Jane Doe
What is Bladder Cancer ?
The bladder is a hollow organ in the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. The average adult bladder holds about 2 cups of urine. Urine is made by the kidneys and is then carried to the bladder through tubes called ureters.
During urination, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra. In women, the urethra is a very short tube that opens just above the vagina. In men, the urethra is longer. It passes through the prostate gland and the penis, and opens at the tip of the penis.
Treatment of Bladder Cancer
Surgery
Surgery is part of the treatment for most bladder cancers. The type of surgery done for bladder cancer will depend on its stage.
Transurethral surgery
For this operation, a type of rigid cystoscope called a resectoscope is placed into the bladder through the urethra. The resectoscope has a wire loop at its end to remove any abnormal tissues or tumors. The removed tissue is sent to a pathologist for examination. Most patients have superficial cancer when they are first diagnosed, so this is usually the first treatment they receive.
After surgery, more steps may be taken to try to ensure that the tumor has been completely destroyed. Any remaining cancer may be treated by burning the base of the tumor (fulguration) while looking at it with the cystoscope. Cancer can also be destroyed using the cystoscope and a high-energy laser.
The side effects of transurethral bladder surgery are generally mild and do not usually last long. There may be some bleeding and pain during urination right after surgery. After transurethral surgery, you can usually return home the same day or the next day and can resume your usual activities in less than 2 weeks.
Unfortunately, even with successful treatment, bladder cancer often recurs (comes back) in other parts of the bladder. If transurethral resection needs to be repeated many times, the bladder can become scarred and lose its capacity to hold much urine. This can lead to frequent urination and the chance of not being able to control urination (incontinence).
Reconstructive surgery
If your whole bladder is removed, you will need another way to store and remove urine. Several types of reconstructive surgery can be done depending on your medical situation and personal preferences.
One option may be to remove a short piece of the intestine and connect it to the ureters. This creates a passageway, known as an ileal conduit, for urine to pass from the kidneys to the outside of the body. Urine flows from the kidneys through the ureters into the ileal conduit. The conduit is connected to the skin on the front of the abdomen by an opening called a stoma (also known as a urostomy).
After this procedure, a small bag is placed over the stoma to collect the urine, which comes out continuously in small amounts. The bag then needs to be emptied once it is full.
Another way for urine to drain is called a continent diversion. For this, a valve is created in a pouch made from the piece of intestine. The valve allows urine to be stored in the pouch. It is emptied several times each day by placing a drainage tube (catheter) into the stoma through the valve. Some patients prefer this method because there is no bag on the outside.
If the cancer has spread or can't be removed with surgery, a diversion may be made without removing the bladder. In this case, the purpose of the surgery is to prevent or relieve blockage of urine flow, rather than trying to cure the cancer.
Lifestyle changes
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life – making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
Talk with your health care team before starting anything. Get their opinion about your exercise plans. Then, try to find an exercise buddy so you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.
Keep in mind exercise can improve your physical and emotional health.
The bladder is a hollow organ in the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. The average adult bladder holds about 2 cups of urine. Urine is made by the kidneys and is then carried to the bladder through tubes called ureters.
During urination, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra. In women, the urethra is a very short tube that opens just above the vagina. In men, the urethra is longer. It passes through the prostate gland and the penis, and opens at the tip of the penis.
The wall of the bladder has several layers. A layer of cells lines the inside of the ureter, bladder, and urethra, and parts of the kidney. These cells are called urothelial or transitional cells, so this inner layer is called the urothelium or transitional epithelium. Beneath the urothelium is a thin layer of connective tissue called the lamina propria. Next is a layer of muscle tissue called the muscularis propria. Beyond this muscle, another zone of fatty connective tissue separates the bladder from other nearby organs.
Types of Bladder Cancer
The main types of cancers that affect the bladder are:
- Transitional cell carcinoma (also called urothelial carcinoma)
- Squamous cell carcinoma
- Adenocarcinoma
- Small cell carcinoma
Symptoms in Bladder Cancer
Bladder cancer signs and symptoms may include:
- Blood in urine (hematuria) — urine may appear dark yellow, bright red or cola colored. Or urine may appear normal, but blood may be detected in a microscopic examination of the urine
- Frequent urination
- Painful urination
- Back pain
- Pelvic pain
Cuases of Bladder Cancer
We do know that the following factors increase a person's risk of developing a bladder cancer:
Smoking
Smoking is the single greatest risk factor for bladder cancer. Smokers have more than twice the risk of developing bladder cancer as nonsmokers.
