Bladder Cancer Treatment

Bladder Cancer Treatment

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.

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

  • Types of bladder cancers:
    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.
  • Types of stones include:

    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.

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).

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.

  • 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).

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.

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.

  • Conservative treatment
    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.
  • 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.
  • 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.
  • 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.
  • Surgical methods
  • Trans Urethral Resection of Bladder Tumour (TURBT)
    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.
  • Partial Cystectomy
    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.
  • Complete Cystectomy or Bladder Removal

    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:

  • ileal conduit
    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.
  • Continent urinary reservoir

    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.

  • Orthotopic Neobladder

    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.

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.