Monday, January 30, 2023

How Is Bladder Cancer Found

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Who Is At Risk For Bladder Cancer

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Anybody can get bladder cancer, but it is most common in older adults . There are also risk factors that raise the chance of getting bladder cancer such as:

  • Radiation therapy in the pelvic area
  • Arsenic in drinking water
  • Chemicals in the workplace

Hairdressers, painters, printers and dry-cleaners are also at risk for bladder cancer due to the long-term exposure of harmful chemicals.

Diagnosis Of Bladder Cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing bladder cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bladder cancer or other health problems.

The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as bladder cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bladder cancer.

The following tests are usually used to rule out or diagnose bladder cancer. Many of the same tests used to diagnose cancer are used to find out how far the cancer has spread . Your doctor may also order other tests to check your general health and to help plan your treatment.

What About Other Treatments That I Hear About

When you have cancer you might hear about other ways to treat cancer or treat your symptoms. These may not always be standard medical treatments. These treatments can be vitamins, herbs, special diets, and other things. You may be curious about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to be helpful. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether its a vitamin, a diet, or anything else.

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Warning Signs Of Bladder Cancer

The most common warning sign of bladder cancer is blood in the urine , which may or may not be visible. Other symptoms may include: change in bladder habits, including having to urinate more often, an urgent need to urinate, or burning when you urinate needing to urinate but not being able to difficulty initiating or stopping urine flow weak, interrupted, or painful urine flow abdominal pain loss of weight or appetite persistent lower back, upper thigh, or pelvic pain.

Urine Tumor Marker Tests

What are the grades and stages of bladder cancer?

Different urine tests look for specific substances made by bladder cancer cells. One or more of these tests may be used along with urine cytology to help see if you have bladder cancer. These include the tests called NMP22® , BTA Stat®, Immunocyt® , and UroVysion®, which are discussed in Can Bladder Cancer Be Found Early?

Some doctors find these urine tests useful in looking for bladder cancers, but they may not help in all cases. Most doctors feel that cystoscopy is still the best way to find bladder cancer.

Some of these tests are more helpful for finding bladder cancer that has come back in someone who has already had it, rather than first diagnosing it.

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Treating Stage 0 Bladder Cancer

Stage 0 bladder cancer includes non-invasive papillary carcinoma and flat non-invasive carcinoma . In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded the bladder wall.

This early stage of bladder cancer is most often treated with transurethral resection with fulguration followed by intravesical therapy within 24 hours.

Other Causes Of Blood In The Urine

Blood in the urine is common. At any one time, between 1% and 18% of the population will have asymptomatic microscopic hematuria, but only 1.3% of patients with this symptom have bladder cancer. Other causes of hematuria include:

  • Some medications , Rifadin , certain blood thinners, laxatives. and chemotherapy drugs
  • Bladder and/or kidney infections

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What Is A Mr Urogram

Another option for imaging is MRI of the abdomen and pelvis or MR Urogram. This test is also effective at finding tumors in the kidney and ureters and evidence of spread of cancer. It may be used to avoid radiation or in patients with contrast dye allergies or borderline kidney function. It is not quite as good at finding kidney stones and similar to CT urogram may miss tumors in the bladder such that patients still require cystoscopy.

Hyaluronic Acid And Hyaluronidase

Bladder Cancer – Overview (types, pathophysiology, diagnosis, treatment)

Hyaluronic acid is a nonsulfated glycosaminoglycan found in normal tissue and tissue fluids. When present in tumor tissues, it promotes metastasis and may interfere with immune surveillance.67 At a cutoff value of 100 ng/mL, urine HA had 92% sensitivity and 93% specificity for detecting bladder cancer.68

Hyaluronidase , an endoglycosidase, degrades HA into small fragments that promote angiogenesis.69 Hyaluronidase secretion by bladder tumor cells correlates with invasive potential. Pham and coworkers70 analyzed 139 urine specimens and detected a 5- to 8-fold elevation of hyaluronidase in the urine of patients with grade 2 or 3 bladder cancer. However, its widespread applicability may be somewhat limited the accuracy of this test for detecting low-grade tumor is poor and may even be less than that of routine voided urine cytology. Further refinement in the assay technique and evaluation in larger clinical trials would help to define the clinical applicability of this marker.

