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Bladder cancer

Definition


Disease: Bladder cancer Bladder cancer
Category: Tumors
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Disease Definition:

This cancer is the kind of cancer that originates in the bladder, which is a balloon shaped organ in the pelvic area that stores urine. Often, Bladder cancer starts in the cells that line the inside of the bladder. Though it can occur at any age, it usually affects older adults. The majority of cases of bladder cancer are discovered in early stages; when it is highly treatable. Yet, even early-stage bladder cancer can recur. For this reason, survivors of bladder cancer often take follow-up screening tests even for years after treatment.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms of bladder cancer may be:

  • Backache
  • Abdominal pain
  • Painful urination
  • Frequent urination
  • Urinary tract infection
  • Blood in urine (hematuria) — blood could appear cola colored or light red in the urine, or could appear in a microscopic examination of the urine.

Causes:

The bladder is a muscular balloon-shaped organ that is located in the pelvis. Its job is to store urine produced by the kidneys during the process of filtering blood. Like a balloon, the bladder enlarges and shrinks depending on the amount of urine in it. Urine travels from the kidneys to the bladder through thin tubes called ureters and is carried away from the body through another narrow tube called the urethra.

 

HOW CANCER DEVELOPS:
When healthy cells go wrong, cancer occurs. Rather than growing healthily in an organized method, the cells grow out of control, develop mutations but don’t die, resulting in a tumor.

Various types of cells can grow cancerous. The kind of treatment a person needs depends totally on the kind of cancerous cells in their bladder.

Types of bladder cancer are:

 

Squamous cell carcinoma:
As a reaction to an infection or irritation, squamous cells appear in the bladder. By time, they can become cancerous. This type of bladder cancer is more common in areas where a certain parasitic infection called schistosomiasis is a more rampant cause of bladder infections. 

 

Transitional cell carcinoma:
This type occurs in the cells that line the interior of the bladder. When a person's bladder is full, transitional cells expand and vice versa. These same cells trace the interior of the ureters and urethra. Thus, cancer can occur in those two places as well.

 

Adenocarcinoma:
This type of bladder cancer starts in cells that compose mucus-secreting glands in the bladder.

Some bladder cancers have more than one type of cells.

Complications

Complications:

Often, bladder cancer recurs; because of this its survivors undergo follow-up tests for many years till treatment is totally accomplished. The type of tests the patient should undergo and how often usually depends, among other factors, on the type of their bladder cancer, as well as their treatment.

These are some of the types of tests that are used in screening for bladder cancer recurrences:

  • Searching for irregular growths in the bladder: Cystoscopy is a common screening test for bladder cancer return.
  • Looking for cancer cells in the urine: Every few months for the first couple of years after cancer treatment, the patient's physician may urge a urine cytology test.
  • Taking haphazard samples of bladder tissue: The patient may be recommended having samples of their bladder tissue analyzed periodically in case they have a high risk of bladder cancer recurrence. With this method, before the cancer recurrence could be seen with cystoscopy, the doctor can diagnose it.

 

HOW OFTEN SHOULD THE PATIENT UNDERGO SCREENING FOR BLADDER CANCER RECURRENCE??
The patient should make a follow-up plan with their doctor. Doctors usually advocate cystoscopy screening every 3 months for the first 2 years after bladder cancer treatment. The following 2 years, the patient may undergo cystoscopy every 6 months. Then, they may undergo cystoscopy annually. Moreover, the doctor may recommend other tests at different periods. Although people who have a less aggressive bladder cancer can undergo tests less often, yet those with aggressive cancers should undergo screening more frequently.


HOW CAN A BLADDER CANCER RECURRENCE BE PREVENTED??
No dependable way to prevent bladder cancer recurrence  is known to doctors, but the patient should talk with their doctor about the ways to cut down their risks, such as:

 

Smoking cessation:
Support programs and medications could help a person stop smoking. The patient can also consult a physician to learn about helpful strategies.

 

Increasing the intake of antioxidant vitamins:
Some research declared that some kind of vitamins reduce the chance of bladder cancer in some people, but  no enough studies were made to side for taking big amounts of antioxidants in pill form. As matter of fact, large doses of vitamin supplements could do harm. A safer way to take in more antioxidants is to eat more fruits and vegetables. If someone wants to find out more ways to get vitamins, they can talk to their doctor.
 

Treatments:

Depending on various factors, like the type and stage of the cancer, the patient's total health and their treatment orientation, cancer treatment options differ. In order to find out what exactly works best for a person, they should consult their doctor.

 

SURGICAL PROCEDURES:
The majority of people with bladder cancer undergo surgery to get rid of the cancerous cells.
The stage of the bladder cancer, as well as the patient's overall health and preferences will determine the type of surgical procedures suitable for them. 


