How Is Bladder Cancer Diagnosed
Bladder cancer is primarily diagnosed by identifying the tumor, imaging the tumors location, and lab tests. Patients will initially see a general practitioner, but the final diagnosis will be made by a urologist or oncologist .
Although bladder cancer is not diagnosed by the symptoms, its a good idea to know when its time to see a doctor. Symptoms of bladder cancer include blood in the urine or urinary obstruction. Other less common symptoms include painful urination, frequent urination, fatigue, and weight loss.
People should also be aware of symptoms if they are at risk of bladder cancer. At the top of the risk list is smoking, a habit that increases the likelihood of bladder cancer six-fold. Other bladder cancer risk factors include schistosomiasis infection , exposure to certain paint, dyes, or petroleum products, advanced age, and male gender.
The gold standard for bladder cancer diagnosis is identifying the tumor directly using cystoscopy. A physician inserts a narrow tube, called a cystoscope, through the urethra into the bladder to view the bladder lining. The physician will note what the tumor looks like and the number of tumors.
During the cystoscopy, a physician will remove a part of the tumor to be analyzed in the lab . A pathologist will study the tumor sample and look for tumor cells in a urine sample to make the definitive diagnosis.
Hard Acidic Or Spicy Foods
Chemotherapy can cause changes in your mouth and throat. When this happens, you can experience things like increased sensitivity and mouth sores.
During this time, its important to avoid foods that can further irritate these areas. This typically includes items that are hard, acidic, or spicy, such as:
- carbonated beverages
What Can I Expect Following Treatment
You may be advised to drink plenty of fluid to flush the rest of the medication from your bladder.
For six hours after each treatment, youll have to be very careful when you urinate to avoid transmitting BCG to others. Men should urinate while seated to avoid splashing.
Disinfect the urine by adding 2 cups of bleach into the toilet. Let it stand for about 20 minutes before flushing. You should also wash your genital area very carefully after you urinate, so your skin doesnt become irritated from the BCG. Wash your hands thoroughly, too.
Men can pass BCG to their partner during sex. For that reason, you should avoid sex for 48 hours after each treatment. Use a condom between treatments and for six weeks following your final treatment.
Women should avoid getting pregnant or breastfeeding while on BCG therapy.
Treatment is usually given every week for six weeks. After that, you might need to do it once a month for six months to a year.
One benefit of BCG is that while it affects the cells in your bladder, it doesnt have a major effect on any other part of your body. But there can be a few side effects such as:
When comparing BCG to other bladder cancer treatments, its important to remember that treatment isnt the same for everybody. Some of the factors that determine your options are:
- type of bladder cancer
- your age and general health
- how well you tolerate certain treatments
Viii Contraindications To Administration:
Patients who are pregnant or lactating, have liver disease, a history of active or prior tuberculosis should not receive chemotherapeutic drugs.
Sex After Intravesical Chemotherapy
Men should use a condom during sex for the first 48 hours after chemotherapy. If you are a woman having chemotherapy, your partner should use a condom during this time. This protects your partner from any of the drug that may be present in semen or vaginal fluid. Your doctor or specialist nurse can give you more information about this.
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What Conditions Are Treated With Bcg Treatment
BCG treatment is used to address early-stage bladder cancer. This includes bladder cancers that havent invaded your bladder wall muscle, such as carcinoma in situ bladder cancers and non-muscle invasive bladder cancers . BCG treatment isnt effective against bladder cancer that has metastasized .
Clinical trials are currently underway to explore BCG treatment for fibromyalgia and diabetes. Experts believe that BCG treatment may increase cytokines , which could potentially benefit people with these conditions. More research is needed in these areas, though.
Possible Side Effects Of Mitomycin Given Into The Bladder
- Mitomycin can cause skin irritation if it comes into contact with the skin. Washing the area with soap and water after urinating can reduce this risk.
- Some patients will develop a bladder infection after this procedure. If you experience an urgency to urinate, burning or pain with urination, blood in the urine or fever, notify your healthcare team right away.
- Intravesicular chemotherapy may cause burning with urination, cramps and diarrhea.
- In some rare cases, mitomycin can cause a decrease in your blood counts. This can include white blood cells , platelets and red blood cells. This is more likely to occur when the medication is given after surgery and there is injury in the bladder , which can allow the medication to be absorbed into the blood stream. However, it can occur with any instillation.
