Genitourinary Cancers

Bladder Cancer

Background

Bladder cancer typically attacks the bladder lining and is often caused by cigarette smoke and toxic chemicals, such as paints and solvents. 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.

Symptoms

These and other symptoms may be caused by bladder cancer. Other conditions may cause similar symptoms, so it's important to consult a doctor should any of the following occur.

Signs and symptoms of bladder cancer include:

  • Blood in the urine (slightly rusty to bright red in color)
  • Frequent urination, or feeling the need to urinate without being able to
  • Pain during urination
  • Lower back pain

Staging

Stage I: Cancer has formed and spread to the layer of tissue under the inner lining of the bladder.

Stage II: Cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III: Cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV: Cancer has spread from the bladder to the wall of the abdomen or pelvis and may have spread to one or more lymph nodes, or to other parts of the body.

Treatment

One of the following types of surgery may be performed:

Surgery

  • Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin, lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or burn the tumor away with high-energy electricity, also called fulguration.
  • Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, nearby organs that are removed include the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
  • Segmental cystectomy: Surgery to remove part of the bladder. This is appropriate for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
  • Urinary diversion: Surgery to make a new way for the body to store and pass urine. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy following surgery to kill any cancer cells that remain. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Photodynamic therapy
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue.

The National Cancer Institute provides more detailed information about bladder cancer.

References
Oregon Urology Institute