Bladder Cancer - What You Need To Know

by Jane Ashley

Our bladders are an essential part of our urinary tract system. The bladder holds urine, produced as waste, and excess fluid by our kidneys. Urine travels from the kidneys to the bladder through the ureters. Urine exits our bodies via the urethra. Although the anatomy varies between men and women, the urinary tract system works the same in both sexes. In men, the prostate is part of the urinary tract too. The bladder is located in the lower abdomen — behind the pubic bone.

Bladder Cancer

What exactly happens when we develop bladder cancer?

The bladder is lined with urothelial cells. Urothelial cells also line the lower part of the kidneys, the ureters, and the urethra. About 90% of bladder cancers are urothelial carcinomas — where the urothelial cells grow out of control and form a tumor. Virtually all of these urothelial tumors are malignant. Cancer can also develop from the urothelial cells in the lower kidney, ureters, or urethra. The remaining 10% of bladder cancers are either squamous cell (the lining of the bladder) or adenocarcinoma (develop from glandular cells).

Over 80,000 people in the U.S. develop bladder cancer. About three-quarters are men. Bladder cancer has been slowly declining over the last 10-12 years. White men are twice are likely as black men to develop bladder cancer. Smoking is linked to bladder cancer in almost half of the diagnoses. About 90% are older than 55. Almost 18,000 people die annually of bladder cancer. Bladder cancer is the 8th leading cause of death in men.

What are the symptoms of bladder cancer?

No one will experience all of these symptoms, but if you experience any of these for 2-3 weeks, you should see your primary care physician.

• Blood in your urine
• Blood clots in your urine
• Pain or burning when you urinate
• Frequent urination
• Feeling the need to urinate throughout the night
• Feeling the need to urinate but not being able to pass urine
• Lower back pain on one side of your body

If someone ignores these early symptoms, bladder cancer can spread to other parts of your body. Bladder cancer may spread to the lungs, liver, or bones.

75%Of Bladder Cancer Occurs In Men

How is bladder cancer treated?

Early-stage, non-invasive bladder cancer is treated with a procedure called TURBT. This acronym stands for transurethral resection of bladder tumor. The procedure is performed via a scope inserted into the urethra. TURBT is usually done on an out-patient basis. Most patients can return to regular activities within a week or two.

If patients have high-grade cells, TURBT is usually followed with a kind of immunotherapy called BCG (a type of tuberculosis bacteria) – given every three months for the first year and then every six months for another year or two. Patients with high-grade cells who don’t respond to BCG may be given pembrolizumab (Keytruda).

The standard treatment for muscle-invasive bladder cancer (Stages II and III) is a surgery called radical cystectomy — removal of the bladder. Many patients receive chemotherapy before their surgery. These patients will have to choose between some options to replace their bladder’s function of storing and passing urine.

1. Patients may have to have a urostomy (creating an opening in the belly called a stoma and use a small bag attached to the belly to collect urine).
2. Another choice that many patients prefer is a continent diversion, where a pouch is created inside the belly, and a catheter is used to drain the urine several times a day.
3. A surgeon can also create a new bladder from a section of the patient’s intestine; this is called a neobladder. Patients can urinate normally, but they no longer experience the “urge” to urinate. Patients with neobladder must urinate every few hours on a regular schedule.

Some of these Stages II and III patients may have the option of undergoing radiation and chemotherapy given simultaneously. This technique is sometimes referred to as bladder preservation therapy.

The outlook for persons diagnosed with metastatic bladder cancer (Stage IV) is guarded. Treatment includes platinum-based chemotherapy. With the advent of immunotherapy, five immunotherapy agents have been approved for the treatment of Stage IV bladder cancer. Thus far, pembrolizumab (Keytruda) has shown the most promising results. Clinical trials may offer these patients better access to effective treatments.

Diagram Of The Bladder

WhatNext?

Many bladder cancer patients find that being in a support group is very helpful. The American Bladder Cancer Society and the Bladder Cancer Advocacy Network helps patients cope with the physical and emotional stresses that bladder cancer causes.

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