Document 5369

Bladder Cancer
The bladder is a balloon shaped organ that collects urine from the kidneys and stores it until it is eliminated through a tube
called the urethra. The most common type of bladder cancer, transitional or urothelial cell, starts in the lining of the bladder.
Early stages of bladder cancer often produce
no symptoms. Your first warning sign may be
hematuria (blood in your urine that may only be
visible under a microscope).
Other common symptoms include:
n P
ainful urination
n F
requent urination or feeling an urge to
urinate without results
n Slow or intermittent urine stream
n P
elvic pain
These symptoms may instead indicate other
medical problems, such as urinary tract
infections, bladder stones or prostate
disorders; you will need a thorough evaluation
to determine the cause.
Risk Factors
The following factors increase your risk of
bladder cancer:
n C
igarette smoking – the single greatest
risk factor
n Exposure to industrial chemicals
n Age – the average age is 67
n Sex – men are at much higher risk
n Race – Caucasians are at higher risk
n Family or personal history of bladder cancer
n C
hronic bladder inflammation or foley
catheter use
n C
hemotherapy or radiation therapy for
other cancers
n A high fat diet
Your doctor will first perform a thorough history
and physical exam. Other tests may include:
n U
rine Cytology – examining urine cells
under the microscope
n Intravenous Pyelogram (IVP) or
CT Urography – special x-rays that include
contrast dye, to view the kidneys, bladder
and connecting tubes
n C
ystoscopy – putting a thin scope into the
urethra to view it and the bladder; if a mass
is seen, a biopsy may be performed at that
time or during more formal treatment
n T
umor Marker Tests – the FDA has
approved several tests that look for BTA or
NMP22, proteins in the urine that may
indicate cancer
n F
lourescence in Situ Hybridization (FISH) –
a urine test that looks for chromosomal
abnormalities and may provide early
detection of transitional cell bladder cancer
Once it has been determined that you have
bladder cancer, your doctor will determine
what “stage” your cancer is in:
n Stage 1 – confined to the bladder lining;
60-70% of patients have Stage 1 disease
n Stage 2 – spread to the muscular walls of
the bladder
n Stage 3 – spread to tissues around
the bladder
n Stage 4 – spread to other organs
Determining the appropriate treatment
depends on a number of factors, including
your health and age, your cancer stage, type
of tumor, tumor grade, and the stage of the
tumor, which is related to how deeply it invades
the wall of the bladder.
Surgical treatment is often recommended for
patients with bladder cancer. Some patients
will receive radiation, chemotherapy or
immunotherapy in addition to or instead
of surgery.
1. S
urgery – there are several surgical
n Transurethral Resection (TUR) – using a
tiny instrument called a cystoscope, your
doctor can view and remove cancerous
tissue through the urethra. Typically used for
low risk bladder cancers (stage 1).
n Segmental Partial Cystectomy – removing
part of the bladder to destroy cancer cells,
usually when the cancer affects only one
n Radical Cystectomy – required when the
cancer has invaded deep into the wall of the
ladder (stage 2 & 3). Usually also involves
removal of other sexual organs and lymph
nodes (the seminal vesicles, vas deferens
and/or prostate in men; the uterus and part
of the vagina in women). In some cases, the
doctor can create a new “bladder” using
part of your intestine; in most cases, a small
piece of intestine is used to carry the urine
into an external appliance/bag. This surgery
sometimes can be performed using smaller
incisions with an operating robot.
2. Radiation Therapy – can sometimes be
used with intravenous chemotherapy in
patients with invasive cancer.
3. Chemotherapy – one or more drugs kill the
cancer cells, either through injection into the
urethra and bladder (intravesical) or into a
vein (intravenous). Intravenous is usually
indicated in preparation for surgery, or when
the cancer has spread beyond the bladder.
4. Immunotherapy – a substance called BCG
is injected into the bladder weekly for about
six weeks to trigger the body’s immune
response against the cancer cells. It is often
used to prevent superficial cancer from
A rehab team may help you return to normal
activities as soon as possible following
treatment. If you have a stoma, an opening in
your abdominal wall through which urine
passes, an enterostomal therapist or nurse will
help you learn about and care for your stoma.
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