Five Types Of Standard Treatment Are Used:
One of the following types of surgery may be done:
- Transurethral resection with fulguration: Surgery in which a cystoscope is inserted into the bladder through the urethra.A tool with a small wire loop on the end is then used to remove thecancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
- Radical cystectomy: Surgery to remove the bladder and anylymph nodes and nearby organs that contain cancer. This surgery may bedone when the bladder cancer invades the muscle wall, or when superficialcancer involves a large part of the bladder. In men, the nearby organs that areremoved are the prostate and the seminal vesicles. In women, the uterus, theovaries, and part of the vagina are removed. Sometimes, when the cancer hasspread outside the bladder and cannot be completely removed, surgery to removeonly the bladder may be done to reduce urinarysymptoms caused by the cancer.When the bladder must be removed, the surgeon creates another way for urine toleave the body.
- Partial cystectomy: Surgery to remove part of thebladder. This surgery may be done for patients who have a low-grade tumor thathas invaded the wall of the bladder but is limited to one area of the bladder.Because only a part of the bladder is removed, patients are able to urinate normally afterrecovering from this surgery. This is also called segmental cystectomy.
- Urinary diversion: Surgery to make a new way forthe body to store and pass urine.
What Does The Grade Of A Bladder Cancer Refer To
Cancer grade refers to the appearance of the tumor cells when examined under a microscope.
- Low grade tumor cells are similar in appearance to normal cells and usually grow slowly. In general, bladder tumors made up of low grade cells tend to stay within the urothelium.
- High grade tumor cells have a very abnormal appearance and tend to grow quickly and spread to deeper layers of the bladder wall. Tumors made up of high grade cells often recur after treatment.
- Although considered superficial because they are located initially in the bladder lining, carcinoma in situ tumors are high grade. Compared to papillary carcinomas, they are more likely to lead to invasive bladder cancer and have a higher rate of recurrence.
There Are Three Ways That Cancer Spreads In The Body
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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Stage Iv Bladder Cancer
Stage IV cancer has metastasized or spread to major organs in other parts of the body. This is often called metastatic cancer. About 5% of bladder cancer cases are diagnosed after theyve already spread to distant organs, according to SEER.
Stage IV bladder cancer is divided into stage IVA and IVB. IVA cancer has spread either:
- Into the wall of the abdomen or pelvis
- Into multiple lymph nodes near the major arteries of the pelvis
IVB bladder cancer has spread to other organs, which can include the lungs, bones, and liver.
Possible Causes Of Bladder Cancer: Smoking
Smoking is the greatest known risk factor for bladder cancer smokers are four times more likely to get bladder cancer than nonsmokers. Harmful chemicals from cigarette smoke enter the bloodstream in the lungs and are ultimately filtered by the kidneys into the urine. This leads to a concentration of harmful chemicals inside the bladder. Experts believe that smoking causes about half of all bladder cancers in men and women.
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What Is Stage 3 Cancer
Stage 3 cancer is sometimes referred to as locally advanced cancer. In this stage, the tumor may have grown to a specific size, the cancer may consist of multiple tumors, and/or the cancer may have spread to adjacent lymph nodes, organs or tissue. In some cases, stage 3 cancers may be considered metastatic cancers, meaning they may have spread beyond their organ of origin.
Many stage 3 cancers have multiple subcategories, usually designated as stages 3A, 3B and 3C. These subcategories are often determined by the size of the tumors, whether multiple tumors are present and the degree to which the cancer has spread locally.
Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:
- The ratio of healthy blood cells to cancerous cells
- Whether cancer cells are found in lymph nodes or the diaphragm
- The degree to which lymph nodes, the liver or spleen may be swollen
Stage 3 cancer is determined in the five most common cancers this way:
Causes And Risk Factors
Researchers dont know exactly what causes bladder cancer, but they do know what increases the risk of getting it. These risk factors range from family history to certain types of medication.
Data published in 2021 on MedRxiv by researchers from the online pharmacy Valisure and Memorial Sloan Kettering Cancer Center showed patients who took Zantac had elevated diagnosis rates of bladder, breast, prostate and thyroid cancer.
Patients should keep in mind that this data suggests a link between ranitidine and increased risk, but it doesnt prove that all people who take ranitidine will get bladder cancer.
