Bladder cancer affects thousands of individuals each and every year, with the highest percentage of cases in men. Research has shown that cigarette smoking is linked to bladder cancer, with other factors including age, history of cancer in the family and occupational risks also playing a role. The most common symptom of bladder cancer is blood in the urine. Other symptoms that are often reports may include frequent urination and a burning sensation while you urinate. Unfortunately, these symptoms are also common to other conditions such as a kidney infection.
Like other cancers, bladder cancer is diagnosed using stages. Stage I is the earliest stage and has the highest survival rates, while stage IV bladder cancer is the most severe and survival rates are often low. As with any cancer, early detection increases the chance for a better prognosis. Treatments for bladder cancer include surgery, radiation therapy, chemotherapy and biological therapy.
Bladder Cancer Research
Metastatic bladder cancer is bladder cancer that has progressed beyond the muscular layer of the bladder and has spread (metastasized) to other parts of the body. Common areas of metastasis are the lymph nodes, lung, skin, bones and liver. Some systemic chemotherapy drugs for bladder cancer those administered intravenously (IV) can slow the progression of metastatic tumors that have progressed to the soft tissue of the lymph, lung or skin. Little help is available for metastatic bladder cancer involving the bones and liver.
Cisplatin, Methotrexate, Vinblasine, Doxorubicin (MVAC)
New cancer research suggests that combining chemotherapeutic agents might double the survival time. A combination of chemotherapy drugs consisting of cisplatin, methotrexate, vinblastine, and doxorubicin (abbreviated MVAC) has shown promise in clinical studies in the treatment of metastatic bladder cancer and has become the treatment of choice. Areas of metastasis such as the skin, lungs and lymph have shown improvement when treated with the combination.
New Chemotherapeutic Agents
Studies on new chemotherapeutic agents are being performed all the time. Some of the drugs being tested are antifolates, taxanes, ifosfamide, gemcitabine, and gallium nitrate. These drugs are showing some effectiveness in the treatment of metastatic bladder cancer but can also have toxic side effects. Clinical studies are being done to discover the maximum effectiveness with minimal toxicity.
Studies are also being done on drugs that respond to light. In photodynamic therapy a light-sensitive drug is administered intravenously through an IV. Over the course of a few days, the cancer cells in the bladder absorb the drug. During a cystoscopy, the doctor will shine a laser light inside the bladder. This activates the drug and selectively targets the cancer cells. Photodynamic therapy is still under study.
Bladder Cancer Clinical Trials
Many clinical trials are being conducted across the United States. Patients can volunteer to take part in clinical trials. These research studies test new treatments for bladder cancer including chemotherapy drugs and other combination treatments. Some risk is associated with clinical trials since the patient may be part of groundbreaking research into novel treatments for bladder cancer.
Early Detection and Prevention
Without any treatment, patients with advanced cancer may have a four to six-month survival expectancy. Some chemotherapeutic agents can prolong survival for up to three years following diagnosis. As with all cancer, early detection and prevention are the most important factors in slowing the progression and treating cancer. The survival rate for patients with superficial cancer who receive early treatment is over ninety percent. The elimination of preventable risk factors like smoking can also reduce the risk of bladder cancer significantly.
Bladder Cancer Symptoms
he most common symptom of bladder cancer is blood in the urine, or hematuria. Hematuria that is visible to the naked eye is known as gross hematuria. Hematuria that can be seen only with the aid of a microscope is known as microscopic hematuria. Eighty to ninety percent of bladder cancers will have either gross or microscopic hematuria occurring frequently or intermittently.
Another symptom of bladder cancer is painful urination, or dysuria. Dysuria is not as common as hematuria and pain is not always a good indicator of the existence of bladder cancer. A symptom less commonly reported is frequent urination or the sensation of having to urinate frequently. While any or all of these symptoms may be associated with bladder cancer they can also be symptoms of a urinary tract infection, bladder stones or benign tumors.
Diagnosis and Testing
If evidence of hematuria is found, the patient may be referred to a urologist. A urologist is a doctor that treats diseases of the urinary tract. The urologist will get a detailed medical history including all symptoms, a family medical history, and the patient's cigarette smoking and occupational history. Once all risk factors have been noted, the urologist may examine the bladder using a number of different diagnostic tools.
