What is Bladder Cancer?
Bladder cancer typically begins in the lining of your bladder,the balloon-shaped organ in your pelvic area that stores urine. Some bladder cancer remains confined to the lining, while others cases may invade other areas.
Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.
The following are the common types of Bladder Cancer, depending on the type of cell where the cancer begins:
• Urothelial carcinoma: is a new term for this type of bladder cancer. It was previously called transitional cell carcinoma or TCC. Urothelial carcinoma accounts for about 90% of all bladder cancers and begins in the urothelium. A tumor of this type may be described further using one of the four subcategories explained below.
• Non-muscle-invasive/superficial urothelial carcinoma: This subtype of urothelial carcinoma is limited to the urothelium and is non-muscle-invasive, meaning it has not spread to the muscle layer. It may spread into the lamina propria beneath the transitional cells. This is sometimes called invasive, though it is not the deeply invasive type that can spread to the muscle layer.
• Muscle-invasive urothelial carcinoma (often called invasive urothelial carcinoma): This subtype of urothelial carcinoma spreads to the bladder's muscularis propria and sometimes to the fatty layers or surrounding tissue outside the muscle.
• Papillary urothelial carcinoma: Papillary is a word that describes a growth that is like a small polyp or flower-shaped cluster of cancer cells. A noninvasive papillary tumor grows into the hollow center of the bladder on a stalk. Invasive papillary urothelial carcinoma can spread into the lamina propria or muscle layer.
• Flat urothelial carcinoma: Noninvasive flat urothelial carcinoma (also called carcinoma in situ, or CIS) grows in the layer of cells closest to the inside of the bladder and appears as flat lesions on the inside surface of the bladder. Invasive flat urothelial carcinoma may invade the deeper layers of the bladder, particularly the muscle layer.
• Squamous cell carcinoma: This type accounts for about 4% of all bladder cancers and starts in squamous cells, which are thin, flat cells.
• Adenocarcinoma: This type accounts for about 2% of all bladder cancers and begins in glandular cells.
1. Blood in the urine (urine looks bright red or rusty).
2. Pain or burning when urinating.
3. Passing urine often.
4. Feeling the need to urinate but no urine comes out.
5. Difficulty in passing urine.
To diagnose bladder cancer, the doctor will take a medical history, do a physical examination and request a urine test. He or she may order an x-ray test and perform a cystoscopy (described below) and if needed, a biopsy for bladder cancer. A urine sample is taken and then examined under a microscope for cancerous cells (for bladder cancer).
An x-ray procedure, called an Intravenous pyelogram (IVP), is used to detect any abnormalities or growths in the bladder. For the IVP x-ray, a special dye containing iodine is given to the patient through a needle inserted in the vein. The dye goes in the bladder, making the bladder easier to see on the x-rays.
A Cystoscopy is a procedure using a thin, lighted tube called a cystoscope that is inserted into the bladder through the urethra. If the doctor sees any abnormal areas or growths, he or she will remove some of that tissue (biopsy) for further examination under a microscope.
The stage of Bladder cancer is largely determined by how "deeply" the tumor has invaded. The following list describes its various stages.
• Stage 0: Cancer cells found on the inner surface of the bladder. This is the earliest stage of bladder cancer and is known as superficial cancer or carcinoma in situ (CIS).
• Stage I: Cancer cells have penetrated the inner lining of the bladder but have not yet reached the muscle layer.
• Stage II: Cancer cells have spread into the muscle layer.
• Stage III: Cancer cells have spread beyond the bladder muscle and into the outer layer of tissue surrounding the bladder.
• Stage IV: Cancer cells have spread towards the abdominal or pelvic wall. In men, the cancer cells may spread to the prostate. In women, the cancer cells may spread to the uterus or vagina. Cancer cells may have also spread to the lymph system and metastasized to other parts of the body.
There are four main types of treatment for bladder cancer: surgery, radiation therapy, chemotherapy and biological therapy. The type and staging of the cancer, age, and overall health, determine which treatment method(s) will be used.
There are three (3) main types of surgeries for bladder cancer : -
Transurethral resection (TUR) is an operation that uses a cystoscope inserted into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer or to burn the tumor away with high-energy electricity.
Cystectomy is an operation to remove the bladder. There are two types of cystectomy - segmental (partial), and radical (complete). Segmental cystectomy is an operation to take out part of the bladder where the cancer is located. Radical cystectomy is the removal of the bladder and nearby organs. In women, this operation includes removing the uterus, fallopian tubes, ovaries and part of the vagina. In men, the prostate and seminal vesicles are removed.
Urinary diversion is an operation to make way for urine to pass out of the body so that it does not go through the bladder.
Radiation therapy (also called radiotherapy) may be needed when the cancer cannot be removed with TUR because it involves a larger area of the bladder. X-rays destroy the ability of cancer cells to grow and multiply. Internal radiation therapy, with radioactive material placed in the bladder, may be combined with external radiation, which comes from a machine located outside the body.
When cancer involves the pelvis or has spread to other parts of the body, the doctor may suggest chemotherapy. Chemotherapy uses drugs to stop the growth of cancer cells. Chemotherapy may be given in different ways - by mouth or injection into a muscle or a vein, or by catheter into the bladder (intravesical chemotherapy).
Depending on the specific drugs, most patients take chemotherapy as an outpatient at the hospital, the doctor's office or at home. Sometimes, it may be necessary to stay in the hospital for a period of time to monitor the effects of the treatment.
You may want to ask some questions before your treatment begins:
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