Bladder Cancer Overview Bladder cancer is the sixth most common type of cancer in the United States and fifth most common in Canada. The Canadian Cancer Society estimated that there would be 6.600 new cases diagnosed in 2007, and in the US the estimate was 53,000. Bladder cancer is 2 to 3 times more common in men than women, and is more prevalent in industrialized nations such as the United States, Canada and France. Incidences of this type of cancer increase with age. Symptoms The most common symptoms of bladder cancer are: hematuria (blood in the urine) frequent urges to urinate painful urination low back pain Risk Factors Smoking is one of the leading causes of bladder cancer. Smokers are at twice the risk of non- smokers for developing this illness. Working in dye, leather and rubber industries also increase the risks. Genetic predisposition (family history) also plays a role, with first degree family members being twice as likely to develop the disease as those with no family history. Other risk factors include: Chronic bladder inflammation (recurrent bladder infections or stones) Arsenic and chlorine by-products in drinking water Diet high in saturated fats Diagnosis and Treatment Urine cytology is one of the most commonly performed tests. It is used to detect abnormal and malignant cells which are shed by people who have bladder cancer. Urine based marker tests are being developed. They have a much higher sensitivity to malignant cells and are more accurate in detecting low grade bladder cancer, which makes them far more useful in monitoring a patient for recurrences. Once a problem has been identified, the patient is sent to a urologist. He or she will perform a procedure to look inside your bladder called a cystoscopy. A tube with a light and camera called a cystoscope is inserted into the bladder through the urethra. Photographs are taken noting any abnormalities and the locations. It is a relatively painless procedure that is done on an outpatient basis. There are two types of bladder cancer: superficial and invasive. Superficial bladder cancer involves only the lining of the urinary bladder, while the invasive type penetrates the muscle wall. Once diagnosed, there are many treatment options available that are based on the type of bladder cancer, the grade of the tumour (determined by biopsy), and the stage of the disease. Surgery is the first line of defence for bladder cancer. For superficial bladder cancers the doctor will most often perform a transurethral resection, or TUR. During TUR, the doctor inserts a cystoscope into the bladder through the urethra and then uses a tool with a small wire loop on the end to remove the cancer. Remaining cancer cells are burnt with an electric current. The patient may need to be in the hospital and may need anaesthesia. If the bladder cancer is the invasive type, the doctor may choose to perform a radical cystectomy, which is the removal of the entire bladder, and any other neighbouring tissues or organs where the cancer cells have spread. In some cases, when the patient has low-grade cancer affecting only one area of the bladder wall, the doctor may opt for removing only the affected areas of the bladder which is called a segmental cystectomy. In the case of total removal of the bladder, the doctor can fit the patient with a bag worn outside the body, a pouch formed from a segment of intestine on the inside the body, or give the patient a neo-bladder (man made), also inside, to collect urine. In addition to surgery, the patient may have to receive intravesical chemotherapy or biological therapy to ensure that the cancer doesn't return. Intravestical therapies involve passing a catheter into the bladder and instilling medications that will wash the lining of the bladder. The drug most commonly used inside the bladder is Mitomycin C, which is a very strong antibiotic. The patient will be asked to hold the medication in for 1-2 hours before releasing it. This is usually done once a week for 6-8 weeks, and will likely involve monthly or quarterly maintenance treatments along with regular cystoscopies every three months to monitor the bladder for any further growths. Biological therapy is the introduction of live bovine tuberculosis virus (TB) into the bladder in order to stimulate an immune response from the lining of the bladder. It is delivered in the same way as Mitomycin via a catheter into the bladder. It is thought that over time, the bladder lining loses its resistance to the toxins that pass through it, affecting its ability to fight off the impurities from the wastes that it contains. Introducing the TB virus also known as Bacillus Calmette-Guerin (BCG) restores the body's natural defences against disease and is currently the most proven and effective form of immunotherapy at this time. The most important thing any patient can do is to educate themselves on their disease, attend follow-up cystoscopies regularly, and be sure to inform your doctor of any changes you may notice in your urine, or bladder activity.
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