IVP and Cystoscopy
One of the least invasive tests is an intravenous pyelogram (IVP). A radioactive dye is injected into a blood vessel through an IV. This dye highlights the entire urinary tract (kidneys, ureters and bladder) so it is visible on x-ray. The x-ray technician will take a series of x-rays in rapid succession. These x-ray films are given to the doctor who will make note of any distortion of shape or irregularities in the urinary tract.
If the IVP does show irregularities in the bladder, the urologist will perform a cystoscopy, a direct examination of the bladder using a cytoscope. To make cystoscopy more comfortable, a local anesthesic will be used to numb the area surrounding the urethra. The cystoscope, a tiny camera with a light at the end, is inserted into the urethra. This allows the urologist to inspect the bladder and note any tumors or irregularities. The doctor records these irregular areas noting the size and location of any tumors present.
During cytoscopy the urologist may also do a "bladder wash." A bladder wash allows the doctor to obtain cells from inside the bladder. These cells will then be evaluated in a laboratory for the presence of cancer.
Bladder Tumor Biopsy
If a tumor is present, the urologist may choose to do a transurethral biopsy. Frequently, a bladder tumor biopsy is performed under general anesthesia. The cystoscope is passed through the urethra and biopsy samples are collected. In some cases, a biopsy is the only way to know for sure if cancer is present. In the early stages of bladder cancer, a biopsy may remove the entire tumor and may be all that is required for treatment.
Bladder Cancer Statistics and Risk Factors
Bladder cancer will affect over 50,000 people this year. Of these individuals, 65 to 75 percent will be men. Bladder cancer is the fourth most common cancer in men and one of the top eight cancers for women. According to the National Cancer Institute, bladder cancer is more prevalent in the westernized countries, like the United States, France and Canada. Asia and South America boast a seventy percent lower rate of bladder cancer than the Western World.
Cigarette Smoking and Bladder Cancer
One of the most preventable risk factors for bladder cancer is cigarette smoking. Cigarette smoking is responsible for one third of all cancer deaths. While its connection with lung cancer is widely known, new evidence shows cigarette smoking also has a strong connection to bladder cancer. Current research finds that cigarette smokers are three times more likely to get bladder cancer than individuals with other risk factors. A strong link exists between the amount and duration of cigarette smoking, but the onset of cancer can be delayed 25 years or more following excessive tobacco use. Other tobacco users like pipe and cigar smokers also face a greater risk of bladder cancer.
Genetics and Bladder Cancer
While cigarette smoking is the strongest link to bladder cancer, other risk factors are associated with the onset of bladder cancer, including age, family history and ethnic group. Bladder cancer is most common between the ages of 50 and 70, especially if there is a known family history of bladder cancer. Caucasians are twice as likely to get bladder cancer as African Americans or Hispanics.
Occupational Risk Factors
Some of the same organic chemicals that are emitted from tobacco, known as aromatic amines, exist in certain occupational environments. People working with rubber, chemicals or leather, hairdressers, machinists, metal workers, printers, painters, textile workers and truck drivers are at risk of occupational exposure to aromatic amines.
Exposure to certain drugs, like cyclophosphamide or arsenic used in chemotherapy, may be a risk factor for bladder cancer. Arsenic is also used in pesticides. Some regions with high concentrations of arsenic in the drinking water show a higher rate of bladder cancer.
Urinary Tract Infections
An additional possible risk factor for bladder cancer is frequent bladder infections or urinary tract infections caused by bacteria. Frequent urinary tract infections can promote the growth of abnormal cells in the bladder. Bladder cancer in women can be misdiagnosed as a chronic urinary tract infection thereby delaying the onset of treatment. This accounts for a higher rate of bladder cancer deaths among women.
Other Risk Factors
Another potential cause of bladder cancer is a parasite in Africa and other tropical regions. This parasite, known as Schistosoma haematobium, may contribute to the risk of cancer by affecting the metabolism of cigarette smoke or by causing irritation of the bladder. These parasites are often responsible for causing bladder cancer in younger individuals.
Researchers are studying other possible connections to bladder cancer including pain relievers that contain the ingredient phenacetin, a weight-loss herb known as aristolochia fungchi, saccharin and other artificial sweeteners, and chlorine by-products. At this time, some connections can be made, but the evidence is not conclusive.
