Bladder cancer (patient information)

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 * Assistant Editor-In-Chief: Meagan E. Doherty, Associate Editor-In-Chief: Ujjwal Rastogi, MBBS.

Overview
The bladder is a hollow organ in your lower abdomen that stores urine. Bladder cancer occurs in the lining of the bladder. It is the sixth most common type of cancer in the United States.

What are the symptoms of Bladder cancer?
Common symptoms of bladder cancer include:
 * Blood in the urine (making the urine slightly rusty to deep red)
 * Pain during urination
 * Frequent urination, or feeling the need to urinate without results.

These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. People with symptoms like these may see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.

Diseases that can have similar symptoms are
 * Bladder infections
 * Cystitis
 * Benign bladder tumors
 * Bladder papilloma
 * Bladder stones

What causes Bladder cancer?
In the United States, bladder cancers usually start from the cells lining the bladder (called transitional cells).

These tumors are classified based on the way they grow:

Papillary tumors have a wart-like appearance and are attached to a stalk. Nonpapillary (sessile) tumors are much less common. However, they are more invasive and have a worse outcome. The exact cause of bladder cancer is uncertain. However, several things may make you more likely to develop it:

Cigarette smoking. Smoking greatly increases the risk of developing bladder cancer. Up to half of all bladder cancers in men and several in women may be caused by cigarette smoke. Chemical exposure at work. About one in four cases of bladder cancer is caused by coming into contact with to cancer-causing chemicals at work. These chemicals are called carcinogens. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk. Chemotherapy: The chemotherapy drug cyclophosphamide (Cytoxan) may increase the risk of bladder cancer. Radiation treatment: Women who had radiation therapy to treat cervical cancer have an increased risk of developing bladder cancer. Bladder infection: A long-term (chronic) bladder infection or irritation may lead to a certain type of bladder cancer. Some research has suggested a link between artificial sweeteners and bladder cancer. The evidence is weak.

Who is at highest risk?
No one knows the exact causes of bladder cancer. However, it is clear that this disease is not contagious. No one can "catch" cancer from another person.

People who get bladder cancer are more likely than other people to have certain risk factors. A risk factor is something that increases a person's chance of developing the disease.

Still, most people with known risk factors do not get bladder cancer, and many who do get this disease have none of these factors. Doctors can seldom explain why one person gets this cancer and another does not.

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 but not in the United States.
 * Treatment with cyclophosphamide or arsenic. These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.
 * Race. Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.
 * Being a man. Men are two to three times more likely than women to get bladder cancer.
 * Family history. People with family members who have bladder cancer are more likely to get the disease. Researchers are studying changes in certain genes that may increase the risk of bladder cancer.
 * Personal history of bladder cancer. People who have had bladder cancer have an increased chance of getting the disease again.

Chlorine is added to water to make it safe to drink. It kills deadly bacteria. However, chlorine by-products sometimes can form in chlorinated water. Researchers have been studying chlorine by-products for more than 25 years. So far, there is no proof that chlorinated water causes bladder cancer in people. Studies continue to look at this question.

Some studies have found that saccharin, an artificial sweetener, causes bladder cancer in animals. However, research does not show that saccharin causes cancer in people.

People who think they may be at risk for bladder cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

When to seek urgent medical care?
See your doctor immediately if you experience any of the above symptoms associated with bladder cancer

Diagnosis
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 exam -- The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
 * Urine tests -- The laboratory checks the urine for blood, cancer cells, and other signs of disease.
 * Intravenous pyelogram -- The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
 * 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.

The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.

Treatment options
People with bladder cancer have many treatment options. They may have surgery, radiation therapy, chemotherapy, or biological therapy. Some patients get a combination of therapies.

The doctor is the best person to describe treatment choices and discuss the expected results of treatment.

A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for people with all stages of bladder cancer. The section on "The Promise of Cancer Research" has more information about clinical trials.

Surgery
is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. The doctor can explain each type of surgery and discuss which is most suitable for the patient:


 * Transurethral resection: The doctor may treat early (superficial) bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and to burn away any remaining cancer cells with an electric current. (This is called fulguration.) The patient may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy.
 * Radical cystectomy: For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra, and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed.
 * Segmental cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.

Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, the surgeon removes the bladder but does not try to get rid of all the cancer. Or, the surgeon does not remove the bladder but makes another way for urine to leave the body. The goal of the surgery may be to relieve urinary blockage or other symptoms caused by the cancer.

Radiation therapy
(Also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.

A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

Doctors use two types of radiation therapy to treat bladder cancer:


 * External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.
 * Internal radiation: The doctor places a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during this treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.

Chemotherapy
Uses drugs to kill cancer cells. The doctor may use one drug or a combination of drugs.

For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.

If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.

The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.

Biological therapy
(Also called immunotherapy) uses the body's natural ability (immune system) to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back.

The doctor may use intravesical biological therapy with BCG solution. BCG solution contains live, weakened bacteria. The bacteria stimulate the immune system to kill cancer cells in the bladder. The doctor uses a catheter to put the solution in the bladder. The patient must hold the solution in the bladder for about 2 hours. BCG treatment is usually done once a week for 6 weeks.

Where to find medical care for Bladder cancer?
Directions to Hospitals Treating Bladder Cancer

Prevention
There is no standard or routine screening test for bladder cancer.

Screening for bladder cancer is under study and there are screening clinical trials taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Two tests may be used to screen for bladder cancer in patients who have had bladder cancer in the past:

Cystoscopy
Cystoscopy is a procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.

Urine cytology
Urine cytology is the examination of urine under a microscope to check for abnormal cells.

Hematuria tests may also be used to screen for bladder cancer.

Hematuria (red blood cells in the urine) may be caused by cancer or by other conditions. A hematuria test is used to check for blood in a sample of urine by viewing it under a microscope or using a special test strip. The test may be repeated over time.

What to expect (Outlook/Prognosis)?
The prognosis of bladder cancer depends on location and stage of the disease. When diagnosed early there is a better chance of recovery than when it is diagnosed during advanced stages.

Possible complications
Bladder cancers may spread into the nearby organs. They may also travel through the pelvic lymph nodes and spread to the liver, lungs, and bones. Additional complications of bladder cancer include:

Anemia Swelling of the ureters (hydronephrosis) Urethral stricture Urinary incontinence

Source

 * http://www.nlm.nih.gov/medlineplus/bladdercancer.html#cat11