Monday, January 23, 2023

What Is Early Stage Bladder Cancer

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What Screening Tests Are Used For Bladder Cancer

Treating Early Stage Bladder Cancer

It is not standard to screen for bladder cancer. Bladder cancer screening may be used in people who are considered high risk. If you have a history of bladder cancer, a history of a birth defect of the bladder, or have been exposed to certain chemicals at work, you may be considered high-risk. You should ask your provider if screening tests are right for you.

Testing the urine for blood, abnormal cells, and tumor markers can help find some bladder cancers early but the results vary. Not all bladder cancers are found, and some people may have changes in their urine but do not have bladder cancer. These tests can be used in those who already have signs of bladder cancer or if the cancer has returned. However, more research is needed to determine how useful testing the urine is as a screening test.

How Is Bladder Cancer Diagnosed

Several different diagnostic tests and procedures may be used to detect bladder cancer, often in combination. They are selected based on a patients symptoms and risk factors and may include:

  • Urinalysis: a quick test used to detect blood and other substances in urine.
  • Urine cytology: urine is examined microscopically to see if cancer cells are present.
  • Genomic urine tests: non-invasive molecular tests, such as Cxbladder, which measure gene expression to detect or rule out bladder cancer.
  • Cystoscopy: a thin, flexible tube with a light and camera is inserted into the bladder through the urethra. If an abnormal area is seen, a small sample of tissue is usually collected for laboratory examination.
  • Imaging: several types of imaging test can be used to visualize the inside of the body, such as ultrasound, CT scan, MRI scan, and x-ray.

What Are The Treatment Options For Bladder Cancer

There are four types of treatment for patients with bladder cancer. These include:

  • Surgery

Sometimes, combinations of these treatments will be used.

Surgical options

Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.

  • Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
  • Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
  • Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .

This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.

Chemotherapy

  • Methotrexate

Intravesical therapy

Radiation therapy

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Expectancy And Survival Rates

An expectancy rate can be termed as the same as survival rate. However, a survival rate can be given in terms of a certain duration of time, whereas an expectancy rate is mostly in terms of a person’s whole life. Bladder cancer is a disease that affects many people differently. Hence, determining its expectancy rate can be difficult. Nevertheless, looking at the disease’s survival rate can give the right answers.

Survival rates are figures that give you how many people have survived with a certain similar disease after diagnosis and for how long. Through this, one can be able to estimate the expectancy rate of a person living with the disease.

In the case of bladder cancer, it happens in stages, which means that every stage has a different effect on the patient.

Bladder Cancer In Men Vs Women

Bladder Cancer sign and symptoms

Bladder cancer is 3 to 4 times more common in people assigned male at birth than in people assigned female at birth.

Researchers believe the increased prevalence of bladder cancer in those assigned male at birth may be due to differences in how carcinogens are metabolized before they pass through the bladder . Or it may be that male sex hormones promote tumor formation in the bladder, whereas female sex hormones inhibit this progression.

In contrast, people assigned female at birth tend to be diagnosed at later stages of the disease, do not respond as well to treatment, and have a higher cancer-specific mortality rate, so it’s especially important for those assigned female at birth to be aware of early symptoms and seek prompt evaluation.

One study looked at the prevalence of the early cancer symptoms in both sexes, concluding that:

  • Visible hematuria was present in 65% of men and 68% of women.
  • Dysuria was present in 32% of men and 44% of women.
  • Urgency was present in 61% of men and 47% of women.
  • Nocturia was present in 57% of men and 66% of women.

Painful urination is often dismissed as due to a bladder infection or friction and may be less likely to be investigated, particularly in women. One study found that 47% of female bladder cancer patients were treated for symptoms up to a year before a diagnosis was made, without receiving any further evaluation. A lower percentage of females than males saw a urologist as well.

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Whos At Risk For Bladder Cancer

There are 70,000 new cases of bladder cancer each year in the United States. The male-to-female incidence ratio is about 3 to 1. Your chances of developing bladder cancer increase with age.

The most common risk factor is smoking, which accounts for at least half of all new cases. Other risk factors include:

  • abuse of phenacetin, an analgesic
  • long-term use of cyclophosphamide , a chemotherapy drug and immune suppressant
  • chronic irritation due to a parasitic disease called schistosomiasis
  • chronic irritation from long-term catheterization
  • exposure to certain industrial chemicals used in the dye, rubber, electric, cable, paint, and textile industries

How Do I Know If I Have Bladder Cancer

Many people with bladder cancer do not exhibit symptoms. A bladder cancer diagnosis is often made when red blood cells are detected in a urine test . Urologists are generally the doctors who diagnose and treat bladder cancer. Their specialty is the urinary tract, which includes the bladder, kidneys, ureters, and urethra.

Common Symptoms of Bladder Cancer

Blood in the urine

In many cases, blood in the urine is an early sign of bladder cancer. The blood may change the color of the urine to pink, orange, or dark red. The color of the urine could even be normal, and small amounts of blood may be discovered during the urine test . Blood may be there one day and gone the next. The urine could remain clear for months. However, if the patient has bladder cancer, the blood will eventually reappear.

The early stages of bladder cancer often cause bleeding but with very little pain or discomfort. Its important to note that blood in the urine does not always indicate that you have bladder cancer. More often than not, its caused by benign tumors, an infection, bladder stones, or another non-cancerous ailment. Its still critical to be seen by a doctor if you have blood in the urine.

Bladder habit changes

While bladder symptoms are more often the result of conditions unrelated to cancer, bladder cancer may cause changes to bladder habits, including:

Needing to urinate with little or no results Having to urinate more than usual Painful urination

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Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

What Tests Will I Have If My Doctor Suspects Bladder Cancer Or Another Urinary Problem

Recognizing the early warning signs of bladder cancer

Your doctor will want to analyze your urine to determine if an infection could be a cause of your symptoms. A microscopic examination of the urine, called cytology, will look for cancer cells.

A cystoscopy is the main procedure to identify and diagnose bladder cancer. In this procedure, a lighted telescope is inserted into your bladder from the urethra to view the inside of the bladder and, when done under anesthesia, take tissue samples , which are later examined under a microscope for signs of cancer. When this procedure is done in the doctors office, local anesthesia gel is placed into the urethra prior to the procedure to minimize the discomfort.

If the diagnosis of bladder cancer is made, then the next step is to remove the tumor for detailed staging and diagnosis.

Transurethral resection is a procedure done under general or spinal anesthesia in the operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall , using a special cystoscope . This procedure is diagnostic as well as therapeutic.

This often can be done as an outpatient procedure, with patients discharged from hospital the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the tumor grade and the depth of invasion. The purpose of the procedure is to remove the tumor and obtain important staging information .

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Prognosis And Survival For Bladder Cancer

If you have bladder cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic and predictive factors for bladder cancer.

Bladder Cancer Diagnosis: Imaging

Intravenous Pyelogram

An intravenous pyelogram is an X-ray test with contrast material to show the uterus, kidneys, and bladder. When testing for bladder cancer, the dye highlights the organs of the urinary tract allowing physicians to spot potential cancer-specific abnormalities.

CT Scans and MRI

CT scans and MRI are often used to identify tumors and trace metastasized cancers as they spread to other organ systems. A CT scan provides a three-dimensional view of the bladder, the rest of the urinary tract, and the pelvis to look for masses and other abnormalities. CT scans are often used in conjunction with Positron emission tomography to highlight cells with high metabolic rates. âHot spotsâ of cells with abnormally high metabolism may indicate the presence of cancer and require further investigation.

Bone Scan

If a tumor is found in the bladder a bone scan may be performed to determine whether the cancer has spread to the bones. A bone scan involves having a small dose of a radioactive substance injected into the veins. A full body scan will show any areas where the cancer may have affected the skeletal system.

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Treatment Of Stage Iv 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.

Other Squamous Cell Carcinoma Risk Factors

Additional UroVysion Information

Having bladder diverticula may increase an individuals chance of developing SCC. Rarely, bacillus Calmette-Guerin treatment for CIS has been reported to lead to development of SCC. Development of bladder cancer at a younger age has been associated with bladder exstrophy. SCC has also been described in urachal remnants.

Coffee consumption does not increase the risk of developing bladder cancer. Early studies of rodents and a minority of human studies suggested a weak connection between artificial sweeteners and bladder cancer however, most recent studies show no significant correlation.

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What Is The Bladder

The bladder is an organ found in the lower part of the belly near the pelvic bones. It acts as a holding area for urine. The bladder expands and can hold about half of a liter of urine, but a person usually feels the urge to urinate when the bladder is 25% full. The bladder will contract and become smaller when it is empty. The ureters are two tubes that connect the kidneys to the bladder. They empty urine from the kidneys into the bladder. The urethra is a tube that connects the bladder to the outside of the body and releases urine.

The bladder wall consists of 4 main layers of tissue.

  • The innermost layer is called the urothelium, or transitional epithelium. It is made up of cells called urothelial or transitional cells.
  • Beneath the urothelium is a thin layer called the lamina propria, made up of connective tissue, blood vessels, and nerves.
  • The next layer is called the muscularis propria, made of muscle.
  • The last layer is a layer of fatty tissue that separates the bladder from other surrounding organs.

Smoking Can Affect The Risk Of Bladder Cancer

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer.

Risk factors for bladder cancer include the following:

  • Using tobacco, especially smoking cigarettes.
  • Having a family history of bladder cancer.
  • Having certain changes in the genes that are linked to bladder cancer.
  • Being exposed to paints, dyes, metals, or petroleum products in the workplace.
  • Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
  • Taking Aristolochia fangchi, a Chinese herb.
  • Drinking water from a well that has high levels of arsenic.
  • Drinking water that has been treated with chlorine.
  • Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
  • Using urinarycatheters for a long time.

Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.

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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.

Tests For Bladder Cancer

UVA Hematologist/Oncologist Michael Devitt, MD Discusses Bladder Cancer

Your doctor may do some tests to check for bladder cancer:

  • internal examination the doctor may check inside your bottom or vagina with their finger, using gloves
  • urine tests your urine will be checked for signs of bladder cancer
  • blood tests to check your general health
  • ultrasound a scan on the outside of your abdomen to check for cancer
  • cystoscopy the doctor puts a small camera into your bladder to see inside
  • biopsy the doctor takes a small sample of the cells from the bladder to check for signs of cancer.

Your doctor might ask you to have further tests. These can include:

  • CT scan and x-rays scans that take pictures of the inside of the body, sometimes also called a CT-IVP or a triple phase abdominal-pelvic CT scan
  • MRI scan a scan that uses magnetism and radio waves to take pictures of the inside of the body
  • bone scan a scan that uses dye to show changes in your bones
  • FDG-PET scan a scan that uses an injection of liquid to show cancer cells.

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