Please be patient! It may take up to ONE minute to load all the Engines.
Problems? Please contact our support.
Alternative namesTransitional cell carcinoma of the bladder
A malignant tumor growth within the bladder. Bladder cancers usually arise from the transitional cells of the bladder (the cells lining the bladder).
These tumors may be classified based on their growth pattern as either papillary tumors (meaning they have a wart-like lesion attached to a stalk) or nonpapillary tumors. Nonpapillary tumors are much less common, but they are more invasive and have a poorer prognosis.
Causes, incidence, and risk factors
As with most other cancers, the exact cause is uncertain. However, several factors may contribute to the development of bladder cancer.
Cigarette smoking has been shown to increase the risk of developing bladder cancer by a factor of nearly five, compared to non-smokers. As many as 50% of all bladder cancer in men and 30% in women may be attributable to cigarette smoke. This risk, however, does show a gradual decline in individuals who quit smoking.
Women who received radiation therapy for the treatment of cervical cancer have an increased risk of developing transitional cell bladder cancer, as do some people who received the chemotherapy drug, cyclophosphamide (Cytoxan).
Chronic (long term) bladder infection or irritation may lead to the development of squamous cell bladder cancer, however, this cancer is very slow growing. Bladder infections do not predispose to transitional cell cancers.
In third world countries, infection with a parasite (schistosomiasis) has been linked to the development of bladder cancer.
Bladder cancers are classified or staged based on their aggressiveness and the degree that they are different from the surrounding bladder tissue (differentiation). There are several different ways to stage tumors; recently the TNM staging system has become more common. This staging system contains several substages, but it basically categorizes tumors using the following scale:
Bladder cancer is divided into five stages:
Bladder cancer spreads by extending into the nearby organs, including the prostate, uterus, vagina , ureters, and rectum. Metastasis can occur to the pelvic lymph nodes or to other parts of the body such as the liver, lungs and bones.
Please note that while most of the symptoms listed below can be associated with bladder cancer, they can also be associated with non-cancerous conditions. Nevertheless, medical evaluation is imperative.
Additional symptoms that may be associated with this disease:
Signs and tests
Physical examination will be performed, including a rectal and pelvic exam.
The choice of an appropriate treatment is based on the stage of the tumor , the severity of the symptoms, and the presence of other medical conditions. Generally, superficial tumors (stages 0 and I) are treated by removing the lesion (without removal of the rest of the bladder) and by sometimes administering local (directly into the bladder) chemotherapy . However, because the risk of recurrence is so high (70 -100%), people with bladder cancer require constant follow-up for the rest of their lives.
Chemotherapy for the treatment of bladder cancer can be administered through the vein or into the bladder. Chemotherapy is usually given by vein to treat patients with stage IV bladder cancer. Alternatively, chemotherapy may also be given to patients with stage II and stage III cancer after surgery in an attempt to prevent recurrence of the tumor. Chemotherapy may be given as a single agent or in different combinations. These include:
The combination of two of these drugs, gemcitabine and cisplatin, have recently been shown to be as effective and with less side effects as an older regimen known as MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) and in many centers has replaced MVAC. The combination of paclitaxel and carboplatin has also been effective and is frequently used.
A Foley catheter can be used to instill the medication directly into the bladder (intravesical chemotherapy) in patients with stage I disease. The catheter is removed immediately after the medication has been instilled, though you are instructed to try to hold the medication in your bladder for at least two hours after treatment. Additionally, you may be asked to rotate from side to side every 15 - 30 minutes to ensure complete exposure of the entire bladder wall to the medication.
Common side effects include bladder wall irritation and pain when urinating. Choice of a specific agent is usually based on the stage of the tumor.
Additionally, bladder cancers are often treated by what is known as intravesical immunotherapy, in which a medication is given that causes your own immune system to attack and kill the tumor cells. Immunotherapy is usually performed using Bacille Calmette-Guerin (commonly known as BCG), which is a solution of genetically altered tubercular bacteria that has been rendered avirulent (not able to produce infection). This medication is administered through a Foley catheter to instill the medication directly into the bladder. Since BCG is a biological agent, special precautions must be taken.
People with stage 0 or I bladder cancer are usually treated with transurethral resection of the bladder (TURB). This procedure is performed under general or spinal anesthesia. A cutting instrument is then inserted through the urethra to remove the bladder tumor.
Most people with stage II or III bladder cancer will opt for bladder removal (radical cystectomy). Partial bladder removal may be performed if there is only a single lesion with no signs of metastasis . However, only about 10% of the people with bladder cancer meet this criterion.
CONTINENT URINARY RESERVOIR:
Clinical tests are currently underway to evaluate the use of photodynamic therapy in bladder cancer treatment. Photodynamic therapy involves using photosensitizing agents and laser light to detect and kill cancer cells. Other studies are looking at new chemotherapy agents that may be more effective.
You will be closely monitored for progression of the disease regardless of the type of bladder cancer treatment you received. Monitoring may include:
Support GroupsThe stress of illness can often be helped by joining a support group where members share common experiences and problems.
Expectations (prognosis)The prognosis is related to the specific stage of bladder cancer and the type of treatment chosen. The prognosis for stage 0 or I cancers is fairly good, although the risk of recurrence or new tumors is high. However, most of these recurrences can be surgically removed and cured. For patients with stage III tumors cure rates are less than 50%. For patients with stage IV disease cure is rare (though patients with only a few metastatic lesions can be cured in some circumstances).
ComplicationsBladder cancers may spread into the nearby organs or may travel through the pelvic lymph nodes, and metastasize to the liver, lungs, and bones. Additional complications of bladder cancer include anemia , hydronephrosis ( swelling of the ureters causing kidney injury ), urinary incontinence , and urethral stricture .
Calling your health care provider
Call your health care provider if you have blood in your urine, or other symptoms of bladder cancer, including urinary urgency , urinary frequency , or painful urination .
PreventionEliminating known carcinogenic agents (cigarette smoking and environmental hazards) may reduce your risk of developing bladder cancer.
Update Date: 5/16/2002William Matsui, M.D., Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT