Bladder Cancer

The bladder is a hollow organ in the lower abdomen. It stores urine, the liquid waste produced by the kidneys. Urine passes from each kidney into the bladder through a tube called a ureter.

An outer layer of muscle surrounds the inner lining of the bladder. When the bladder is full, the muscles in the bladder wall can tighten to allow urination. Urine leaves the bladder through another tube, the urethra.


Bladder Cancer: Who's at Risk?

No one knows the exact causes of bladder cancer. However, it is clear that this disease is not contagious. No one can "catch" cancer from another person.

People who get bladder cancer are more likely than other people to have certain risk factors. A risk factor is something that increases a person's chance of developing the disease.

Still, most people with known risk factors do not get bladder cancer, and many who do get this disease have none of these factors. Doctors can seldom explain why one person gets this cancer and another does not.

Studies have found the following risk factors for bladder cancer:

  • Age. The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.
  • Tobacco. The use of tobacco is a major risk factor. Cigarette smokers are two to three times more likely than nonsmokers to get bladder cancer. Pipe and cigar smokers are also at increased risk.
  • Occupation. Some workers have a higher risk of getting bladder cancer because of carcinogens in the workplace. Workers in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.
  • Infections. Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas but not in the United States.
  • Treatment with cyclophosphamide or arsenic. These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.
  • Race. Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.
  • Being a man. Men are two to three times more likely than women to get bladder cancer.
  • Family history. People with family members who have bladder cancer are more likely to get the disease. Researchers are studying changes in certain genes that may increase the risk of bladder cancer.
  • Personal history of bladder cancer. People who have had bladder cancer have an increased chance of getting the disease again.

Chlorine is added to water to make it safe to drink. It kills deadly bacteria. However, chlorine by-products sometimes can form in chlorinated water. Researchers have been studying chlorine by-products for more than 25 years. So far, there is no proof that chlorinated water causes bladder cancer in people. Studies continue to look at this question.

Some studies have found that saccharin, an artificial sweetener, causes bladder cancer in animals. However, research does not show that saccharin causes cancer in people.

People who think they may be at risk for bladder cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.


Symptoms

Common symptoms of bladder cancer include:

  • Blood in the urine (making the urine slightly rusty to deep red),
  • Pain during urination, and
  • Frequent urination, or feeling the need to urinate without results.

These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. People with symptoms like these may see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.


Diagnosis

If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:

Physical exam - The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.

Urine tests - The laboratory checks the urine for blood, cancer cells, and other signs of disease.

CT Scan - The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.

Cystoscopy - The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure.

The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.

A patient who needs a biopsy may want to ask the doctor some of the following questions:

  • Why do I need to have a biopsy?
  • How long will it take? Will I be awake? Will it hurt?
  • How soon will I know the results?
  • Are there any risks? What are the chances of infection or bleeding after the biopsy?
  • If I do have cancer, who will talk with me about treatment? When?

Treatment

Many people with bladder cancer want to take an active part in decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people often feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

The doctor may refer patients to doctors who specialize in treating cancer, or patients may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about bladder cancer.


Surgery

For a few days after transurethral resection, patients may have some blood in their urine and difficulty or pain when urinating. Otherwise, transurethral resection generally causes few problems.

After cystectomy, most patients are uncomfortable during the first few days. However, medicine can control the pain. Patients should feel free to discuss pain relief with the doctor or nurse. Also, it is common to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each person.

After segmental cystectomy, patients may not be able to hold as much urine in their bladder as they used to, and they may need to urinate more often. In most cases, this problem is temporary, but some patients may have long-lasting changes in how much urine they can hold.

If the surgeon removes the bladder, the patient needs a new way to store and pass urine. In one common method, the surgeon uses a piece of the person's small intestine to form a new tube through which urine can pass. The surgeon attaches one end of the tube to the ureters and connects the other end to a new opening in the wall of the abdomen. This opening is called a stoma. A flat bag fits over the stoma to collect urine, and a special adhesive holds it in place. The operation to create the stoma is called a urostomy or an ostomy. The section called "Rehabilitation after Bladder Cancer" has more information about how patients learn to care for the stoma.

For some patients, the doctor is able to use a part of the small intestine to make a storage pouch (called a continent reservoir) inside the body. Urine collects in the pouch instead of going into a bag. The surgeon connects the pouch to the urethra or to a stoma. If the surgeon connects the pouch to a stoma, the patient uses a catheter to drain the urine.

Bladder cancer surgery may affect a person's sexual function. Because the surgeon removes the uterus and ovaries in a radical cystectomy, women are not able to get pregnant. Also, menopause occurs at once. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. Many women take hormone replacement therapy (HRT) to relieve these problems. If the surgeon removes part of the vagina during a radical cystectomy, sexual intercourse may be difficult.

In the past, nearly all men were impotent after radical cystectomy, but improvements in surgery have made it possible for some men to avoid this problem. Men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they have dry orgasms. Men who wish to father children may consider sperm banking before surgery or sperm retrieval later on.

It is natural for a patient to worry about the effects of bladder cancer surgery on sexuality. Patients may want to talk with the doctor about possible side effects and how long these side effects are likely to last. Whatever the outlook, it may be helpful for patients and their partners to talk about their feelings and help one another find ways to share intimacy during and after treatment.

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