate
method for urine storage is created. Three common types
of urinary diversion are:
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| An ileal conduit is a small urine
reservoir that is surgically created from a small segment
of bowel. The ureter that drain urine from the kidneys
are attached to one end of the bowel segment and the other
end is brought out through an opening in the skin (a stoma).
The stoma allows the patient to drain the collected urine
out of the reservoir. People who have had an ileal conduit
will need to wear an external urine collection appliance
at all times. Possible complications associated with ileal
conduit surgery include: bowel obstruction, blood clots,
urinary tract infection, pneumonia, skin breakdown around
the stoma, and long-term damage to the upper urinary tract. |
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- Continent urinary reservoir
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A continent urinary reservoir is another
method of creating a urinary diversion. In this method,
a segment of colon is removed and used to create an internal
pouch to store urine. This segment of bowel is specially
prepared to prevent reflux of urine back up into the ureter
and kidneys, and also to reduce the risk of involuntary
loss of urine. Patients are able to insert a catheter
periodically to drain the urine. A small stoma is placed
flush to the skin. Possible complications include: bowel
obstruction, blood clots, pneumonia, and urinary tract
infection, skin breakdown around the stoma, ureteral reflux,
and ureteral obstruction.
Partial bladder removal may be performed in some patients.
Removal of part of the bladder is usually followed by
radiation therapy and chemotherapy to help decrease the
chances of the cancer returning. For those patients who
undergo complete bladder removal, chemotherapy is also
given after surgery to decrease the risk of a recurrence.
. Some patients may be treated with chemotherapy before
surgery, to try and shrink their tumor down, so that they
might be able to avoid having the entire bladder removed. |
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This surgery is becoming more common
in patients undergoing cystectomy. A segment of bowel
is folded over to make a pouch (a neobladder or "new
bladder"), then attached to the urethral stump, which
is the beginning of where the urine normally empties from
the bladder.
This procedure allows patients to maintain some degree
of normal urinary control, although there are complications,
and the urination is usually not the same as before surgery.
For example, this procedure can be associated with leakage
of urine at night, the need to perform manual catheterization
periodically, and other complications listed above for
the continent urinary reservoir. |
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| Disadvantages
of the surgery |
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| Bladder cancer surgery may affect
a person's sexual function. Because the surgeon removes
the uterus and ovaries in a radical cystectomy, women
are not able to get pregnant. Also, menopause occurs at
once. If the surgeon removes part of the vagina during
a radical cystectomy, sexual intercourse may be difficult.
In the past, nearly all men were impotent after radical
cystectomy, but improvements in surgery have made it possible
for some men to avoid this problem. Men who have had their
prostate gland and seminal vesicles removed no longer
produce semen, so they have dry orgasms. Men who wish
to father children may consider sperm banking before surgery
or sperm retrieval later on. |
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