Surgery for early-stage bladder cancer:
If the cancer mass is small and hasn’t pierced the wall of the bladder, the patient may be advised:

 

Surgery to remove the tumor:
Transurethral resection of bladder tumor (TURBT) is often used to take away bladder cancers that are stuck to the inner beds of the bladder. During TURBT, the doctor inserts a small wire loop into the patient's bladder through the urethra. An electric current (fulguration) is used within the loop to burn away cancer cells. In other cases, a high-energy laser could replace the electric current. Hurtful or bloody urination may appear for a few days following the procedure.

 

Surgery to remove the tumor and a small portion of the bladder:
During segmental cystectomy (or partial cystectomy), the surgeon takes off only the part of the bladder that contains cancer cells. This is an option if the tumor is constricted to one part of the bladder and can simply be removed without affecting bladder work.
The surgeon makes an incision in the patient's abdomen to remove the tumor. General anesthesia is used, and the patient usually stays in the hospital for 7 to 10 days. There’s a high risk of bleeding and infection during this surgery. After segmental cystectomy, the patient may experience frequent urination since the operation reduces the size of the bladder. These side effects may improve by time, but to some people it’s a permanent case.

 

Surgery for the invasive bladder cancer:
If the cancer invaded deeper layers of the bladder wall, the patient may consider undergoing one of these surgeries:

 

Surgery to remove the entire bladder:
The procedure in which the entire bladder, as well as the surrounding lymph nodes are removed is called a radical cystectomy. In males, a radical removal of the prostate and seminal vesicles is also included in this surgery. In females, cystectomy involves removing the uterus, ovaries and part of the vagina.

Infection, bleeding, blood clots and bowel obstruction are major risks in cystectomy. In males, cystectomy causes infertility. Though, the surgeon sometimes keeps an eye not to damage nerves needed for an erection. In females, removal of ovaries causes infertility, as well as early menopause in women who didn’t go through it before the surgery.

 

Surgery to create a new way for urine to leave the body:
After the surgery, the patient's body will need an immediate way to eject urine. The doctors may offer many options, but this depends entirely on the patient's cancer condition, health and preference.

A tube might be created from a piece of the intestine (urinary conduit) and inserted to run from the kidneys to the outside of the body. The urine flows into a pouch (urostomy bag) that the patient wears on their abdomen.

Another option is, by using a piece of the patient's intestine, the surgeon might make a small container for urine within the patient's body (cutaneous continent urinary diversion). The patient can simply drain that accumulated urine through a small hole in their abdomen by using a catheter a few times a day.

Yet another procedure might be creating an inner bladder-like container from a piece of the patient's intestine called a neobladder. The alternate bladder allows the patient to urinate normally since it is fixed inside the body and directly connected to the urethra. A catheter may be needed to drain all the urine from the new bladder.

 

IMMUNOTHERAPY:
Also called biological therapy, it works by motivating the patient's immune system to help fend off those cancerous cells. This kind of therapy is typically administered through the urethra and into the bladder directly (intravesical therapy). Some drugs are used in biological therapy, and they include:

An immune-stimulating bacterium:
One example is Bacille Calmette-Guerin (BCG), which is a bacterium used in tuberculosis vaccines. Some side effects of BCG are bladder irritation and blood in the urine. After BCG treatment, some people may feel like they have the flu.

 

A synthetic version of immune system cell:
The cells that fight infection are called interferon. An artificial type of interferon  may be used to cure bladder cancer. In some cases it could be combined with BCG. Flu-like symptoms are the only side effects of these medications. Biological therapy is usually advised after TURBT to reduce cancer reoccurrence. At other times, it’s advised before surgery to shrink the tumor to a more controllable size.

 

CHEMOTHERAPY:
In order to kill cancer cells, this method uses medications. It usually demands a combination of 2 or more drugs, which could be given intravenously, or directly allotted to the patient's bladder, passing through the urethra (intravesical therapy). It’s mainly used to kill cancer cells that remain after surgery. Chemotherapy may also be used before surgery. It shrinks the tumor enough to allow a less invasive surgery. Sometimes, chemotherapy is joined with radiation therapy.
 

RADIATION THERAPY:
It is done by pinpointing high-energy beams at the cancer to demolish the cancer cells. With the use of a machine outside the body (external beam radiation) or a device placed inside the bladder (brachytherapy).

In some cases, radiation therapy can be combined with chemotherapy. Radiation therapy is mainly used before surgery to contract the tumor in order to be more easily removed with surgery. After surgery, radiation therapy can be used to kill cancer cells that might remain.
 

Prognosis:

Not available

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