What is Bladder Cancer?
Bladder cancer is the abnormal growth of cells that make up the bladder. Bladder cancer is responsible for approximately 3% of all malignancies diagnosed in Australia each year. It is more common in men than women and typically affects those over 60 years of age.
Bladder cancer at an early stage of growth may not produce any noticeable signs or symptoms. Common signs of bladder cancer include haematuria (blood in the urine that looks red or rusty), which is usually painless and may appear only from time to time over a few months, a burning sensation during urination and a need to urinate often.
When bladder cancer causes noticeable symptoms, they are usually related to the irritation brought about by tumor growth. Irritable symptoms include urination that is frequent, urgent, painful or difficult. These symptoms are more common among patients with ‘carcinoma in situ' (CIS), cancer that has not spread and is still in place. In fact, irritable urination (emptying of the bladder) may be the only noticeable symptom of CIS.
If a bladder tumor blocks a ureter (tubes that pass urine out of the kidneys, into the bladder), patients may experience pain in the side of the body between the ribs and the top of the hip. In some cases, tumor growth may constrict the urethra (the tube that passes urine from the bladder out of the body) and slow the flow of the urine. Bladder cancers may also shed pieces of dead tissue, fragments of other tissue and other forms of tumor-related matter that are then passed out with the urine.
If the tumor has spread beyond the bladder to the surrounding tissue, you may experience pelvic pain, bone pain at the site of new cancer, leg swelling (edema) due to the involvement of lymph nodes, loss of weight and fatigue. Anemia and high blood levels of urea and other metabolic by-products, often due to urinary tract obstruction, may be further indications of late-stage bladder cancer.
Since such symptoms are also caused by bacterial infections and kidney stones, it is essential to see your doctor for an accurate diagnosis.
When you experience symptoms of bladder cancer, your doctor will conduct physical examinations in order to formulate an accurate diagnosis. Other tests such as cystoscopy (thin lighted tube with a camera is inserted up the bladder to detect abnormalities), biopsy (sample of tissue is removed to examine in the lab) and intravenous pyelogram (dye is injected and traced with X-ray).
Bladder cancer can be treated with chemotherapy, radiation therapy, and surgery. A number of treatments may be used in conjunction with each other. The choice of treatments depends on a number of factors, including age, general health and the extent and stage of the tumor. Discuss this with your doctor to ascertain the most appropriate course of treatment for you.
Bladder cancers that have grown into surrounding tissues such as muscle need surgical management. There are many surgical treatment options. Some of these include:
- Radical cystectomy: For women, a standard form of surgery is a radical cystectomy, which involves removing the entire bladder and associated tissues, with pelvic lymphadenectomy (removal of the lymph nodes within the hip cavity). Radical cystectomy in women includes removal of the uterus, fallopian tubes, ovaries, anterior vaginal wall (the front of the birth canal) and urethra.
- Cystoprostatectomy: In men, a common surgical procedure is a cystoprostatectomy, which involves the removal of the bladder and prostate, with pelvic lymphadenectomy.
- Transurethral resection of the bladder tumor (TURBT): This procedure involves the insertion of a thin tube through the urethra and up into the bladder. The surgeon can then remove the tumor without the need for a large external excision.
- Urinary diversion: Urinary diversion is a method where an alternate means of urine waste disposal is created when the bladder is removed. The most common diversion is the ileal conduit, which involves taking a piece of bowel, forming a pipe and inserting it where the bladder once was. The conduit then carries the urine from the ureters out onto the skin of the abdomen where the conduit ends in a stoma (a small opening). Urine is then emptied into a plastic bag attached to the skin, where it can be emptied at various intervals.
Other forms of diversion involve the formation of an internal pouch made out of part of the bowel. The pouch has an inbuilt valve so that urine collects inside and does not leak through the stoma. When it needs emptying, a small plastic tube called a catheter can be passed through the stoma and the valve, allowing urine to flow out.
- Intra-vesical treatment: It involves flushing the bladder with chemotherapy or immunotherapy to flush out any residual tumor cells following surgery. Chemotherapy drugs are placed directly into the bladder in order to prevent the tumor invading the deeper layers of the bladder wall or recurring.
- Radiation therapy: Uses powerful X-rays and other high-energy rays to kill cancer cells using a machine called the linear accelerator. The cancer cells get damaged and cannot grow or multiply, resulting in the death of the cells.
How is your course of treatment decided?
A number of tests will be performed in order to allow doctors to determine the best course of treatment for each individual. The tests include cystoscopy and a CT scan. These show your doctor the size of the tumor and help determine whether radiation therapy is solely used or whether it can be used in conjunction with other treatments.
Possible complications of cancer surgery include:
- Cystectomy: Infection, excess bleeding, pain, nerve damage, lack of orgasm and blood clots
- Cystoprostatectomy: Lack of semen, problems with maintaining an erection
- Transurethral bladder surgery: Mild bleeding and pain while urinating or recurrence
- Urinary diversion: Incontinence, stones, infections, and blockage of urine flow
Possible complications of chemotherapy include:
- Diarrhea or constipation
- Nausea and vomiting
- Hair loss
- Loss of appetite
The X-rays used during radiation therapy may damage normal body cells as well as cancer cells, although healthy cells usually recover from the damage. The incidence and severity of any side effects vary from patient to patient and may include:
- Tiredness or fatigue
- Bladder irritation, cramps or painful urination/blood in the urine
- Diarrhea and bowel cramps
- Proctitis or pain in the rectum/bleedingVaginal discomfort
A variety of measures can be taken to alleviate these symptoms, discuss these issues with your doctor and radiation therapy team for the best advice for you.