July 17th is Bladder Cancer Awareness Day

As part of Bladder Cancer Awareness Day, take the time to get familiar with some general bladder cancer facts.  We will begin with the basic types of bladder cancer and go through symptoms, diagnosis and treatment options.

Bladder cancers can form in many locations in and around the bladder, including the ureters and the lining of the kidneys (called renal pelvis). Bladder cancer cells can penetrate through the different layers of the wall of the bladder.

Bladder tumors are also grouped into several types by the types of cells it contains:

• Transitional cell carcinoma: This is the most common form of bladder cancer, accounting for more than 90 percent of these cancers that begin in the cells lining the bladder.

 Cancer that is confined to the lining of the bladder is called non-invasive or superficial bladder cancer.

• Squamous cell carcinoma: A rare form, accounting for 5 percent of all bladder cancersbegins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.

Though less common, squamous cell carcinoma can be more aggressive than transitional cell carcinoma.

• Adenocarcinoma: Although rare, these are very aggressive tumors accounting for 1-3 percent of bladder cancers which develops in the inner lining of the bladder as a result of chronic irritation and inflammation.

• Small cell: Extremely rare, approximately 1-2 percent of all bladder cancers.

Patients often are treated with similar therapies as those used for lung cancer.

 The most common risk factors for developing bladder cancer include:

• Smoking
• Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies
• A diet high in fried meats and fat
• Being older, male, or white
• Chronic bladder inflammation (recurrent urinary tract infections, urinary stones)
• External beam radiation
• Consumption of Aristolochia fangchi (herb used in some weight-loss formulas)
• Infection with Schistosoma haematobium (parasite found in many developing countries)

Symptoms of bladder cancer frequently consist of:

• Blood in the urine (hematuria) can either be macroscopic or microscopic

Microscopic is typically discovered when blood is found by urine tests done because of other symptoms or as part of a general medical checkup

• Change in bladder habits
• Frequent urination or feeling the need to urinate without being able to do so
• Pain during urination
• Lower back pain

Patients experiencing these symptoms should undergo a complete medical history and general physical exam as well as urinalysis.

If bladder cancer has not been ruled out by exam ad UA, further testing for definitive diagnosis may include:

• Cystoscopy - A urology doctor will insert a cystoscope (thin, lighted tube) into the bladder through the urethra to directly look and examine the lining of the bladder.

In patients with a negative cystoscopy (no evidence of bladder tumor), an intravenous pyelogram (IVP) can be performed.

• Bladder Biopsy - Asample of bladder tissue is examined under the microscope.

This can identify bladder cancers and tell what type of cancer (urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, etc.) is present and how deeply the cancer has penetrated.

• Chest X-ray - A chest X-ray is done to look for any mass or spot on the lungs that might be a metastatic tumor, if it is suspected that the bladder cancer has spread distantly.

• Ultrasound - This is a test that uses high-frequency sound waves creating echoes that are recorded and translated into video or photographic images that are displayed on a monitor.

• Computed tomography (CT or CAT) scan - This is a special X-ray that uses a computer to create a series of images, or slices, of the inside of the body.
• Magnetic resonance imaging (MRI) - This is a test that produces images of the inside of the body using a large magnet, radio waves and a computer.

The cancer treatment for bladder cancer depends on how deeply the cancer has penetrated into the bladder wall, the stage of the cancer (whether it is only in the bladder or has spread to other places), and the patient’s general health.

 Cancer treatments for bladder cancer include:

• Transurethral resection of bladder tumor (TURBT) - This is the most common cancer treatment procedure for early stage or superficial cancers where the tumor is removed via cystoscope.

This procedure can be repeated if patients have superficial tumor recurrences.

• Intravesical therapy - Cancer treatment that is placed directly into the bladder through a catheter is immunotherapy. Bacillus Calmette-Guerin (BCG) is considered to be quite effective for treating low-stage bladder cancer. BCG is placed into the bladder stimulating the body's immune system to destroy bladder cancer cells.

Other intravesical therapies include interferon (immunotherapy) and mitomycin C (chemotherapy).

• Cystectomy - When the bladder cancer has invaded the muscle wall of the bladder, the recommended cancer treatment is to remove the entire bladder and nearby lymph nodes.

In men, the prostate is also removed. In women, the uterus (womb), ovaries, a small portion of the vagina and fallopian tubes (tubes that connect the ovaries and uterus) are often removed with the bladder.

• Radiation therapy - This is a cancer treatment that uses high-energy rays (such as X-rays) to kill cancer cells. It is usually delivered from the outside of the body (external beam radiation), and it is routinely performed as an outpatient treatment. It is usually given daily (each session lasting for approximately 20-25 minutes) daily for up to five to seven weeks.

It can also be given with weekly chemotherapy (low-dose) with the goal of enhancing the killing effects of the radiation.

• Systemic chemotherapy - This therapy uses drugs that kill cancer cells via the bloodstream. Chemotherapy is most commonly used once the cancer cells have spread beyond the bladder to distant organs (i.e. lungs or liver).

 There is evidence to suggest that giving chemotherapy before or after removal of the bladder may decrease the likelihood of cancer spreading after surgery.