Bladder Cancer

What is Bladder Cancer?

The bladder is an expandable, hollow organ in the pelvis that stores urine (the body's liquid waste) before it leaves the body during urination. The urinary tract, made up of the kidneys, ureters, bladder, and urethra, is lined with a layer of transitional cells called the urothelium. This layer of cells is separated from the bladder muscles (called the muscularis propria) by a thin, fibrous band called the lamina propria. The lamina propria separates tumors that have spread into muscle (called invasive cancer) from those that have not (superficial or non-invasive cancers).

Bladder cancers are malignant tumors that begin in the bladder. Different bladder cancers are described by how deep they grow and if they grow into the bladder or through the muscles around the bladder (superficial or invasive).

There are three types of bladder cancer: transitional cell carcinoma, or TCC (about 90% of bladder cancer cases); squamous cell carcinomas (about 8%); and adenocarcinomas (about 2%). There are other less common types of cancer that arise in the bladder, including sarcomas (which begin in the muscle layers of the bladder) and small cell anaplastic cancers (a rare type very likely to spread to other parts of the body).

All three types can metastasize beyond the bladder. The tumor can grow into the surrounding organs (uterus and vagina in women; prostate in men), called locally advanced disease. It can also spread to the nearby lymph nodes, and/or into the liver, bones, or lungs; this is called distant metastasis. In some cases, it can spread to other parts of the body.

As we well know, there are many kinds of cancer; unfortunately they all come about because of the out-of-control growth of abnormal cells.

Leading Cancers in Women, Men, & Children

For Women: Breast cancer is the leading cancer for women in the US. Lung cancer is the second most common form of cancer and colorectal cancer is third among white women. The number 2 and 3 cancers are reversed among black and Asian/Pacific Island women. For all women, the fourth leading cancer is cancer of the uterus.

For Men: Prostate cancer is the leading cancer for men in the US. It is followed by lung cancer and then colorectal cancer. The fourth most common cancer is race-dependent. It is bladder cancer for white men, cancer of the mouth and throat for black men; and stomach cancer for Asian/Pacific Island men.

For Children: The most common malignancies in childhood are leukemia, followed by brain tumors, and lymphoma.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Bladder cancer is a fairly common form of cancer in the United States. Whites contract bladder cancer twice as often as blacks, and men are affected two to three times as often as women. Most bladder cancers occur after the age of 55, but the disease can also develop in younger people.

Each year, more than 50,000 people in the United States find out they have bladder cancer. The outlook for patients with early bladder cancer is very good. The chances of recovery from more advanced bladder cancer are improving as researchers continue to look for better ways to treat this disease.

Smoking, gender, and diet can affect the risk of developing bladder cancer.

Risk factors include the following:

- 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.
- Having an infection caused by a certain parasite.

Possible signs of bladder cancer include blood in the urine or pain during urination.

These and other symptoms may be caused by bladder cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- Blood in the urine (slightly rusty to bright red in color).
- Frequent urination, or feeling the need to urinate without being able to do so.
- Pain during urination.
- Lower back pain.

What is hematuria?

Hematuria means blood in the urine. Microscopic hematuria indicates that the blood is only seen when the urine is examined under a microscope, while gross hematuria means that there is enough blood in the urine so that it can be seen with the naked eye. Despite the quantity of blood in the urine being different, the types of diagnoses that can cause the problem are the same, and the workup or evaluation that is needed is identical.

Since blood in the urine must come from one of the organs involved in making or transporting the urine, the evaluation of hematuria requires that we consider the entire urinary tract. This organ system includes the kidneys, ureter (the tube that carries the urine from the kidney to the bladder), bladder, prostate, or urethra (tube leading out of the bladder). It must be emphasized that even a single episode of hematuria requires evaluation, even if it resolves spontaneously.

What are the causes of hematuria?

There are multiple causes of hematuria. Some are serious, including cancers, trauma, stones, infections, and obstructions of the urinary tract. Others are less important, and may require no treatment. These may include viral infections, nonspecific inflammations of the kidney, medications which thin the blood's clotting ability, and benign prostate enlargement.

How is hematuria evaluated?

The evaluation for hematuria consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and finally, obtaining a culture of the urine. A significant history would include whether or not there was any pain or discomfort associated with the hematuria; whether the blood was in the beginning, end, or throughout the urinary stream; and finally, whether there is a personal history of smoking, kidney stones, injuries to the urinary tract, trouble urinating, or previous urologic evaluation.