Bladder Cancer Surgery: TURBT and Radical Cystectomy
Up to eighty percent of all bladder cancers are diagnosed as superficial bladder cancers. Once positively diagnosed and biopsied, many superficial bladder cancers (SBC) can be surgically removed by a procedure known as a transurethral resection of a bladder tumor, or TURBT. For invasive bladder cancer more aggressive therapy (cystectomy or bladder removal) is necessary to stop its progression to metastatic bladder cancer.
Transurethral Resection of Bladder Cancer (TURBT)
The TURBT is the most conservative surgery for bladder cancer. Still, it has some side effects including possible bleeding and infection, perforation of the bladder, and blocked ureters.
Transurethral resection generally takes place in the hospital with the patient under general anesthesia. The doctor inserts a cystoscope, a small, lit camera, in through the urethra and into the bladder. A small tool with a wire loop at the end is inserted through the cystoscope. A high-frequency electric current passes through the wire tool removing and burning cancer cells. This method is called fulguration. In some situations, fulguration will not be enough to eradicate the tumor.
In superficial bladder cancers that recur following TURBT, the doctor will use a laser to obliterate the tumor. However, because laser surgery also destroys surrounding tissue, if the tumor has not been previously biopsied and positively diagnosed as bladder cancer, its use is not recommended.
Follow-up to TURBT: Transurethral resection is often a successful treatment for patients with low-risk cancers. These cancers are described as noninvasive, papillary cancers. The noninvasive characteristic keeps them from penetrating into deeper layers of tissue but does not prevent their recurrence. Up to seventy percent of patients with superficial bladder cancer have some recurrence within five years of treatment. Therefore, follow-up therapy is an important part of post transurethral resection therapy.
Follow-up therapy includes a cystoscopic evaluation three months after the initial TURBT treatment and then every six months for an additional year. If cancer reappears, follow-up cystoscopy and urinalysis is typically performed every three months for the first year and every six months for an additional three to five years.
Partnering Chemotherapy with TURBT: Patients with high-risk tumors those that are likely to become invasive may benefit from the TURBT procedure but may need other "adjuvant " treatment. Because of the relatively high chance of progressing (thirty percent), high risk bladder cancers are often treated with transurethral resection combined with intravesical therapy. Intravesical therapy is a type of chemotherapy or immunotherapy instilled directly into the bladder.
Cystectomy: Bladder Surgery for Invasive Bladder Cancer Once cancer cells have penetrated the muscular layer of the bladder the stage is referred to as invasive cancer. Invasive bladder cancer (IBC) cannot be treated with TURBT or intravesical therapy.
The most common mode of therapy for invasive bladder cancer is the surgical removal of the bladder a procedure known as a radical cystectomy. A radical cystectomy also includes the removal of the nearby lymph nodes, and part of the urethra. In men it may include the removal of the prostate, seminal vesicles and vas deferens. In women, it may include the removal of the ovaries, fallopian tubes and part of the vagina. Any area in direct contact with the cancer cells is removed to prevent the cancer from spreading to other parts of the body.
As with any surgery, a radical cystectomy may have side effects. Some patients may experience sexual dysfunction, salt imbalances, bone loss, or deterioration of the kidney.
Preservation of the Bladder
Although the best statistics for survival of invasive bladder cancer are associated with radical cystectomy, bladder removal eliminates the reservoir for urine storage and a new bladder must be constructed. Each patient is evaluated for the most appropriate method according to general health, age and extent of surgery.
Sometimes, a new bladder can be made out of part of the intestines. These are called orthotopic neobladders and allow patients to have close to normal urinary function. Some patients will require a pouch on the outside of the body to hold urine. This is known as an ostomy. The ostomy attaches to a stoma, or opening in the body created for the excretion of urine. Patients requiring an ostomy receive education and support from medical personnel about care of the affected area.
New Options for Treatment
Researchers are looking to other modes of therapy to preserve the bladder. New studies indicate some value in trimodality therapy. This therapy involves combining three therapies: transurethral resection, radiation, and systemic chemotherapy. Other treatments involve the use of chemotherapy drugs along with surgical procedures to keep a partial bladder intact. Clinical trials help researchers find new ways to treat invasive bladder cancer.
Bladder Cancer Treatment: Chemotherapy, Immunotherapy and Radiation
Certain tumors require intravesical therapy in conjunction with transurethral resection. This is called "adjuvant therapy."
