Bladder Cancer

Bladder cancer is a type of cancer that begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age. The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. Bladder cancer signs and symptoms include: blood in the urine (either visible or only detected on microscopic analysis), urinary frequency, or pelvic pain. It's not always clear what causes bladder cancer. Bladder cancer has been linked to smoking, radiation and certain chemical exposures. Bladder cancer often recurs. Because of this, bladder cancer survivors often undergo follow-up testing for years after successful treatment. What tests you'll undergo and how often will depend on your type of bladder cancer and your treatment, among other factors. In general, doctors recommend a screening exam of the inside of your urethra and bladder (Cystoscopy) every three to six months for the first four years after bladder cancer treatment. Then you may undergo Cystoscopy every year. Your doctor may recommend other tests at various intervals as well.

Tests and procedures used to diagnose bladder cancer may include:

• Cystoscopy. Cystoscopy. During cystoscopy, your doctor inserts a narrow tube (cystoscope) through your urethra. The cystoscope has a lens and fiber-optic lighting system, allowing your doctor to see the inside of your urethra and bladder. You usually receive a local anesthetic during cystoscopy to make you more comfortable. The process usually only takes a few minutes.
• Biopsy. During cystoscopy, your doctor may pass a special tool through your urethra and into your bladder in order to collect a small tissue sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer. TURBT is usually performed under general anesthesia.
• Urine cytology. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
• Imaging tests. Imaging tests, such as CT scan, IVP or ultrasound, allow your doctor to examine the structures of your urinary tract. You may receive a dye, which can be injected into a vein. The types of surgical procedures available to you may be based on factors such as the extent of your bladder cancer, your overall health and your preferences.
  

Treatment for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:

• Surgery to remove the tumor. Transurethral resection of bladder tumor (TURBT) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TURBT, your doctor passes a small wire loop through your urethra and into your bladder. The loop is used to burn away cancer cells with an electric current (fulguration). In some cases, a high-energy laser may be used instead of electric current. TURBT may cause painful or bloody urination for a few days following the procedure.

Biological therapy (immunotherapy)
Biological therapy, sometimes called immunotherapy, works by signaling your body's immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy). Biological therapy drugs used to treat bladder cancer include:

• An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is an inactive bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
• A synthetic version of an immune system protein. Interferon is a protein that your immune system makes to help your body fight infections. A synthetic version of interferon, called interferon alfa, may be used to treat bladder cancer. Interferon alfa is sometimes used in combination with BCG. Interferon alfa can cause flu-like symptoms.

Biological therapy can be administered after TURBT to reduce the risk that cancer will recur.

Treatment for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may have to undergo radical surgery to attempt to cure your cancer.

• Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.
• Surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for you to expel urine. Several options exist. Which option is best for you depends on your cancer, your health and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube helps drain urine to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen. In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day. In select cases, your surgeon may create a new bladder out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your new bladder.

Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing a tube through your urethra (intravesical therapy). Chemotherapy may be used to kill cancer cells that might remain after an operation. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy.

Radiation therapy
Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy may be used before surgery to shrink a tumor so that it can more easily be removed. Radiation therapy can also be used after surgery to kill cancer cells that might remain. Radiation therapy is sometimes combined with chemotherapy