What Is Bladder Cancer?

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Bladder Cancer

Bladder cancer symptoms include painless blood in the urine or frequent and painful urination. Bladder cancer is highly treatable with options such as surgery, chemotherapy and radiation. Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder.

It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms include blood in the urine, pain with urination, and low back pain.

Risk factors for bladder cancer include smoking, family history, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals. The most common type is transitional cell carcinoma. Other types include squamous cell carcinoma and adenocarcinoma. Diagnosis is typically by cystoscopy with tissue biopsies. Staging of the cancer is typically determined by medical imaging such as CT scan and bone scan.

Treatment depends on the stage of the cancer. It may include some combination of surgery, radiation therapy, chemotherapy, or immunotherapy. Surgical options may include transurethral resection, partial or complete removal of the bladder, or urinary diversion. Typical five-year survival rates in the United States are 77%.

Bladder cancer, as of 2015, affects about 3.4 million people with 430,000 new cases a year.Age of onset is most often between 65 and 85 years of age.Males are more often affected than females.In 2015 it resulted in 188,000 deaths.

The most common type of bladder cancer is transitional cell carcinoma, which begins in urothelial cells that line the inside of the bladder. Urothelial cells are transitional cells, which are able to change shape and stretch when the bladder is full. This type of cancer is also called urothelial carcinoma. Other types of bladder cancer include squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

People who smoke have an increased risk of bladder cancer. Being exposed to certain chemicals and having chronic bladder infections can also increase the risk of bladder cancer.

The most common sign of bladder cancer is blood in the urine. Bladder cancer is often diagnosed at an early stage, when the cancer is easier to treat.

What Is Bladder Cancer?

The bladder is a hollow, flexible pouch in your pelvis. Its main job is to store urine before it leaves your body. Your kidneys make pee. Tubes called ureters carry the pee from your kidneys to your bladder. When you use the bathroom, the muscles in your bladder push the urine out through a tube called the urethra.

You get bladder cancer when cells inside of it grow out of control. Over time, a tumor forms. It can spread to nearby fat and tissue. In severe cases, it can spread to distant parts of your body, including your lymph nodes, bones, lungs, or liver.

Bladder cancer is rare. It accounts for just 5% of all new cancers in the U.S.

Types of bladder cancer

Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. The type of bladder cancer determines which treatments may work best for you.

Types of bladder cancer include:

  • Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and tumors can form in those places as well. Urothelial carcinoma is the most common type of bladder cancer in the United States.
  • Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder, for instance from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the United States. It’s more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections.
  • Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United States.

Risk factors

Factors that may increase bladder cancer risk include:

  • Smoking. Smoking cigarettes, cigars or pipes may increase the risk of bladder cancer by causing harmful chemicals to accumulate in the urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
  • Increasing age. Bladder cancer risk increases as you age. Bladder cancer can occur at any age, but it’s rarely found in people younger than 40.
  • Being white. White people have a greater risk of bladder cancer than do people of other races.
  • Being a man. Men are more likely to develop bladder cancer than women are.
  • Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it’s thought that being around certain chemicals may increase the risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
  • Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have an elevated risk of developing bladder cancer.
  • Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis.
  • Personal or family history of cancer. If you’ve had bladder cancer, you’re more likely to get it again. If one of your first-degree relatives — a parent, sibling or child — has a history of bladder cancer, you may have an increased risk of the disease, although it’s rare for bladder cancer to run in families. A family history of hereditary nonpolyposis colorectal cancer, also called Lynch syndrome, can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organs.

Who is affected?

About 10,000 people are diagnosed with bladder cancer every year and it’s the seventh most common cancer in the UK.

The condition is more common in older adults, with more than half of all new cases diagnosed in people aged 75 and above.

Bladder cancer is also more common in men than in women, possibly because in the past, men were more likely to smoke and work in the manufacturing industry.

What Causes It?

Doctors aren’t sure. But they do know that several things increase your risk for the disease. They include:

Genetic makeup, race, and family history. Bladder cancer is most common in white men over age 40. If you or someone in your immediate family (parents or siblings) has had cancer of the bladder or the urinary tract before, you’re more likely to get it.

Chronic bladder inflammation. If you have bladder infections that keep coming back or another condition that causes your bladder to be irritated for long periods of time, you stand a better chance of getting bladder cancer.

Smoking . Every time you inhale tobacco fumes, you’re taking in all kinds of harmful chemicals. Over time, these build up in your bladder. You may pee some of them out. But they can still damage the lining of your bladder and put you at risk for cancer.

Working around harmful chemicals. People who work in certain industries (painters, machinists, printers, hairdressers, and truck drivers, among others) may be exposed to harmful chemicals for long periods of time. This can increase their risk of disease.

Taking certain diabetes medications. If you’ve taken pioglitazone (Actos) for more than a year, you may stand a greater chance of getting bladder cancer. Other diabetes meds that contain pioglitazone (Actoplus Met and Duetact) can also raise your risk.

Prior chemo or radiation treatment. If you’ve had radiation therapy to your pelvis, you’re more likely to develop bladder cancer. The same is true if you’ve taken the chemo medication cyclophosphamide (Cytoxan) for a long time.

The 5-year survival rate for bladder cancer is about 77%. That means that about 7 out of 10 people who are diagnosed with the disease will still be alive 5 years later. But that’s just an estimate. Your outcome is based on your unique situation. That includes things like your age, overall health, how early the cancer was found, and how well it responds to treatment.