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Early Detection And Screening

Because bladder cancer causes urinary symptoms such as blood in the urine, it may be found early. However, because blood in urine is caused by a lot of conditions other than cancer, urinalysis isnt a useful screening test for the general population.

There isnt a test yet that is able to screen the general population for bladder cancer. Doctors may recommend specific tests to screen for bladder cancer based on known risk factors.

Expert cancer care

Causes Of Bladder Cancer

There are certain things that can affect the chances of developing bladder cancer. These are called risk factors.

The main risk factor is age. Bladder cancer is more common in people over the age of 60. It is rare in people under the age of 40. Another risk factor is smoking. Smoking may cause about 4 in 10 bladder cancers.

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Nuclear Matrix Protein 22 Tests

The nuclear matrix protein 22 test detects a nuclear mitotic apparatus protein that is a component of the nuclear matrix. Nuclear matrix proteins make up the framework of a cells nucleus and play an important role in gene expression.3739 NMP22 is a protein that localizes with the spindle poles during mitosis and thus regulates chromatid and daughter cell separation.40,41 There is a substantially higher level of NMP22 in the urine of patients with bladder cancer. However, because this protein is released from dead and dying urothelial cells, many benign conditions of the urinary tract, such as stones, infection, inflammation, and hematuria, and cystoscopy can cause a false-positive reading. Both a laboratory-based quantitative microplate enzyme immunoassay and a qualitative point-of-care test are available and are FDA-approved for use in bladder cancer surveillance. The latter is also approved for detection of bladder cancer in high-risk patients.

The sensitivity of the quantitative enzyme immunoassay has ranged from 47% to 100%, most often falling between 60% and 70%,17,19,20,23,4248 depending on the cutoff used. The specificity for the NMP22 test is 60% to 90%, again depending somewhat on the cutoff value used.17,1921,23,28,30,4244,49,50 Analysis of data shows that the NMP22 test is superior to cytology for detection of grade 1 and 2 bladder cancer but that it offers lower specificity.

Possible Side Effects Of A Ct Scan

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Sensitivity or allergic reaction to the contrast dye can occur in some patients, which may manifest as rash, nausea, wheezing, shortness of breath, or itching or swelling of the face. Symptoms are usually mild and clear on their own. Uncommon but more severe manifestations are low blood pressure and breathing difficulties.

Of additional note, while the amount of radiation used in CT scans can vary in clinical practice, CT scans deliver considerably more radiation than a typical x-ray. Therefore CT scans can carry risks associated with increased radiation exposure, such as radiation-induced future cancer.

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What Will Happen After Treatment

You’ll be glad when treatment is over. But its hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about this. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of your follow-up visits. People who have had bladder cancer are at high risk of having a second bladder cancer.

If you have no signs of cancer, most experts advise seeing with your doctor every 3 to 6 months. These visits might include urine tests, blood work, and other tests. If you still have your bladder, you will need regular exams of your bladder, too. The time between doctor visits may be longer after a few years if no new cancers are seen.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us or talk to your doctor to find out what you can do to feel better.

You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as well as you can.

Screening For Bladder Cancer

Screening is the use of tests or exams to look for a disease in people who have no symptoms. At this time, no major professional organizations recommend routine screening of the general public for bladder cancer. This is because no screening test has been shown to lower the risk of dying from bladder cancer in people who are at average risk.

Some providers may recommend bladder cancer tests for people at very high risk, such as:

  • People who hadbladder cancer before
  • People who had certain birth defectsof the bladder
  • People exposed to certain chemicals at work

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Latest Bladder Cancer Data

Bladder cancer is the 10th most common cancer worldwide. It is the 6th most common cancer in men and the 17th most common cancer in women.