No matter how obvious the reason for hematuria appears to be, a complete evaluation is almost always necessary to rule out a serious underlying disease, such as a cancer. There are usually three diagnostic tests necessary to give us a look at the entire urinary tract, and these include the intravenous pyelogram (IVP), cystoscopy, and urine cytology.

The intravenous pyelogram, or IVP, is an x-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of x-rays are then taken over a thirty-minute period, looking for abnormalities. This study is especially useful for evaluating the kidneys and ureter, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. In this procedure, a small viewing tube, or cystoscope, is used to visually inspect the bladder and the urethra. In most instances, this can be done without discomfort by the use of local anesthetic jelly. The cystoscope is passed up the urethra into the bladder, and the inspection is carried out. The entire examination takes less than ten minutes. The final test is a urine cytology, which involves voiding urine into a cup and having that urine examined by a pathologist to look for cancer cells.

How is hematuria treated?

Management of hematuria depends upon the underlying cause. Many times a cause cannot be found, which is fortunate, because it generally suggests that there is not a harmful situation present. Remember that the real reason for a hematuria workup is not to prove a specific cause, but to rule out a serious problem. If no cause is found for the hematuria, the urine should be checked on a yearly basis to make certain that no changes are occurring. However, if gross hematuria were to recur, repeat evaluation may be necessary, and a physician should be consulted. A blood test to check kidney function and a blood pressure check should be done as well. Men over fifty should have a yearly PSA, or prostate specific antigen, to screen for prostate cancer.

Further discussion of the treatment for hematuria would depend upon the results of the previously mentioned workup and the exact cause for the hematuria. The urologist who performs this examination would direct any further treatment or workup that would be necessary.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.
- Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
- Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
- The type of bladder cancer cells and how they look under a microscope.
- The patient’s age and general health.

Treatment options depend on the stage of bladder cancer.

Cancer

What is cancer?
Cancer begins in Human cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should.

Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.
When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

So we can said that cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.

Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the cancer type and how advanced it is. Treatment plans may include surgery, radiation and/or chemotherapy.

Symptoms
Symptoms of cancer depend on the type and location of the tumor. For example, lung cancer can cause coughing, shortness of breath, or chest pain. Colon cancer often causes diarrhea, constipation, and blood in the stool.
Some cancers may not have any symptoms at all. In certain cancers, such as gallbladder cancer, symptoms often do not start until the disease has reached an advanced stage.
The following symptoms can occur with most cancers: chills, fatigue, fever, loss of appetite, malaise, night sweats, weight loss, etc..

Mesothelioma

Mesothelioma is a form of lung cancer that is almost always caused by asbestos exposure and is most commonly found in the outer lining of the lungs called the mesothelium. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos and glass particles, or they have been exposed to asbestos dust and fiber in other ways.
Asbestos exposure doesn't result immediately in cancer. It takes years for the cancer to form and cause symptoms. Workers exposed in the 1950's, 60's, and 70's are just now being diagnosed with mesothelioma.
Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum).
Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart), or the tunica vaginalis (a sac that surrounds the testis).
Pleural mesothelioma is the most common form, often presenting with symptoms in the chest area. Peritoneal mesothelioma is much less common. This can effect the organs in the abdomen, and its symptoms are related to this area of the body, that is, abdominal swelling, nausea, vomiting, and bowel obstruction. The rarest form of mesothelioma is pericardial mesothelioma, which involves the sac surrounding the heart.

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss.
Symptoms of mesothelioma do not appear immediately after being exposed, taking about 25 to 50 years after the initial exposure to develop. It is a very slow progressing disease that usually strikes middle age to senior adults long after their exposure to asbestos.

Symptoms of mesothelioma vary based on the type of mesothelioma, but general symptoms include:
- shortness of breath
- persistent cough
- chest pain
- wheezing
- abdominal mass
- abdominal swelling
- abdominal pain
changes in bowel habits

Many of these symptoms are non-specific, meaning they aren't exactly red flags for mesothelioma. However, when combined with previous exposure to asbestos, it may suggest to your physician to evaluate for mesothelioma. It is very important that your doctor is aware of any prior exposure to asbestos. Mesothelioma is also a rare disease, so it can be overlooked in the diagnostic process.