Symptoms

Bladder cancer signs and symptoms may include:

  • Blood in urine (hematuria)
  • Painful urination
  • Pelvic pain

If you have hematuria, your urine may appear bright red or cola colored. Sometimes, urine may not look any different, but blood in urine may be detected during a microscopic exam of the urine.

People with bladder cancer might also experience:

  • Back pain
  • Frequent urination

But, these symptoms often occur because of something other than bladder cancer.

What Are the Symptoms of Bladder Cancer?

The most common — and often, the first — symptom is blood in your urine. It may be just a little, or it can be enough to change the color of your pee. It may turn orange, pink, or darker red.

You may see blood one day, but not the next. If you have bladder cancer, the blood eventually comes back. In some cases, you can’t see blood in your urine. Your doctor or lab tech will only see it under a microscope.

Make an appointment if you have any of these other symptoms:

  • You have to pee more often than usual
  • Your urine changes color
  • It hurts or burns when you pee
  • You feel like you have to pee — even if your bladder’s not full
  • You can’t pee, or you pee very little

If you notice any of these things, call your doctor, but don’t panic. Having these symptoms doesn’t mean you have cancer. You could have a urinary tract infection, bladder infection, or some other less serious condition.

Once bladder cancer starts to spread, you may notice that:

  • You can’t pee, even when you feel like you have to
  • Your lower back hurts
  • You’re losing weight without trying
  • You’re not as hungry as usual
  • You have swollen feet
  • Your bones hurt
  • You often feel extremely tired or weak

Again, see your doctor if any of these things happen to you. They could also signal that you have something other than bladder cancer.

How Do I Know If I Have Bladder Cancer?

To find out whether you have bladder cancer, the first thing your doctor probably will do is a complete medical history. He’ll ask you about your overall health, as well as anything that increases your risk, like having a family member who had bladder cancer.

Next, he’ll probably do physical exam. This may include a pelvic exam (for women) or a digital rectal exam (DRE). In this procedure, your doctor will put on a glove and insert one finger into your rectum. This will allow him to feel a tumor in your bladder. It’ll also give him an idea of how big it is or whether it has spread.

If your doctor finds something that’s not normal, he’ll order lab tests. He might also send you to see a urologist. That’s a doctor who focuses on diseases affecting the urinary system (kidneys, bladder, etc.) and male reproductive system. Your urologist may run the following tests to get a better idea of what’s going on:

Urine Tests

When you pee in a cup at your doctor’s office, there are a number of things he and other health professionals can look for:

  • Urinalysis. Your doctor will check to see if there’s any blood, or other substances, in your urine.
  • Urine cytology. Your doctor will use a microscope to check your urine for cancer cells.
  • Urine culture. Your doctor will send your urine to a lab. After a few days, lab technicians will check to see what kinds of germs grow in it. These results will tell your doctor if you have a bladder infection.
  • Urine tumor marker tests. These look for substances that are released by bladder cancer cells. Your doctor may use one or more of these along with a urine cytology to see if you have the disease.

Cystoscopy

Your doctor will place a cystoscope through the opening of your urethra — the duct that you pee through — and into your bladder.

The cytoscope is a thin tube with a light and video camera on the end. Your doctor will inject salt water through the tube and into your bladder. This will allow him to see the inner lining of your bladder with the camera.

He may give you medicine to numb your urethra and bladder. If the procedure is done in the operating room, you’ll be given anesthesia so you won’t be awake.

What Are the Stages of Bladder Cancer?

Bladder cancer, like other cancers, is measured in stages. The stages describe how far your cancer has spread. This key piece of information will help you and your doctor choose the best treatment for your unique case.

There are two types of stages for bladder cancer — the clinical stage and the pathologic stage.

The clinical stage is your doctor’s informed opinion of how far your cancer has spread. This is based on results of a number of tests, including physical exams, imaging tests like MRIs or CT scans, and biopsies.

Your doctor will use this information to plan your treatment.

The pathologic stage is something your doctor determines after surgery to remove the cancer. He’ll look at previous test results. He’ll also examine what he found during surgery to give you an idea of how far your cancer has spread.

Bladder Cancer Treatments: What to Know

If you have bladder cancer, there are several available treatment options. Your doctor will help you decide which treatment is best for you and this will depend on a number of things. These include your age, how much the cancer has spread (doctors call this your cancer “stage”), and any other health conditions you have.

Surgery

Transurethral resection of bladder tumor (TURBT) is the most common surgery for bladder cancer that’s in the early stages. This procedure is done in a hospital, but you should be able to go home the same day or the next.

Your doctor will put an instrument called a resectoscope into your bladder through your urethra. That’s the tube that urine flows through when you go to the bathroom. The resectoscope has a wire loop at the end. Your doctor will use it to remove abnormal tissues or tumors. If you still have cancer after the tumor is removed, your doctor can destroy it using a laser and another tool called a cystoscope.

Prevention

Although there’s no guaranteed way to prevent bladder cancer, you can take steps to help reduce your risk. For instance:

  • Don’t smoke. Not smoking means that cancer-causing chemicals in smoke can’t collect in your bladder. If you don’t smoke, don’t start. If you smoke, talk to your doctor about a plan to help you stop. Support groups, medications and other methods may help you quit.
  • Take caution around chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
  • Choose a variety of fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.

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