Bladder cancer is a form of cancer affecting the internal lining of the bladder. Bladder cancer can be superficial or invasive.
What is going on in the body?
Cancer occurs when a cell undergoes changes that cause it to grow and multiply uncontrollably. Eventually a mass of cells, known as a tumor, will form. More than one tumor in the bladder may develop at the same time. If not treated, a tumor will grow through the bladder wall. It may then spread to structures around the bladder. Cells from the tumor can also enter the bloodstream and spread to distant parts of the body, a process known as metastasis.
What are the causes and risks of the disease?
Use of tobacco products, smoking in particular, may lead to bladder cancer. The cancer-causing chemicals are absorbed in the lungs and then excreted into the urine. The lining of the bladder is exposed to concentrated amounts of these poisons for long periods.
Other chemicals, such as aniline dyes, are known to cause similar damage. The following occupations are associated with an increased risk of bladder cancer:
working in the chemical or petroleum industries
operating a drill press
working with dye
working with leather
working in the textile industry
working with rubber, as in tire manufacturing or repair
Other known risk factors for bladder cancer include the following:
Suspected risk factors include:
- artificial sweeteners
- frequent urinary tract infections
- high dietary cholesterol
- highly chlorinated drinking water
- pain medicines containing phenacetin (no longer on the market)
- water contaminated with pesticides
What can be done to prevent the disease?
Avoiding exposure to tobacco products will help prevent this and other cancers. When working with chemicals at work or at home, a person should take precautions to avoid contamination.
How is the disease diagnosed?
Often a person will see a healthcare professional because he or she has noticed blood in the urine. The diagnosis begins with a medical history and physical exam. A urine sample will be checked for cancer cells. An X-ray of the bladder, called intravenous urogram or IVU, is routinely part of the diagnostic work-up.
The professional may also do a cystoscopy, looking at the inside of the bladder with a thin, lighted tube. If a tumor is seen, the examiner can take a piece of it (a biopsy) for microscopic examination. If the cancer is confirmed, more surgery may be necessary to investigate how deep the cancer has grown into the bladder wall. Other studies such as CT scans may be done to determine the extent of the problem. These are known as staging.
Long Term Effects
What are the long-term effects of the disease?
Five-year survival rates for early bladder cancer are as high as 90%. Early detection saves lives. Bladder cancer that has invaded the bladder muscle wall or adjacent tissues is cured less frequently. Bladder cancer is usually fatal if not successfully treated.
What are the risks to others?
Bladder cancer is not contagious and poses no risk to others.
What are the treatments for the disease?
The main treatment for bladder cancer is surgery to remove as much of the cancer as possible. Removing the entire bladder is not always necessary. Certain chemotherapy medicines can be instilled into the bladder. In some cases, a biological response modifier, such as Bacillus Calmette-Guerin (BCG), can also be instilled into the bladder. The entire surface of the bladder is treated in this way. Any remaining cancers will be bathed in the medicines.
Often this treatment is successful, and no further surgery is necessary. Sometimes, however, the entire bladder must be removed. In this case, urine will be diverted to an external collection pouch in a procedure known as a urostomy.
If the cancer has spread to other parts of the body, then chemotherapy or radiation therapy may be used. Advanced bladder cancer is not usually curable. Chemotherapy and radiation therapy may be used if the patient is not able to have surgery, or if the surgery shows evidence of remaining tumor in the body.
What are the side effects of the treatments?
Surgery to remove superficial tumors followed by instillation of medicines can be uncomfortable and cause the person to be tired. The discomfort will resolve when the treatments are completed. Other side effects can be easily managed and will be specific to the medicines used.
If the bladder is removed, the person will need to adjust to the appliance. With support and understanding, the person can return to a normal life. For persons with advanced disease, the chemotherapy may be rigorous but the side effects are manageable.
What happens after treatment for the disease?
A person who has early stage bladder cancer will have the inside of the bladder examined at intervals, along with urine testing. Over time, the frequency of exams will decrease if the cancer does not return. People with advanced cancer will be followed with CT scans and other X-rays to determine the response of the cancer to the treatment.
How is the disease monitored?
In the early stages, examining the inside of the bladder is the most effective way to monitor response. Urine samples can indicate if cancer cells have shed. For later stage disease, diagnostic studies such as X-rays are the most helpful. Any new or worsening symptoms should be reported to the healthcare professional.
Redman, B.G; Kawachi, M.;&Schwartz, D.(1996). Urothelial and kidney cancers in Cancer Management: A Multidisciplinary Approach. PRR: Huntington, NY. Pp.417-431.
Christine Miaskowski, Patricia Buchsel, 1999 Oncology Nursing: Assessment and Clinical Care. Mosby pg. 1031-1083