BLADDER CANCER

Bladder: Urothelial carcinomas

(Bladder carcinoma)

Bladder cancer is any malignancy of the urinary bladder. Each year, more than 50,000 Americans are diagnosed with the disease, which cause about 11,000 deaths. Men outnumber women three to one and the incidence is higher among whites than other races.

Certain environmental factors seem to increase the risk of bladder cancer. Included are cigarette smoking and exposure to naphthaline, benzidine, aniline dyes and chemicals used in rubber and leather processing. Research has also implicated cyclamates, a type of artificial sweetner but these have been banned in the United States.

Blood in the urine or hematuria is the most common warning sign. There may also be burning or pain during urination. Advanced bladder cancer may cause fatigue, weight loss and abdominal, pelvic or back pain.

Diagnostic Studies and Procedures

A urinalysis can detect even invisible blood in urine. If malignancy is suspected, imaging such as ultrasound, CT scans or MRI or an intravenous pyelogram (IVP, a special X-ray of the urinary tract) can usually locate the tumor.

A cystoscope, a flexible vieving tube with magnifying devices, allows a doctor to inspect the urethra and bladder and collect tissue samples. If cancer is confirmed, additional tests will be performed to determine its extent.

Medical Treatments

If diagnosed early, bladder cancer is highly curable. Superficial tumors are treated with a procedure called transurethral electroresection, in which an instrument similar to a cystoscope is passed through the urethra to the bladder and an electrical current or laser beam destroys the cancer. Anticancer drugs may also be instilled directly into the bladder weekly for about six weeks.

Because bladder cancer often recurs, follow-up visits are recommended every two ot three months during the first two years and then every four months thereafter.

 

About 12 percent of patients with superficial bladder cancer eventually develop more invasive cancers that require surgery. The operation may be followed by radiation or chemotheraphy.

In the most advanced cases, the bladder must be removed and a new exit for urine created through the lower abdomen. Most commonly, a pouch to collect urine is created from a segment of the small intestine. Then an opening or stoma is made in the abdominal wall and this allows the urine to flow to an external collection bag, which has to be emptied periodically. Sometimes, the ureters, tubes that carry urine from the kidneys to the bladder will be attached to a segment of the lower colon, thus allowing urine to pass from the kidneys into the rectum instead.

Alternative Therapies

To improve their quality of life, some cancer patients adopt the following alternative approaches:

Nutrition Therapy.  Although diet cannot cure cancer, some researchers believe it is important in preventing it. For example, a low intake of vitamin A is associated with an increased risk of bladder cancer. To increase vitamin A in your diet, eat more yellow or orange fruits and vegetables plus broccoli and dark green leafy vegetables.

Yoga and Meditation. These and other relaxation therapies, such as massage and visualization can help patients cope with cancer pain and the side effects of treatments. There is also some evidence that visualization may bolster the body’s ability to fight cancer.

Self-Treatment

If you smoke, quit immediately. Also minimize exposure to possible cancer-causing agents. Use protective equipment if your job requires exposure to harmful chemicals (see box below).

JOB RELATED RISKS

Occupations linked to an increased risk of bladder cancer include:

Asbestos handdlers	Metal workers
Chemical workers	Petroleum workers
Hairdressers and manicurists	Printers
Leather tanners	Rubber workers
Machinists	Textile workers
Truck drivers

Some studies have linked heavy consumption of coffee (more than four cups a day) with an increased risk of bladder cancer. Chemical caffeine removers have also been linked to the disease. If you drink caffeine-free coffee, try to find water decaffeinated brands to avoid this possible risk.

Recents results of two long-term studies did not find a link between hair dyes and bladder cancer – a fear raised by earlier research. Still, some experts advise using semipermanent, light-colored dyes that wash out in a few weeks.

If treatment results in a urinary stoma, consider joining a support group of fellow patients. Such groups offer emotional support and helpful advice.

Other Causes of Bladder Symptoms

An enlarged prostate, cystitis, a bladder infection or obstruction, urethritis and bladder stones all can cause symptoms similar to those of bladder cancer.

QUESTIONS TO ASK YOUR DOCTOR

~ What can I do to reduce my risk of bladder cancer?

~ Will I maintain normal urinary function after treatment for bladder cancer?