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Turbt Radiation And Chemotherapy
Other patients may have another type of procedure called a transurethral resection of bladder tumor , in which the bladder tumor are removed from the bladder lining. The surgeon may use a procedure called fulguration to try to eliminate cancer cells that remain after the tumor is removed. Another treatment option for some patients is external radiation therapy with or without chemotherapy treatment. Some patients may choose to take part in a clinical trial to investigate a new type of treatment for bladder cancer.
Permission To Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks in the following way: .
The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Bladder Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
Images in this summary are used with permission of the author, artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.
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Sexuality And Bladder Cancer
Having bladder cancer and treatment can change the way you feel about yourself, other people, relationships and sex. These changes can be very upsetting and hard to talk about. Doctors and nurses are very understanding and can give you support. You can ask for a referral to a counsellor or therapist who specialises in body image, sex and relationships.
Cancer That Has Spread To The Bladder
Sometimes cancer that has started elsewhere in the body can spread to the bladder. This can happen with prostate, rectum, ovary, cervix and womb cancer for example.
Cancers that have spread from somewhere else in the body are called secondary cancers. The cancer cells are the same type as the first cancer. So is the treatment.
If you have cancer that has spread to the bladder, you need to go to the section about your primary cancer.
Cancer and Its Management J Tobias and D HochhauserWiley Blackwell, 2015
A M Kamat and othersThe Lancet, 2016. Volume 388, Pages 276 -2810
AJCC Cancer Staging Manuel American Joint Committee on CancerSpringer, 2017
Bladder cancer: diagnosis and management of bladder cancerNational Institute of Health and Clinical Excellence, 2015
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Risk Factors For Bladder Cancer
There are some things that can make you more likely to develop bladder cancer. These are called risk factors and they include:
- smoking chemicals in cigarettes can cause bladder cancer, so if you smoke, your risk is up to three times that of a non-smoker
- age most people with bladder cancer are over 60 years of age
- family history a first degree relative with bladder cancer increases risk up to nearly 2 times higher than the general population
- chemicals being in contact with certain chemicals for a long period of time, like aromatic amines, benzene products and aniline dyes, which have been linked to bladder cancer
- frequent infections of the bladder over a long period of time
- some types of radiation therapy around the pelvis, and the chemotherapy drug cyclophosphamide.
Having these risk factors doesnt mean you will develop bladder cancer. Often there is no clear reason for getting bladder cancer. If you are worried about your risk factors, ask your doctor for advice.
Possible Causes Of Bladder Cancer: Chemical Exposure
Exposure to certain chemicals on the job can increase risk of bladder cancer. Occupations that may involve exposure to cancer-causing chemicals include metal workers, hairdressers, and mechanics. Organic chemicals called aromatic amines are especially associated with bladder cancer and are used in the dye industry. Those working with dyes, metal workers, or in the manufacturing of leather, textiles, rubber, or paint should be sure to follow recommended safety protocols. Smoking increases the risk even more for these workers.
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Bladder Cancer Symptoms: Bladder Changes
Bladder cancer sometimes causes changes in bladder habits like having to urinate more often or feeling an urgent need to urinate without producing urine. Another symptom of bladder cancer is pain or burning during urination without evidence of a urinary tract infection. These symptoms of bladder problems, like bleeding, are usually caused by conditions other than cancer. In some people, bladder cancer tends to cause no symptoms until it reaches an advanced stage that is difficult to cure.
Types Of Bladder Cancer
Once diagnosed, bladder cancer can be classified by how far it has spread.
If the cancerous cells are contained inside the lining of the bladder, doctors describe it as non-muscle-invasive bladder cancer . This is the most common type of bladder cancer.
When the cancerous cells spread beyond the lining, into the surrounding bladder muscle, it’s referred to as muscle-invasive bladder cancer . This is less common, but has a higher chance of spreading to other parts of the body.
If bladder cancer has spread to other parts of the body, it’s known as advanced or metastatic bladder cancer.
Read more about diagnosing bladder cancer.
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What Are The Stages Of Bladder Cancer
Bladder cancer can be either early stage or invasive .
The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.
Stages II to IV denote invasive cancer:
- In Stage II, cancer has spread to the muscle wall of the bladder.
- In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
- In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.
A more sophisticated and preferred staging system is known as TNM, which stands for tumor, node involvement and metastases. In this system:
- Invasive bladder tumors can range from T2 all the way to T4 .
- Lymph node involvement ranges from N0 to N3 .
- M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.
What Are The Symptoms Of End Stage Bladder Cancer
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Stage 3 Bladder Cancer
Stage 3 bladder cancer means that the cancer cells have spread beyond the bladder muscle.1,2,3 Stage 3 bladder cancer includes the following combined TNM stages:
In all three types of stage 3 bladder cancer, the cancer cells have not spread to the lymph nodes near the bladder and they have not spread to other parts of the body.
In a bladder tumor that is stage T3a or stage T3b, the bladder cancer cells have grown into the layer of fatty tissue that surrounds the outside of the bladder. This layer of fatty tissue is called perivesical tissue.
In a stage T3a bladder tumor, the bladder cancer cells in the perivesical tissue are only visible through a microscope. In a stage T3b bladder tumor, the bladder cancer cells have grown into the perivesical tissue and are large enough that they are visible using an imaging test or they can be felt by a healthcare professional. A stage T4a bladder tumor is different in women and men. In women, the stage T4a tumor has grown through the perivesical tissue and into the uterus and/or vagina. In men, the stage T4a tumor has grown through the perivesical tissue and into the prostate. However, in both women and men, a stage T4a tumor has not grown into the pelvic wall or the abdominal wall.
Palliative Or Supportive Care
If your cancer is at an advanced stage and can’t be cured, your medical team should discuss how the cancer will progress and which treatments are available to ease the symptoms.
You can be referred to a palliative care team, who can provide support and practical help, including pain relief.
Page last reviewed: 01 July 2021 Next review due: 01 July 2024
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Can Cystectomy Be Avoided In Muscle
The answer is yes for many patients. Radical cystectomy is a major operation and requires diversion of the urinary stream, which has life-altering implications. Identification of patients that can have their cancer eradicated with transurethral resection plus systemic therapy alone and avoid cystectomy is a priority. Transurethral resection of bladder tumor plus systemic therapy has been known for decades to achieve durable bladder-intact survival in a subset of patients. Research presented at the 2021 America Society of Clinical Oncology Annual Meeting defined an approach using Gemzar , cisplatin chemotherapy combined with Opdivo immunotherapy designed to preserve the bladder in as many patients as possible.
Researchers initially treated patients with with 4 cycles of Gemzar, cisplatin, plus Opdivo immunotherapy followed by clinical re-staging to determine next steps. Re-staging was comprehensive and included urine cytology, MRI/CT of the bladder, cystoscopy, and bladder/prostatic urethral biopsies. Patients achieving a clinical complete response were eligible to proceed without cystectomy and receive Opdivo every 2 weeks and close surveillance otherwise, patients underwent cystectomy. If local recurrence occurred patients proceeded to cystectomy. This approach allowed a majority of patients with MIBC to avoid cystectomy.10
Living With Bladder Cancer
Cancer is a life-changing experience. And although theres no surefire way of preventing a recurrence, you can take steps to feel and stay healthy. Eating plenty of fruits, veggies, whole grains, and keeping to modest portions of lean meat is a great start. If you smoke, stop. Limit alcohol to one drink a day for women and up to two drinks a day for men. Daily exercise and regular checkups will also support your health and give you peace of mind.
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Whats The Treatment For Stage 3 Bladder Cancer
The standard treatment for stage 3 bladder cancer is surgery, usually in combination with other therapies.
Be sure to discuss your treatment goals with your doctor. Assess all the potential benefits and risks of each therapy. Some treatments aim for a cure. Others work to slow progression or relieve symptoms. The recommended treatment may depend on your overall health.
If cancer continues to progress or comes back during treatment, you may have to reconsider your options.
Mechanistic Interactions Between Bladder Cancer And Aging
Several broad hypotheses have proposed potential mechanisms for the association between cancer and aging, whereby the biological processes of aging could influence the development and/or progression of cancer in older adults. The processes interact at multiple levels for example, tumor protein 53 a tumor suppressoris involved in both cancer and aging: alteration of the p53 gene is the most frequently encountered mutation in human cancers , and the efficiency of the response to p53 has been found to vary according to age. In a mouse study, Feng et al. reported that the efficiency of the p53 response was significantly reduced in older mice compared with their younger counterparts. The reduced response predominantly resulted from decreased transcriptional activity and p53-dependent apoptosis decreased stabilization of p53 after stress was found to be the major factor in this decline.
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