Chemical exposures at work
People who regularly work with certain chemicals or in certain industries have a greater risk of bladder cancer than the general population. Organic chemicals called aromatic amines are particularly linked with bladder cancer. These chemicals are used in the dye industry. Other industries linked to bladder cancer include rubber and leather processing, textiles, hair coloring, paints, and printing. Strict workplace protections can prevent much of the exposure that is believed to cause cancer.
Diet
People whose diets include large amounts of fried meats and animal fats are thought to be at higher risk of bladder cancer.
Aristolochia fangchi
This herb is used in some dietary supplements and Chinese herbal remedies. People who took this herb as part of a weight loss program had higher rates of bladder cancer and kidney failure than the general population. Scientific studies on this herb have shown that it contains chemicals that can cause cancer in rats.
These are factors you can do something about. You can stop smoking, learn to avoid workplace chemical exposures, or change your diet. You cannot do anything about the following risk factors for bladder cancer:
Age
Seniors are at the highest risk of developing bladder cancer.
Sex
Men are three times more likely than women to have bladder cancer.
Race
Whites have a much higher risk of developing bladder cancer than other races.
History of bladder cancer
If you have had bladder cancer in the past, your risk of developing another bladder cancer is higher than if you had never had bladder cancer.
Chronic bladder inflammation
Frequent bladder infections, bladder stones, and other urinary tract problems that irritate the bladder increase the risk of developing a cancer, more commonly squamous cell carcinoma.
Birth defects
Some people are born with a visible or invisible defect that connects their bladder with another organ in the abdomen or leaves the bladder exposed to continual infection. This increases the bladder's vulnerability to cellular abnormalities that can lead to cancer.
Treatment of Bladder Cancer
Surgery
Surgery is part of the treatment for most bladder cancers. The type of surgery done for bladder cancer will depend on its stage.
Transurethral surgery
For this operation, a type of rigid cystoscope called a resectoscope is placed into the bladder through the urethra. The resectoscope has a wire loop at its end to remove any abnormal tissues or tumors. The removed tissue is sent to a pathologist for examination. Most patients have superficial cancer when they are first diagnosed, so this is usually the first treatment they receive.
After surgery, more steps may be taken to try to ensure that the tumor has been completely destroyed. Any remaining cancer may be treated by burning the base of the tumor (fulguration) while looking at it with the cystoscope. Cancer can also be destroyed using the cystoscope and a high-energy laser.
The side effects of transurethral bladder surgery are generally mild and do not usually last long. There may be some bleeding and pain during urination right after surgery. After transurethral surgery, you can usually return home the same day or the next day and can resume your usual activities in less than 2 weeks.
Unfortunately, even with successful treatment, bladder cancer often recurs (comes back) in other parts of the bladder. If transurethral resection needs to be repeated many times, the bladder can become scarred and lose its capacity to hold much urine. This can lead to frequent urination and the chance of not being able to control urination (incontinence).
Reconstructive surgery
If your whole bladder is removed, you will need another way to store and remove urine. Several types of reconstructive surgery can be done depending on your medical situation and personal preferences.
One option may be to remove a short piece of the intestine and connect it to the ureters. This creates a passageway, known as an ileal conduit, for urine to pass from the kidneys to the outside of the body. Urine flows from the kidneys through the ureters into the ileal conduit. The conduit is connected to the skin on the front of the abdomen by an opening called a stoma (also known as a urostomy).
After this procedure, a small bag is placed over the stoma to collect the urine, which comes out continuously in small amounts. The bag then needs to be emptied once it is full.
Another way for urine to drain is called a continent diversion. For this, a valve is created in a pouch made from the piece of intestine. The valve allows urine to be stored in the pouch. It is emptied several times each day by placing a drainage tube (catheter) into the stoma through the valve. Some patients prefer this method because there is no bag on the outside.
If the cancer has spread or can't be removed with surgery, a diversion may be made without removing the bladder. In this case, the purpose of the surgery is to prevent or relieve blockage of urine flow, rather than trying to cure the cancer.