Intravesical therapy is a procedure where liquid medicine is inserted directly into the bladder with a catheter. Either a chemotherapy drug or immunotherapy medicine is used. This local administration of therapy reduces the side effects that are often present with traditional systemic chemotherapy. Systemic chemotherapy is administered intravenously (IV), or orally in pill form, and travels throughout the entire body killing cancer cells as well as healthy cells.
Goal of Intravesical Therapy
The goal of intravesical therapy is to prevent bladder tumors from growing or progressing. It is often used to eliminate carcinoma in situ or papillary tumors that cannot be surgically removed with transurethral resection. Intravesical therapy has also been successful in reducing the need for radical bladder surgery (cystectomy) in some patients.
Administration of Intravesical Chemotherapy
Administration of intravesical therapy, when used as an adjuvant therapy to transurethral resection, begins two weeks after the TURBT procedure. A chemotherapy agent known as Mitomycin C is introduced into the bladder through a catheter. The medication remains in the bladder for up to two hours. This treatment is repeated once a week for six to eight weeks and may be continued less frequently for up to a year.
Intravesical Chemotherapy Side Effects
The chemotherapy drugs used in the intravesical treatments affect the cells inside the bladder but will not damage cells in other parts of the body. Because chemotherapy drugs can alter healthy cells while destroying cancer cells some side effects are associated with Mitomycin C. Side effects can include inflammation of the lining of the bladder which can result in painful urination, a frequent need to urinate, and blood in the urine.
Another agent often used in intravesical therapy is referred to as Bacille Calmette-Guerin, or BCG. BCG is an immunotherapy drug a drug that consists of live, but weak bacteria effective in stimulating the immune system to kill cancer cells itself. Like intravesical chemotherapy, BCG is introduced through a catheter and retained in the bladder for up to two hours. BCG is recommended for high-risk tumors and not suggested for those who have already had a transurethral resection.
Radiation Therapy for Bladder Cancer
Another form of treatment for invasive bladder cancer is radiation therapy. Also known as radiotherapy, radiation therapy employs high-energy x-rays to kill cancer cells. The treatment is local and kills only the cells within a determined area. Radiation therapy may be given five days a week for up to seven weeks.
Radiation therapy may have side effects including nausea, vomiting, diarrhea or fatigue. It can also cause cystitis or inflammation of the bladder, which may lead to urgent and frequent painful urination. In some cases, the advantages of radiation therapy may outweigh the side effects. Radiation may preclude the need for radical cystectomy the removal of the entire bladder allowing the bladder to be preserved.
Bladder Cancer Surgery in India
The Urocare INDIA offering bladder cancer surgery in India provide patients with high quality healthcare facilities in warm and homely surroundings. They provide modern state of art equipment and genuine medical expertise at an attractive and effective cost. Indian surgeons offering bladder cancer surgery are well qualified, trained and well experienced. They are well renowned for holding expertise in the field of cancer treatment. Patients can have access to the team of well trained doctors, surgeons and advanced laboratory services at renowned hospitals of Delhi, Mumbai, Chennai, Pune, Bangalore and Hyderabad. These surgeons are holding expertise in handling tough and complicated medical cases. Indian surgeons are attracting large number of patients from Europe, USA, Canada, South Africa and Australia including underdeveloped countries like Nigeria. The cost bladder cancer surgery at Indian treatment centers is quite affordable to the pockets of abroad patients.
The main purpose of bladder cancer treatment is to remove cancer tumors from the gall bladder entirely with the help of the surgery. The amount of surgery required by the patient will depend on the stage of the disease. The tests you have done with your medical specialist will help you to decide whether surgery is essential for you or not. Numerous medical operations are done to remove cancer tumors from the gall bladder. Some of these operations fall in the group of major surgery. These operations are performed under the influence of general anesthetic. The type of treatment you get depends on the location of cancer cells in the gallbladder and how far it has spread outside the bladder. The doctor may provide you with simple removal of gallbladder, removal of gallbladder with a part of the liver and lymph nodes and removal of bladder with surrounding tissues.
Bladder cancer is generally an uncommon cancer. This cancer has a peculiar spreading in Northern India, Japan, Eastern Europe and South America. The Hispanics and native American Indians are mostly diagnosed of having bladder cancer. This disease can be eliminated by removing the gallbladder, lymph nodes and a part of the liver. Majority of bladder cancers are “adenocarcinomas” with subtypes like tubular, nodular and papillary depending on the appearance of the cancer tumors under a microscope. Less common cancer types involve adenosquamous, signet ring cells and squamous cells.