Bladder cancer is a chronic disease that affects the bladder, the organ that stores urine. Tumors can form when the body creates new cells that are not needed or when old cells don’t die when they are supposed to. These tumors may be cancerous or benign. If cancerous cells develop on the inner lining of the bladder wall, it is called superficial bladder cancer. If the cancer spreads through the lining, it becomes invasive cancer.
The exact cause of bladder cancer is unknown, but there are risk factors associated with the onset of the disease. These include age, smoking habits, gender, and family. A person’s occupation can expose him or her to a variety of carcinogens (cancer-causing substances) as well.
There are three types of bladder cancer: transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma. These are named after the kind of cells the tumors grow in. Transitional cell carcinoma affects the transitional cells that form the elastic inner lining of the bladder. It accounts for over 90% of bladder cancers. Approximately 4% of bladder cancers stem from the rigid squamous cells, which resemble skin cells in shape and size. Only about 1-2% of bladder cancers are adenocarcinomas, cancers that originate from cells that have gland-like (secretory) properties.
Symptoms of bladder cancer are similar to most urological conditions and may include frequent urination, blood in the urine and pain while urinating. Only a qualified physician can make an accurate diagnosis.
Your doctor will ask you questions regarding your medical and family histories and perform an initial physical examination. This usually includes a series of blood and urine tests. Your doctor will feel the abdomen and pelvic areas for any abnormalities. The exam may also include a vaginal or rectal exam. After the initial test, your doctor may recommend one or more of the following tests to better evaluate your condition:
- Urine Cytology
- Urine Culture
- Intravenous Pyelogram (IVP)
- CT (CAT) Scan
- Bone Scan
Consult your physician for further information on these medical examinations.
Treatment options for bladder cancer include surgery, chemotherapy, radiation therapy, and immunotherapy. Consult your doctor about your options in order to decide which ones are best for your particular case.
Bladder cancer surgery involves the removal of the cancerous tissues. If the cancer is very far advanced, some or all of the bladder may be removed. If the bladder is surgically removed, either it will be replaced with a pouch made out of tissue from your small intestine, or the urinary tract will be rerouted to exit the body through the abdomen, where urine is collected in an external bag.
Chemotherapy is the use of powerful medications to destroy cancer cells. Chemotherapeutic medicine may be administered in a variety of forms, including injections, pills and catheters. For patients with bladder cancer, the drugs are usually administered directly into the bladder in a procedure called intravesicular chemotherapy.
Chemotherapy drugs kill cancer cells very effectively. Unfortunately, they can also damage normal, healthy cells, potentially resulting in side effects such as nausea and vomiting, hair loss, weakened immune system and fever. Chemotherapy is prescribed because the chance of treating or eradicating the cancer outweighs the potential adverse side effects. Your doctor will advise you as to the type and severity of side effects you can expect during the course of your chemotherapy.
Radiation therapy is administered externally, using high energy X-rays or a similar type of radiation. External radiation therapy is when this concentrated radiation is aimed at a tumor from outside the body.
Immunotherapy is a type of biologic therapy used to treat cancer or improve the effectiveness of other cancer treatments by stimulating the immune system to work harder. There are several different types of immunotherapy that can be used, depending on each patient’s individual condition.
Some of the most common types of immunotherapy include:
- Biological response modifiers – stimulate the immune system to indirectly attack tumors by increasing the amount of cytokines, the chemicals produced by cells to instruct other cells.
- Colony-stimulating factors – stimulate the production of bone marrow cells to increase red and white blood cells, as many other cancer treatments cause these cell counts to decrease. Red and white blood cells effectively treat infection and carry oxygen and carbon dioxide through the body.
- Tumor vaccines – protect the body from cancer cells similar to other types of disease vaccines, but are administered after patients have been diagnosed with cancer to treat the disease rather than prevent it
- Monoclonal antibodies – these substances are designed to bind to cancer cells in the body, allowing your doctor to precisely target the tumor when delivering other types of drugs or treatment.
In urology, immunotherapy is used in a few conditions. The most common is bladder instillation therapy for superficial bladder cancer. BCG (Bacillus Calmette-Guerin) is an old version of a Tuberculosis vaccine which has been effectively used for bladder cancer for more than 25 years. This is instilled into the bladder weekly for 6 weeks and works as a nonspecific biologic response modifier. A newer exciting form of immunotherapy for prostate cancer is Provenge (Dendreon Pharmaceuticals). This medication uses a combination of immunotherapy techniques to enhance a patients own immune cells to fight advanced prostate cancer. Other types of immunotherapy (interleukin-2, interferon) were commonly used in the past for kidney cancer but these have been replaced by oral medications working through a different mechanism.
Like other forms of cancer treatment, there are certain side effects associated with immunotherapy treatment, including flu-like symptoms of a fever, chills and nausea, as well as rashes, swelling and fatigue. Talk to your doctor about any side effects you experience to ensure that no significant damage is occurring.
Avoiding the following factors may help you prevent the development of bladder cancer:
- Do not smoke or use any tobacco products.
- Minimize exposure to certain chemicals.
- Minimize the use of the drug phenacetin.
If you have any further questions regarding bladder cancer or its treatment options, ask your doctor.