There were more than 573,000 new cases of bladder cancer in 2020.

The 10 countries with the highest rates of bladder cancer and the highest number of deaths from bladder cancer in 2020 are shown in the tables below.

ASR = age-standardised rates. These are a summary measure of the rate of disease that a population would have if it had a standard age structure. Standardisation is necessary when comparing populations that differ with respect to age because age has a powerful influence on the risk of dying from cancer.

Tests That May Be Done

Bladder Cancer

Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.

Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .

Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.

Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.

Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.

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Changes In Bladder Habits Or Symptoms Of Irritation

Bladder cancer can sometimes cause changes in urination, such as:

  • Having to urinate more often than usual
  • Pain or burning during urination
  • Feeling as if you need to go right away, even when your bladder isn’t full
  • Having trouble urinating or having a weak urine stream
  • Having to get up to urinate many times during the night

These symptoms are more likely to be caused by a urinary tract infection , bladder stones, an overactive bladder, or an enlarged prostate . Still, its important to have them checked by a doctor so that the cause can be found and treated, if needed.

Tests To Find Bladder Cancer

To find bladder cancer, doctors may run tests to see whether there are certain substancessuch as bloodin the urine. Tests may include:

For patients who have symptoms or have had bladder cancer in the past, newer tests that look for tumor markers in urine may include:

  • NMP22 BladderChek®

Researchers dont know yet whether these tests are reliable enough to be used for screening, but they may help find some bladder cancers.

Most doctors recommend a cystoscopy to find bladder cancer, and its often performed without anesthesia. During this procedure, the doctor inserts a long, thin tube with a camera into the urethra to see the inside of the bladder for growths and collect a tissue sample . The tissue is studied in a lab to search for cancer and obtain more information. During a cystoscopy, doctors may also perform a fluorescence cystoscopy, or blue light cystoscopy, inserting a light-activated drug into the bladder and seeing whether any cancer cells glow when they shine a blue light through the tube.

Doctors may also order imaging tests to see whether the cancer has spread. The most common imaging tests include:

Magnetic resonance imaging uses magnets and radio waves to take pictures of the inside of the body. Before the test, a contrast medium is administered orally or by injection to help make the scan clearer.

Ultrasound uses sound waves to take pictures of the inside of the body.

Bladder cancer treatment: The care you need is one call away

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Multidisciplinary Team Approach For Bladder Cancer Care

The Rogel Cancer Center follows a multidisciplinary team approach to bladder cancer care. Your comprehensive diagnostic evaluation including a review of all test and imaging results will involve input from many highly trained and skilled specialists. Your urologist will work with oncologists, radiologists, pathologists and other cancer experts to form a complete diagnosis and an effective, personalized treatment plan.

Our teams work together as a coordinated team to provide you with prompt answers and guidance with fewer appointments.

Treatment Of Stage Iv Bladder Cancer

Bladder Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of stage IV bladder cancer that has not spread to other parts of the body may include the following:

Treatment of stage IV bladder cancer that has spread to other parts of the body, such as the lung, bone, or liver, may include the following:

  • External radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
  • Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
  • A clinical trial of new anticancer drugs.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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There Are Different Types Of Treatment For Patients With Bladder Cancer

Different types of treatment are available for patients with bladder cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Cancer Stages For Superficial Bladder Cancer

Ta: The most common superficial bladder cancer is stage Ta. This tumor looks like a cauliflower in the bladder, and it does not grow into any of the layers of the bladder. Further treatments for single Ta tumors are usually not needed. Patients do need to come back for regular cystoscopy to make sure the tumor does not come back. In patients with tumors that come back, or patients with many of these tumors at the initial surgery, medicine can be given inside the bladder to prevent cancer from coming back. Stage Ta cancers do come back with some regularity, but they rarely change into cancers that can grow into the bladder wall or go to other parts of the body.

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