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Chemotherapy Resources And Support
Receiving a cancer diagnosis and undergoing chemotherapy can definitely take a physical, emotional, and mental toll. However, there are many resources available to help you get the support you need.
For example, it may be helpful to speak with and learn from others who are on a similar journey as you. You can do this through joining an in-person or online support group.
If youre not quite ready to engage with a support group, one-on-one counseling may be a good option. Try to find a mental health professional who specializes in counseling people with cancer.
Some support resources to get started with include:
- Medical care team. If you have a medical care team, ask them for recommendations on support services. There may even be support groups or counselors that are associated with your treatment center.
- American Cancer Society. The
What Are The Potential Side Effects Of Intravesical Chemotherapy
Most cancer treatments have the potential for side effects, and intravesical chemotherapy is no exception. Still, this treatment is associated with far fewer side effects than traditional chemotherapy because the medication is delivered directly into the bladder and not administered orally or intravenously, thereby leaving other parts of the body unaffected. The most common side effects of intravesical chemotherapy include irritation and a burning sensation in the bladder.
At Moffitt Cancer Center, our Urologic Oncology Program is led by a multispecialty team that offers the latest advances in bladder cancer treatment, including intravesical chemotherapy and immunotherapy. We are also a recognized leader in bladder cancer research and clinical trials, and have been distinguished as a Comprehensive Cancer Center by the National Cancer Institute. Moffitt is the only cancer center based in Florida with this distinction.
If you would like to consult with a Moffitt oncologist about your bladder cancer treatment options, contact us at or submit a new patient registration form online. A referral is not required to visit Moffitt.
X Preparation Of Agent:
Bcg Or Intravesical Chemotherapy
BCG produces generally better results but has more serious treatment effects. Intravesical chemotherapy has fewerserious treatment effects but may not be as effective as BCG. If you have a high-risk tumour you would usually receive BCG, if anintermediate risk tumour you would often receive intravesical chemotherapy.
When you are given a single dose of intravesical chemotherapy during youroperation, it is because when a tumour is removed from the bladder there is aworry that some of the cancer cells can break off and stick to the bladder wallwhere they can grow and form new tumours. It is now the recommended standard practice to put a singledose of intravesical chemotherapy into the bladder at the end of the surgerywhich destroys any cancer cells floating about and can reduce the chances of gettingfurther recurrences. BCG is not given at this time because of the risk ofabsorption of the BCG through the operation site.
Cystectomy isrecommended for non-invasive tumours or carcinoma-in-situ that are resistant orrefractory to intravesical treatment. While offering long-term control,removing the bladder has major implications and potential complications, andwould not be undertaken unless the risks of progression are high.
Radiotherapy and systemic chemotherapy arenot effective treatments for non-muscle invasive bladder cancer.
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What Happens During Bcg Cancer Treatment
Before beginning BCG treatment, local anesthesia is given to numb the area and keep you comfortable. Next, your healthcare provider will place a catheter into your urethra and inject the liquid BCG solution into your bladder.
The BCG solution needs to come in contact with cancer cells to kill them. So, once the medication is injected, your healthcare provider will remove the catheter and ask you to lie on your back, stomach and both sides for 15 minutes each.
When the process is complete, youre free to leave your appointment. However, you should avoid peeing for at least one more hour.
How long do you hold BCG in your bladder?
Once the BCG solution is injected into your bladder, youll hold it for a total of two hours. After this point, youll be able to pee.
What does BCG do to the bladder?
When the BCG solution enters your bladder, your immune system cells begin to attack the cancer cells in your bladder.
BCG treatment schedule
The initial BCG cancer treatment occurs weekly for six weeks. This is called induction therapy.
If the treatment is working, your doctor may prescribe BCG maintenance therapy. Maintenance therapy is given once a week for three weeks at the three-, six- and 12-month marks. For some people, this may be continued up to three years.
How Should I Prepare For Bcg Treatment For Bladder Cancer
Prior to BCG treatment, your healthcare provider will give you a list of specific guidelines to help you prepare. In general, you should avoid caffeinated beverages and diuretics for four hours before your appointment. When you arrive for your procedure, you should pee to ensure that your bladder is empty.
