Bladder cancer
Alternative names:
transitional cell carcinoma of the bladder
Treatment:
The choice of an appropriate treatment is based on the stage of the tumor, the severity of the symptoms, and the presence of other medical conditions. Generally, noninvasive tumors (Stages 0 and A) are treated by removing the lesion and administering local chemotherapy. However, because of the risk of recurrence is so high (70 -100%), people with bladder cancer require constant follow-up for the rest of their lives.
The treatment for Stage B bladder tumors may involve a trial of BCG chemotherapy with serial follow-up. however, most people with Stage B, C, or D tumors will require bladder removal (radical cystectomy).
MEDICATIONS: Chemotherapy for the treatment of bladder cancer is usually administered through a foley catheter to instill the medication directly into the bladder (intravesical chemotherapy). The catheter is removed immediately after the medication has been instilled, though you are instructed to try to hold the medication in your bladder for at least two hours after treatment. Additionally, you may be asked to rotate from side to side every 15 - 30 minutes to ensure complete exposure of the entire bladder wall to the medication.
Several different types of medications may be used for intravesical chemotherapy, such as: - Thiotepa
- Mitomycin-C
- Doxorubicin (Adriamycin)
These medications are usually given weekly. The various forms of intravesical chemotherapy kill bladder tumors by altering the structure of the tumor cells. Common side effects include bladder wall irritation, genital area skin rash, and bone marrow suppression. Choice of a specific agent is usually based on the stage of the tumor.
Additionally, bladder cancers are often treated by what is known as intravesical immunotherapy, in which a medication is given that causes your own immune system to attack and kill the tumor cells. Immunotherapy is usually performed using Bacille Calmette-Guerin (commonly known as BCG), which is a solution of genetically altered tubercular bacilli that has been rendered completely avirulent (not able to produce infection). This medication is administered through a foley catheter to instill the medication directly into the bladder. Since BCG is a biological agent, special precautions must be taken.
Potential side effects, which include bladder irritability, urinary frequency, urinary urgency, and painful urination are reported by 90% of the people treated with BCG. However, the symptoms usually resolve within a few days after treatment. Other rare side effects include hematuria (blood in the urine), malaise, nausea, chills, joint pain, and itching. Potentially, a systemic tubercular (TB) infection can develop, requiring treatment with anti-tuberculosis medication. Systemic infection is suspected if you develop an elevated temperature that lasts for more than one day.
SURGERY: - TRANSURETHRAL RESECTION OF THE BLADDER (TURB):
People with Stage 0 or A bladder cancer are usually treated with transurethral resection of the bladder (TURB). This procedure is performed under general or spinal anesthesia. A cutting instrument is then inserted through the urethra to remove the bladder tumor.
Most people with Stage B, C, or D bladder cancer will opt for bladder removal (radical cystectomy). Partial bladder removal may be performed if there is only a single lesion with no signs of metastasis. However, only about 10% of the people with bladder cancer meet this criteria.
Radical cystectomy in men usually involves removal of the bladder, prostate, and seminal vesicles. In women, the urethra, uterus, and the anterior (front) vaginal wall are removed along with the bladder. Often, the pelvic lymph nodes are also removed during the surgery for pathological examination. About half of the people treated with radical cystectomy will be completely cured; the other half show signs of metastasis at the time of the surgery.
A urinary diversion surgery (a surgical procedure to create an alternate method for urine storage) is usually performed with the radical cystectomy procedure. An ileal conduit and a continent urinary reservoir are two procedures for creating a urinary diversion.
ILEAL CONDUIT: - An ileal conduit is basically a small urine reservoir that is surgically from a small segment of bowel. The ureters are attached at one end of the bowel segment and the other end is brought out onto the surface of the body to create a stoma.
- People who have had an ileal conduit will need to wear an external urine collection appliance at all times. Possible complications associated with ileal conduit surgery include: bowel obstruction, blood clots, urinary tract infection, pneumonia, skin breakdown around the stoma, and long-term damage to the upper urinary tract.
CONTINENT URINARY RESERVOIR: - A continent urinary reservoir is another method of creating an urinary diversion. In this method, a segment of colon is removed and used to create an internal pouch to store urine, This segment of bowel is specially prepared to prevent reflux of urine back up into the ureters and kidneys, and also to reduce the risk of involuntary loss of urine. A small stoma is placed flush to the skin. Possible complications include: bowel obstruction, blood clots, pneumonia, urinary tract infection, skin breakdown around the stoma, ureteral reflux, and ureteral obstruction.
CURRENT RESEARCH:
Clinical tests are currently underway to evaluate the use of photodynamic therapy in bladder cancer treatment. Photodynamic therapy involves using photosensitizing agents and laser light to detect and kill cancer cells.
MONITORING:
You will be closely monitored for progression of the disease regardless of the type of bladder cancer treatment you received. Monitoring will include: - Cystoscope evaluations every 3 to 6 months after initial treatment.
- Periodic urine cytology evaluations.
- Bone scan and/or CT scan to evaluate for metastasis.
- Complete blood count (CBC) to monitor for signs and symptoms of anemia indicating disease progression.
- Monitor for other signs and symptoms indicating disease progression, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness.
Support groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See support group - bladder cancer.
Expectations (prognosis):
The prognosis is related to the specific stage of bladder cancer and the type of treatment chosen. The prognosis for stage 0 or A cancers is fairly good, although about 70% of these people will have a recurrence of the disease within three years. Some sources report that about 45% of the people with stage B or C cancers survive past 5 years, provided they receive appropriate treatment.
Complications:
Bladder cancers may spread into the nearby organs or may travel through the pelvic lymph nodes, and metastasize to the liver, lungs and bones. Additional complications of bladder cancer include anemia, hydronephrosis (swelling of the ureters causing kidney injury), urinary incontinence, and urethral stricture.
Calling your health care provider:
Call your health care provider if you have blood in your urine, or other symptoms of bladder cancer, including urinary urgency, urinary frequency, or painful urination.
Also, call your health care provider for an appointment to be examined if you are over 40 years of age, you are a smoker, or you work in an area of high industrial exposure to potential carcinogens.
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