Bladder cancer is an abnormal growth or tumor arising from the lining of the bladder. The technical term for most bladder cancers is "transitional cell carcinoma. The normal bladder has a flat, smooth, shiny, watertight lining consisting of layers of cells tightly connected with each other.
The lining of the bladder can be imagined to be similar to the lining in the oral cavity mouth. Underneath this lining is the muscle tissue of the bladder. The muscle is responsible for pushing out the urine at the time of voiding. Bladder tumors almost always arise from the shiny bladder lining.
The cells grow abnormally fast causing a tumor to sprout up from the flat lining into a growth projecting into the interior of the bladder cavity. In general, tumors at this stage are not life-threatening.
They usually do not cause any symptoms and remain unnoticed until an episode of bleeding into the urine. After an episode of bleeding into the urine, the patient should undergo an evaluation by a urologist. The urologist is usually called upon to look into the bladder with a cystoscope a telescope that can be inserted into the bladder. The urologist may also order various types of X-ray studies. This type of testing is very successful at finding bladder tumors. This procedure, called "transurethral resection of bladder tumor," is accomplished using cystoscopes; therefore there are no surgical incisions.
Depending on the amount of tissue that is removed as well as other factors, the procedure is either done on an outpatient basis or with a short hospital stay. Stage and Grade. The tissue that is removed is examined by the pathologist under the microscope. The pathologist must assign a "stage" and a "grade" to the tumor tissue. Speak to your doctor or nurse for information about these types of cancer.
The stage of a cancer means how far it has grown in your body. The most common way doctors decide on a stage for bladder cancer is the TNM system tumour, nodes metastasis. This system describes:. Another way of staging cancer is with numbers. Stage 1 is the earliest cancer and stage 4 is the most advanced but this is not used often for bladder cancer.
Ask your doctor or nurse to explain the stage of the cancer. The grade of the cancer means how quickly a cancer might grow. Knowing the grade helps your doctors work out the best treatment plan for you:.
It is an early stage cancer but is always high grade. This means it can grow quickly and might spread. If you have bladder carcinoma in situ your doctor will start treatment straight away. Treatment for this type of bladder cancer can be very effective. Your treatment team can tell you more.
Bladder cancer can usually be effectively treated if it is found before it spreads outside the bladder. If you have bladder cancer, your doctor will talk to you about your individual situation when working out your prognosis.
Treatment for bladder cancer depends on how quickly the cancer is growing. Treatment is different for non-muscle invasive bladder cancer and muscle-invasive bladder cancer. You might feel confused or unsure about your treatment options and decisions. Treatments for non-muscle-invasive bladder cancer include surgery, immunotherapy and chemotherapy. Most people with non-muscle-invasive bladder cancer have an operation to remove the cancer.
For some people bladder cancer can come back after surgery. You will need to have regular follow-up tests. This way you can start appropriate treatment if the cancer comes back.
Immunotherapy uses your own immune system to treat cancer. Because this immunotherapy goes directly into the bladder through a tube catheter it is called intravesical immunotherapy. To find out more about how the immune system works, read the immune system explained. You will usually have more than one dose of the immunotherapy for it to be effective.
Most commonly you will have treatment once a week for several weeks. This may happen in a hospital or clinic. The treatment may have to be repeated depending on your response. This treatment uses medication to destroy or slow the growth of cancer cells, while causing the least possible damage to healthy cells. Intravesical chemotherapy goes directly into the bladder through a tube called a catheter. It is only used for non-muscle-invasive bladder cancer to help keep the cancer from coming back.
You may have one dose or more than one dose, depending on your situation. Treatments for non-muscle-invasive bladder cancer include surgery, chemotherapy, radiation therapy and immunotherapy. The most common treatment for muscle-invasive bladder cancer is surgery to remove the bladder. This is called a radical cystectomy. Sometimes doctors need to remove other parts of the body, like the uterus or prostate. This may mean you are no longer able to have children. This can be a difficult choice and you might like to ask for support.
But a very small amount of blood might be normal in some people. Frequent urination and pain when you pass urine dysuria are less common symptoms of bladder cancer.
If you have these symptoms, it's important to see your health care provider. People can get bladder cancer when they come into contact with tobacco or other cancer-causing agents.
There also are some risks related to genes and certain types of infections. Another known risk factor is a type of radiation beam aimed at the pelvis. Patients with other cancers, such as lymphomas and leukemia, who receive treatment with the drug cyclophosphamide, may be at a higher risk for bladder cancer. You are more likely to get bladder cancer if you smoke or breathe in tobacco smoke.