Intravesical therapy for bladder cancer
Intravesical therapy is treatment with a drug that is put directly into the bladder (through a catheter) rather than being given by mouth or injected into a vein. This may be either immunotherapy, which causes the body's own immune system to attack the cancer cells, or chemotherapy.
Medicines given this way mainly affect the cells lining the bladder, with little to no effect on cells elsewhere. This means that any cancer cells outside of the bladder lining, including those that have grown deeply into the bladder wall, are not treated. Drugs given into the bladder also can't reach cancer cells in the kidneys, ureters, and urethra, or those that have spread to other organs.
Intravesical therapy is treatment with a drug that is put directly into the bladder (through a catheter) rather than being given by mouth or injected into a vein. This may be either immunotherapy, which causes the body's own immune system to attack the cancer cells, or chemotherapy.
Medicines given this way mainly affect the cells lining the bladder, with little to no effect on cells elsewhere. This means that any cancer cells outside of the bladder lining, including those that have grown deeply into the bladder wall, are not treated. Drugs given into the bladder also can't reach cancer cells in the kidneys, ureters, and urethra, or those that have spread to other organs.
Chemotherapy for bladder cancer
Chemotherapy (chemo) is the use of drugs to treat cancer. Chemotherapy can be given in different ways.
When the drug is put directly into the area to be treated, it is called local chemotherapy. Intravesical therapy, where the drug is placed into the bladder, is a form of local chemo. It was described in the previous section.
Cancer is often treated by giving the drugs in pill form, or by injection into a vein (IV) or muscle (IM). The drugs enter the bloodstream and circulate throughout the body. This is called systemic chemotherapy. Systemic chemo can affect cancer cells far away from the main tumor. This makes it a good way to attack cancer cells that have spread from the bladder to lymph nodes and other organs.
Chemotherapy is sometimes given before surgery. This is done to try to shrink a large tumor so that it can be more easily removed by surgery. Giving chemo before surgery is known as neoadjuvant therapy.
Sometimes chemotherapy is given with radiation therapy in order to help the radiation work better. Chemo can make the radiation more effective, but it also increases side effects. When chemo is given with radiation, the most common drugs used include:
When the drug is put directly into the area to be treated, it is called local chemotherapy. Intravesical therapy, where the drug is placed into the bladder, is a form of local chemo. It was described in the previous section.
Cancer is often treated by giving the drugs in pill form, or by injection into a vein (IV) or muscle (IM). The drugs enter the bloodstream and circulate throughout the body. This is called systemic chemotherapy. Systemic chemo can affect cancer cells far away from the main tumor. This makes it a good way to attack cancer cells that have spread from the bladder to lymph nodes and other organs.
Chemotherapy is sometimes given before surgery. This is done to try to shrink a large tumor so that it can be more easily removed by surgery. Giving chemo before surgery is known as neoadjuvant therapy.
Sometimes chemotherapy is given with radiation therapy in order to help the radiation work better. Chemo can make the radiation more effective, but it also increases side effects. When chemo is given with radiation, the most common drugs used include:
- Cisplatin
- Cisplatin plus fluorouracil (5-FU)
- Mitomycin with 5-FU
- Gemcitabine and cisplatin
- Methotrexate, vinblastine, doxorubicin (Adriamycin®), and cisplatin (called M-VAC)
- Carboplatin and either paclitaxel or docetaxel
Radiation therapy for bladder cancer
Radiation therapy uses high-energy radiation to kill cancer cells. External beam radiation therapy focuses radiation from outside of the body on the cancer. This is the type of radiation most often used to treat bladder cancer.
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.
Radiation therapy may be used:
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.
Radiation therapy may be used:
- As part of the treatment for earlier stage bladder cancer, after limited surgery
- As the main treatment for people with earlier stage cancers who can't have surgery
- As part of the initial treatment for advanced bladder cancers
- To help prevent or treat symptoms caused by advanced bladder cancers
Lifestyle changes
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life – making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
Talk with your health care team before starting anything. Get their opinion about your exercise plans. Then, try to find an exercise buddy so you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.
Keep in mind exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- Along with a good diet, it will help you get to and stay at a healthy weight.
- It makes your muscles stronger.
- It reduces fatigue and helps you have more energy.
- It can help lower anxiety and depression.
- It can make you feel happier.
- It helps you feel better about yourself.