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Bladder Cancer Treatment

The bladder is an organ located in the pelvic cavity that stores and discharges urine. Cancer of the bladder accounts for approximately 90% of cancers of the urinary tract, which also includes the kidneys, pelvis, ureters, and urethra.


Types
Bladder cancer usually starts in the bladder lining, which consists of a mucous layer of surface cells, smooth muscle, and a fibrous layer. Tumors are categorized as low-stage (superficial) or high-stage (muscle invasive).


Prevalence
According to the National Cancer Institute, industrialized countries like the United States, Canada, and France have a much higher rate of bladder cancer than Asia and South America, where rates are lowest.

The incidence of bladder cancer is also related to age, with people over the age of 70 developing the disease two to three times more often than people 55–69, and 15 to 20 times more often than people 30–54.

Bladder cancer is the fourth most common type of cancer in men and the eighth most common type in women. In the United States, approximately 38,000 men, but only about 15,000 women, are diagnosed with the disease each year. The disease is also more prevalent in Caucasians than in African Americans and Hispanics.


Causes and Risk Factors
Cancer-causing agents (carcinogens) in the urine may lead to the development of bladder cancer. Cigarette smoking contributes to more than 50% of the cases, and cigars or pipe smoking also increases the risk. Other risk factors include
  • Age
  • Chronic bladder inflammation, including recurrent urinary tract infections and urinary stones
  • Consumption of Aristolochia fangchi (an herb used in some weight-loss formulas)
  • Diet high in saturated fat
  • Exposure to second-hand smoke
  • External beam radiation
  • Family history of bladder cancer
  • Gender (male)
  • Race (Caucasian)
  • Infection with Schistosoma haematobium (parasite found in many developing countries)
  • Treatment with certain drugs, including cyclophosfamide, which is used to treat cancer
  • Exposure to carcinogens in the workplace

Signs and Symptoms
The primary symptom of bladder cancer is blood in the urine (hematuria), which may be visible to the naked eye or only under a microscope. Other symptoms include frequent urination and pain when urinating.


Diagnosis
Your doctor will use both urological and imaging tests to determine whether or not you have bladder cancer. A complete medical history will help identify potential risk factors, like smoking or exposure to dyes and chemicals. Laboratory tests — urinalysis, urine cytology and urine culture — will help detect urinary tract infections or cancer cells.

Intravenous pyelogram (IVP) is the standard imaging test for bladder cancer. Your doctor will administer a dye through a vein and then take x-rays as the dye moves through the urinary tract. This test provides information about the structure and function of the kidneys, ureters, and bladder. Other imaging tests include CT scan, MRI scan, bone scan, and ultrasound.

If bladder cancer is suspected, your doctor will recommend a cystoscopy and biopsy.

Cystoscopy
  • Performed under local anesthesia.
  • A cystoscope — a thin, telescope-like tube with a tiny camera attached — is inserted into the bladder through the urethra so the physician can detect abnormalities
Biopsy
  • Performed under local anesthesia.
  • Tissue samples are taken from the lesion(s) and examined for cancer cells.

Treatment
Treatment options for bladder cancer depend on the stage of the disease, the type of cancer, and the patient's age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy, or a combination of several.

Surgery is used to treat patients in both the early and advanced stages of bladder cancer. In the early stages of bladder cancer, a surgeon will often simply remove the cancerous tumor using instruments inserted through the urethra.

In advanced stages of the disease, partial or radical removal of the bladder — a cystectomy —may be required. Radical cystectomy includes removal of nearby lymph nodes and sometimes also the prostate gland in men and the uterus, ovaries, fallopian tubes, or a section of the vagina in women. Radical cystectomy also involves the creation of an opening in the abdomen for the discharge of urine, or a urostomy.

Chemotherapy is used to destroy cancer cells throughout the body by using a variety of drugs that are administered either orally or intravenously. In early stages of bladder cancer, intravesical chemotherapy (infused into the bladder through the urethra) may also be recommended. Drugs used in the treatment of bladder cancer include valrubicin (Valstar™), thiotepa (Thioplex®), mitomycin, and doxorubicin (Rubex®).

Immunotherapy fights cancer in early stages by enhancing the immune system. In this treatment, BCG, a vaccine derived from the bacteria that causes tuberculosis, is infused through the urethra into the bladder, once a week for six weeks. This vaccine stimulates the immune system, which then destroys cancer cells. Sometimes BCG is used in combination with interferon.

Radiation therapy involves the use of high-energy x-rays to destroy cancer cells, and it can be administered two ways: through external beam radiation (x-rays are emitted from a machine outside the body) or internal radiation (x-rays are emitted from radioactive "seeds" implanted into the tumor.) Either type of radiation therapy may also be used after surgery to destroy any remaining cancer cells. Radiation therapy is also used to ease symptoms in advanced cases of bladder cancer.

Photodynamic therapy is a new treatment for early bladder cancer. It involves administering drugs to make cancer cells more sensitive to light and then shining a special light onto the bladder. This treatment is being studied in clinical trials.


Follow-Up
Because bladder cancer has a high rate of recurrence, urine cytology and cystoscopy are performed every three months for two years, every six months for the next two years, and yearly thereafter.

Prognosis
Patients whose bladder cancer is detected early have a five-year survival rate of about 85 percent, while only five percent of patients with advanced stages of bladder cancer live two years after diagnosis.

Prevention
While bladder cancer cannot be prevented, you can reduce the risk of developing it by not smoking and by drinking plenty of fluids daily.



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