Smoking tobacco may be the cause of half of all bladder tumors. If you smoke, you are more likely to get bladder cancer than those who have stopped smoking.
Some things in the workplace may put you at a greater risk for bladder cancer. Contact with chemicals used to make plastics, paints, textiles, leather and rubber may cause bladder cancer. Your healthcare provider will first perform a full medical history and physical exam. If your diagnosis is bladder cancer, additional tests will find out the stage of your disease.
It will also give your doctor an idea of what treatment is best for you. Some of these tests are described here. If any of these tests suggest that you have bladder cancer, the next step to confirm the diagnosis is a transurethral resection of a bladder tumor TURBT described below.
You will likely be put to sleep for this procedure. The tissue sample will be sent to a laboratory where they will find out important information about your cancer. They will also see whether the cancer has spread. This will help with choosing the right treatment. Other Additional Imaging tests: These tests may help your doctor diagnose and stage bladder cancer. Grade and stage are two important ways to measure and describe how cancer develops. A tumor grade tells how aggressive the cancer cells are.
A tumor stage tells how much the cancer has spread. Grading is one of the ways to know if the disease will come back. Tumors can be low or high grade. High-grade tumor cells are very abnormal, poorly organized and tend to be more serious. They are the most aggressive type.
The tumor stage tells how much of the tissue has the cancer. Doctors can tell the grade and stage of bladder cancer by taking a small sample of the tumor. This is called a biopsy. A pathologist in a lab examines the sample under a microscope and determines the grade and stage of the cancer. Bladder cancer is described by how far into the wall of the bladder the cancer has grown which is the clinical stage. Non-muscle invasive bladder cancers are found in the inner layer cells of the bladder.
These cancers do not invade the muscular wall. Over half of patients with low-grade Ta cancers will have a tumor recurrence. However, it is important that the disease is diagnosed early. This helps doctors predict the course of the disease and choose the best treatment to stop it from growing. A cancer diagnosis can be very frightening.
However, your doctor and medical team are there to help you. Talk with your health care team about all the available forms of treatment. They will tell you about possible risks and the side effects of treatment on your quality of life.
Your options for treatment will depend on how much your cancer has grown. Your urologist will stage and grade your cancer and assess the best way to manage your care considering your risk.
Treatment also depends on your general health and age. If these options fail to treat your cancer, your doctor may recommend removing the complete bladder. The surgery is done through the urethra using a cystoscope, so there is no cutting into the abdomen. You will be given general or spinal anesthesia.
A rigid cystoscope is what your doctor will use for this procedure. This scope is straight and does not bend. It has a light at the end and is bigger and allows surgical instruments to pass through it. Your doctor is able to see inside the bladder, take tumor samples and resect cut away the tumor. If a tumor is clearly seen, the doctor will attempt to remove it all. The doctor may also remove very small samples of other areas of the bladder that may look abnormal.
These samples will also be checked for grade and stage. You may be left with a Foley catheter in your bladder after this procedure to allow your bladder to heal. During your follow-up examinations your doctor will check to make sure all the cancer is removed. Intravesical "within the bladder" therapy, is when a treatment drug is put directly into your bladder.
The drug is put into the bladder with the help of a catheter a thin tube that is placed through the urethra. You will hold the drug in your bladder for one to two hours and then pass it out. Intravesical chemotherapy is usually given immediately after surgery. Immunotherapy is a treatment that boosts the ability of your immune system to fight the cancer. BCG also has been used as a tuberculosis vaccine.
Your cells will pick up the tracer as it passes through your body. When the scanner passes over the bladder, the tracer allows your doctor to better see where and how much the cancer is growing.
Grading and Staging. Tumor Grade Grading is one of the ways to know if the cancer will return. Tumor Stage The tumor stage tells how much of the bladder tissue has cancer. The stages of bladder cancer are: Ta: Tumor on the bladder lining that does not enter the muscle Tis: Carcinoma in situ - a high-grade cancer - looks like a reddish, velvety patch on the bladder lining T1: Tumor goes through the bladder lining but does not reach the muscle layer T2: Tumor grows into the muscle layer of the bladder T3: Tumor goes past the muscle layer into tissues around the bladder T4: Tumor has spread to nearby structures such as lymph nodes and the prostate in men or the vagina in females.
Choices for Treatment Treatments for muscle invasive bladder cancer include: Bladder removal cystectomy with chemotherapy or without chemotherapy Chemotherapy with radiation, in addition to TURBT Chemotherapy Chemotherapy uses drugs to kill cancer cells.
Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells, such as: Blood cells: If chemotherapy drugs lower the levels of healthy blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells.
If your levels are low, you may need to stop the chemotherapy or reduce the dose of the drug. There are also medicines that can help your body make new blood cells. Cells in hair roots: Chemotherapy may cause hair loss.
If you lose your hair, it will grow back after treatment. But your hair color and texture may be different. Cells that line the digestive system: Chemotherapy can cause a poor appetite, upset belly and vomiting, loose stools, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.
Symptoms most often go away when treatment ends. Nerve cells: Some drugs used for bladder cancer may cause tingling or numbness in your hands and feet. Your healthcare team can suggest ways to control these side effects. Surgery to Remove the Bladder Cystectomy FFor MIBC, because the cancer has grown into the muscle, in most cases the whole bladder is removed in some cases only part of the bladder is removed. What happens during surgery? There are many things to think about before choosing open or robotic bladder removal: Your body weight History of prior surgery History of prior radiation Where to go for surgery.
There is some evidence that complex surgery such as bladder removal has better outcomes when performed at Centers of Excellence facilities rather than hospitals, etc. If you have concerns, get a second point of view. Partial Cystectomy removal of part of the bladder For MIBC, partial cystectomy is a less likely choice as the cancer may be more advanced. Urinary Diversion after Bladder Removal When your bladder is removed or partly removed, your urine will be stored and made to leave your body by a different route urinary diversion.
Here are some of the urinary diversion choices your surgeon may offer: Ileal conduit: To make an ileal conduit, the surgeon will take a piece of your upper intestine and use it to make an opening stoma on the surface of your stomach. The ureters are joined so that the urine leaves your body by the opening. A bag will be attached to collect the urine and you will "dump" the bag many times a day. This is the most simple and most often used diversion after bladder surgery.
Continent cutaneous reservoir: Your surgeon makes a pouch inside your body and you will learn to use a catheter to remove your urine. Orthotopic neobladder: Your surgeon makes an internal pouch, much like your bladder, to store urine. Your ureters are joined to this new "bladder" and you are able to empty through your urethra the same way you did before surgery. In some instances, you may need to use a catheter to remove the urine.
Chemotherapy with radiation Bladder Preservation Chemotherapy with radiation may be used for bladder preservation keeping the bladder or parts of it.
Bladder Cancer Clinical Trials. What about Clinical Trials? After Treatment. However, continuous observation may include some or all of the following: Imaging e. CT scan about every months for years; and then once a year. Laboratory tests may be every months for years; and then once a year. Kidney and liver function tests will be a part of these tests. Assessment for quality of life issues, such as urinary symptoms and sexual function.
Here are some possible problems you may have after treatment: Gastrointestinal GI problems. You may have problems with your bowel function right after surgery. This often happens after abdominal surgery. Your health care provider will take steps to check bowel function and avoid GI problems. Urinary diversion. Urinary diversion after bladder surgery may present challenges for which you should prepare yourself.
You may need to learn how to remove urine from your body with a catheter. There also is the chance for leakage from the stoma opening that is made to take away urine. Infections linked to urinary diversion may happen, as may infections linked to the kidneys. It is of great value to learn as much as you can about the urinary diversion method you will use, and how to manage changes to your body. Also, before you leave the hospital, your health care providers will make sure you get the education you need so you can manage your new way of life.
Hormonal changes. For females who are not yet menopausal, you may have hot flashes after your ovaries are removed. Reproductive health. When the prostate is removed, a man can no longer father a child. Also, a man may be unable to have sex after surgery. When the uterus is removed, a woman can no longer get pregnant. If the surgeon removes part of a woman's vagina, then sex may be difficult.
Sexual dysfunction: Bladder cancer surgery is likely to change your sex life. If you have a partner, you may be worried about sexual intimacy and your relationship. It may help you and your partner if you talk about your feelings. You can find other ways to be intimate after you had treatment.
If you do not have a partner, you may want to explore how to manage your dating life after bladder cancer surgery. Either way, you and your partner may benefit from the help of a counselor who specializes in talking about sexual issues.
Your healthcare provider may be able to refer you to medical professionals and counselors who specialize in sexual issues after cancer treatment. You can also find a certified sex therapist near you on the website of the American Association of Sexuality Educators, Counselors and Therapists. Managing Pain: You may have pain or discomfort for the first few days after bladder surgery.
0コメント