About Bladder Cancer
Bladder cancer is the fourth most common cancer in men and the eighth most common in women. In the U.S., approximately 38,000 men and 15,000 women will be diagnosed with the disease this year. Not staggering numbers, but the disease is more prevalent among Caucasians than among African Americans or Latinos and the lowest rates are among Asians. According to the National Cancer Institute, bladder cancer primarily affects men and women over the age of forty.
Studies have found that cancer-causing agents in the urine can facilitate the development of bladder cancer and that cigarette, cigar or pipe smoking is a significant causal factor in over fifty-percent of bladder cancer cases. The risk of the occurrence of bladder cancer increases with age. Those over age of seventy develop the disease 2 to 3 times more often than fifty-five to sixty-nine year olds and 15 to 20 times more often than thirty to fifty-four year olds. There is an approximately 1.5 fold greater risk of bladder cancer in men who have had radiation therapy for their prostate cancer.
Bladder cancer has been known to lead to urinary incontinence, anemia and a blockage of the urethra that prevents urine from draining normally into the bladder. However, the most serious complication that results from bladder cancer is the all too common spread of disease into other organs.
Insight: Bladder Cancer: What's New? (Slide show opens in separate window)
The First Warning Sign of Bladder Cancer's Onset is Typically Blood in the Urine
By far, the most common early symptom of bladder cancer is hematuria (the presence of blood in the urine) but it is not always visible to the naked eye and too often, a diagnosis of cancer is delayed because said bleeding is intermittent. It may show up on a urine test or urine may simply appear reddish or darker than normal. But, remember even if you see signs of blood in your urine, that won't necessarily mean that you have bladder cancer. A variety of common conditions, from urinary tract infections and kidney disease to kidney and bladder stones or prostate problems, can result in hematuria.
Each of those conditions can also precipitate symptoms similar to those of bladder cancer. It's important to involve your doctor early so that any illness can be diagnosed and treated as soon as possible. If you develop any symptom listed below, contact your physician to determine its cause:
- Recurrent urinary tract infections, urinary stones or chronic bladder inflammation.
- Unusual or uncharacteristic temporary retention of urine or slower urinary stream.
- Pain or inflammation in the lumbar area.
- Unusually frequent urination.
- Bladder tenesmus (painful spasms) or a burning sensation during miction (urination).
- Pain centered around your pelvis, around your groin or any swelling of the your lower extremities.
Bladder cancer is typically diagnosed by examining cells in the urine under a microscope and by inspecting the bladder with a cystoscope, a slender tube fitted with a lens and a light and inserted into the bladder via the urethra.
If cancer is suspected, a small tissue sample will be removed during a cystoscopic procedure and examined under a microscope. If bladder cancer is confirmed, computed tomography (or CT) may be needed to determine the stage and of type cancer, as well as whether or not the cancer has whether it has spread into other parts of the body, such as the lymph nodes, lungs, bones, or liver.
You should also be aware of the various causal and risk factors that have been shown to contribute to the development of bladder cancer. If you answer "yes" to any of the following items you may want to add a bladder cancer screening to your check-up regimen:
- Have you consumed the Aristolochia Fangchi herb used in weight-loss formulas?
- Is your diet high in saturated fats?
- Do you smoke or are you regularly exposed to second-hand smoke?
- Have you been treated with external beam radiation therapy?
- Do you have a family or personal history of bladder cancer?
- Have you ever been treated with a cancer drug such as cyclophosfamide?
- Have you ever been infected with Schistosoma Haematobium, common parasite in many developing countries?
The Most Common Form of Bladder Cancer is Transitional Cell Carcinoma
TCC or Transitional cell carcinoma is by far the most common form of bladder cancer. It accounts for around ninety-percent of bladder cancer cases. Furthermore, seventy percent of Transitional cell carcinoma cases are characterized as superficial, meaning that the cancer is confined to the lining of the patient's bladder, and therefore unlikely to spread into neighboring tissue (i.e. metastasize).
The remaining thirty percent of Transitional cell carcinoma cases are characterized as muscle invasive, meaning that they have invaded through the lining into the muscular wall of the bladder, and therefore potentially into other nearby organs. Remember, every patient's treatment and survival rate depend on how deeply the disease has invaded the bladder, and whether or not it has spread or metastasized into surrounding or distant tissue.
Less common forms of bladder cancer include squamous cell carcinoma, which accounts for around eight percent of bladder cancer cases, and adenocarcinomas, which make up only between one and two percent of bladder cancer cases (however, they account for fully ninety to ninety-five percent of all colorectal cancers). Of course, different forms of bladder cancer will respond differently to treatment, accordingly the approach to treatment will vary from patient to patient.
Taking an Active Role in Your Cancer Treatment and Care
The treatment prescribed for a particular type of bladder cancer will depend on how deeply the tumor has invaded the bladder wall. For instance, superficial tumors (meaning those that have not invaded the muscle layer) can be "shaved off" using an electrocautery device. Immunotherapy in the form of BCG (Bacillus Calmette-Guerin) instillation is also used to treat and prevent the recurrence of superficial tumors related to bladder cancer. Immunotherapy has been shown to be quite effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy, into the bladder, can also be used to treat superficial tumors.
Untreated, even superficial tumors will eventually begin to infiltrate the bladder's muscular wall. And once such tumors have infiltrated the bladder, they require a more radical surgery wherein a part or the patient's entire bladder must be removed and the urinary stream diverted. The procedure that we usually perform is called Robotic Radical Cystectomy and is considered to be the gold standard treatment for bladder cancer.
In some cases, we can create a neobladder (a substitute bladder) from intestinal tissue, but such procedures depend on patient preference, the age of a patient, renal function, and the precise location of the tumor.
Like many cancer patients, you may choose to take an active role in the decisions affecting your medical care. To do so take the time to consult with regular physician and learn as much as you can about bladder cancer and the available treatment options. As part of this process, you should also consider getting a second opinion from a bladder cancer specialist, such as a medical oncologist, urologist or urologic oncologist. You can also take steps to help reduce your risk:
- Learn to love broccoli, cabbage and other cruciferous vegetables.
- Stop smoking.
- Drink plenty of fluids and be careful with chemicals as well as private water sources.
- Most importantly, see your doctor immediately if you ever notice blood in your urine or notice that your urine has reddened over time.
In the end, the best treatment for you will depend on a variety of factors, including the type and extent of your bladder cancer, as well as on your overall health, personal preferences and your age.
A nomogram is a predictive tool for patients and physicians designed to help decide which treatment options are most suitable for the patient. It is a series of computerized devices which can be used in men who are at risk for bladder cancer, as well as those already diagnosed with the disease. For more information, visit Nomogram.org.