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Can Chemotherapy Treatment Cause Bladder Cancer
Some chemotherapy drugs can cause bladder cancer. The long-term side effects of Cytoxan and Ifosfamide which irritate the bladder lining and are associated with damage to the bladder and the bone marrow. Bladder cancer is a well-known risk and continues to arise at least 10-15 years after the drug was given.6
Before You Start Chemotherapy
You need to have blood tests to make sure its safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Before each treatment you need to stop drinking fluids. This stops the urine from diluting the drug in your bladder and will help you hold the urine more easily. Your hospital will tell you when to stop drinking.
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Late Effects After Radiation For Bladder Cancer
Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.
Radiation to the bladder area can cause late effects to the bladder including:
The bowel is sensitive to the effects of radiation. The late effects that may occur after radiation treatment that includes the rectum, colon, or small bowel include:
Impact on Reproductive Organs, Sexual Function, and Fertility
Radiation to the pelvis in a man may cause problems with sexual health such as infertility, low testosterone levels, low sperm count, or the inability to get and maintain an erection .
Impact on Reproductive Organs, Sexual Function, and Fertility
You may have long-term changes to your vagina and uterus after radiation to your pelvis. You may experience vaginal dryness, atrophy , less feeling/sensation in the genital area, bleeding, or painful intercourse.
Fertility and Childbearing
Damage to the Kidney
When the radiation field includes the kidney, renal insufficiency and hypertension can happen. The kidneys are not typically included in the bladder radiation field but may be in some cases. Ask your radiation oncologist about what organs were in your treatment field.
Radiation can lead to permanent changes in the skin.
Do Both Treatments Have The Same Side Effects
You can have side effects with either BCG or gemcitabine. However, research shows that problems after gemcitabine are less severe than with BCG. BCG treatments may be especially difficult for older people or people with poor immune systems.4
BCG contains live bacteria. About 60 percent of people who receive BCG have bladder irritation or pain with urination. Some people have bladder infections, high fevers, or flu-like symptoms. If you have more than 1 treatment, you are at higher risks of side effects.2-5
Gemcitabine has few side effects as intravesical treatment. Side effects, such as bladder irritation or lower urinary tract irritation, may occur. Rarely, you could have dermatitis, nausea, or vomiting.2-4
Read Also: Locally Advanced Bladder Cancer Stage
What Happens When Your Bladder Is Removed Due To Cancer
When the bladder is surgically removed , urine in the body has no place to collect. In some cases, surgeons can construct a neobladder out of small intestine tissue, which will work pretty much the same way as the old bladder but will require contracting the abdominal muscles to urinate. If a neobladder is not possible, the surgeon will create a urinary diversion. Urine will be directed to a pouch or directly through a hole in the abdomen. In both cases, urine will leave the body through a hole in the abdomen into a urostomy bag on the abdomen or leg.
Who Can Have This Treatment
BCG is appropriate for noninvasive and minimally invasive bladder cancers. It usually follows a procedure called transurethral resection of bladder tumor . Its intended to help prevent recurrence.
This treatment only affects cells inside the bladder. Its not useful for later stage bladder cancer that has spread into or beyond the bladder lining, or to other tissues and organs.
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Other Reasons For Bladder Instillations
In addition to IC, bladder washes may be a suggested treatment for patients with chronic UTIs, accumulated sediment in urine, or other conditions that reduce bladder capacity and contribute to frequent urination not caused by an underlying problem such as a tumor or enlarged prostate. Bladder baths may also help with issues related to blocked urinary catheters.
Which Chemo Drugs Are Used To Treat Bladder Cancer
Chemo drugs may be used alone or in combination, depending on what theyre being used for, a persons overall health, and other factors.
When chemo is given with radiation, the most common drugs used include:
When chemo is used without radiation, the most common combinations include:
- Gemcitabine and cisplatin
- Dose-dense methotrexate, vinblastine, doxorubicin , and cisplatin
- Cisplatin, methotrexate, and vinblastine
- Gemcitabine and paclitaxel
For some people, the side effects of getting more than one chemo drug might be too much to handle. For those people, treatment with a single drug, such as gemcitabine or cisplatin, may be an option. Other drugs sometimes used alone for bladder cancer include, docetaxel, paclitaxel, doxorubicin, methotrexate, ifosfamide, and pemetrexed.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.
Most bladder cancers are transitional cell cancers, but there are other types as well, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. These rare types of bladder cancer may be treated with drugs different from those listed above.
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