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.
Treatment Options Under Clinical Evaluation For Patients With Any T Any N M1 Disease
Prognosis is poor in patients with stage IV disease and consideration of entry into a clinical trial is appropriate.
Other chemotherapy regimens appear to be active in the treatment of metastatic disease. Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed.
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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Stage Ii Bladder Cancer
Stage II cancer has invaded the muscle of the bladder wall but is still confined to the bladder. Depending on the extent and grade of the cancer, we may recommend a partial or total cystectomy. Some people may need chemotherapy before surgery. We may be able to remove the tumor with TUR followed by radiation and chemotherapy.
Understanding Your Bladder Cancer Stage
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The staging system most often used for bladder cancer is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:
- T describes how far the main tumor has grown through the bladder wall and whether it has grown into nearby tissues.
- N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.
- M indicates if the cancer has spread to distant sites, such as other organs, like the lungs or liver, or lymph nodes that are not near the bladder.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.
The earliest stage cancers are called stage 0 , and then range from stages I through IV .
As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
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Standard Treatment Options For Stage Iv Bladder Cancer
Standard treatment options for patients with T4b, N0, M0 disease
Treatment options for patients with T4b, N0, M0 disease include the following:
Chemotherapy alone or as an adjunct to local treatment
Cisplatin-based combination chemotherapy regimens are the standard of care for first-line therapy for stage IV bladder cancer in patients who can tolerate it. The only chemotherapy regimens that have been shown to result in longer survival in randomized controlled trials are MVAC, dose-dense MVAC, and CMV. GC was compared with MVAC in a randomized controlled trial and neither regimen was associated with a statistically significant difference in response rate or survival. The two regimens are generally considered equivalent, but they have never been compared in a noninferiority trial. Of note, patients with good performance status and lymph node-only disease have a low but significant rate of achieving a durable complete remission with MVAC or GC. In the large, randomized, controlled trial comparing MVAC with GC, for example, 5-year OS in patients with lymph node-only disease was 20.9%. Dose-dense MVAC and standard-dose MVAC were compared in a randomized controlled trial, and dose-dense MVAC was associated with longer survival.
Ongoing studies are evaluating new chemotherapy combinations.
Ongoing studies are evaluating new chemotherapy combinations.
Bladder Cancer Treatment: Surgery
Early-stage cancers are most commonly treated by transurethral surgery. An instrument with a small wire loop is inserted through the urethra and into the bladder. The loop removes a tumor by cutting or burning it with electrical current, allowing it to be extracted from the bladder.
Partial and Radical Cystectomy
Partial cystectomy includes the removal of part of the bladder. This operation is usually for low-grade tumors that have invaded the bladder wall but are limited to a small area of the bladder. In a radical cystectomy, the entire bladder is removed, as well as its surrounding lymph nodes and other areas that contain cancerous cells. If the cancer has metastasized outside of the bladder and into neighboring tissue, other organs may also be removed such as the uterus and ovaries in women and the prostate in men.
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Treating Stage Iii Bladder Cancer
These cancers have reached the outside of the bladder and might have grown into nearby tissues or organs and/or lymph nodes . They have not spread to distant parts of the body.
Transurethral resection is often done first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy is then the standard treatment.Partial cystectomy is rarely an option for stage III cancers.
Chemotherapy before surgery can shrink the tumor, which may make surgery easier. Chemo can also kill any cancer cells that could already have spread to other areas of the body and help people live longer. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemo is given first, surgery to remove the bladder is delayed. The delay is not a problem if the chemo shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with radiation is possible instead of surgery.
Some patients get chemo after surgery to kill any cancer cells left after surgery that are too small to see. Chemo given after cystectomy may help patients stay cancer-free longer, but so far its not clear if it helps them live longer. If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.
Changes To This Summary
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Revised to state that of the roughly 81,000 new cases annually, about 62,000 are in men and about 19,000 are in women .
Updated with estimated new cases and deaths for 2022.
Revised to state that in 2018, the U.S. Food and Drug Administration issued an alert about preliminary data from two ongoing first-line therapy trials comparing pembrolizumab or atezolizumab with cisplatin- or carboplatin-based therapy. The data showed that immunotherapy was associated with shorter survival in patients with low expression of PD-L1.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which iseditorially independent of NCI. The summary reflects an independent review ofthe literature and does not represent a policy statement of NCI or NIH. Moreinformation about summary policies and the role of the PDQ Editorial Boards inmaintaining the PDQ summaries can be found on the and PDQ® – NCI’s Comprehensive Cancer Database pages.
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Evaluation Of Upper Urinary Tract
Additional workup for all patients with bladder cancer includes evaluation of the upper urinary tract with intravenous urography , renal ultrasonography, computed tomography urography, or magnetic resonance urography.21,22 Renal ultrasonography alone is insufficient to complete the evaluation of hematuria in a patient with bladder cancer because it cannot delineate details of the urinary collecting system. Traditional IVU has been largely replaced by CT urography because of increased detail and data combined in the CT .
For patients unable to undergo contrast injection , magnetic resonance urography may be used to evaluate the upper urinary tract. These tests are useful for disease staging and excluding other causes of hematuria. Pelvic imaging should be performed before transurethral resection to improve staging accuracy because postoperative inflammation mimics the appearance of tumor infiltration.21 Pelvic imaging also may detect synchronous upper tract urothelial cancer, which can occur in 5 percent of patients with bladder cancer.22
Types Of Bladder Cancer
Bladder cancer can be described based on where it is found:
- non-muscle invasive the cancer has not spread to other layers of the bladder or muscle
- muscle-invasive the cancer has spread to other layers of the bladder, muscle or other parts of the body.
There are 3 main types of bladder cancer:
- urothelial carcinoma 80 to 90% of bladder cancers sometimes called transitional cell carcinoma
- squamous cell carcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive
- adenocarcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive .
There are other, less common types of bladder cancer. Treatment for these may be different. Speak to your doctor or nurse for information about these types of cancer.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options.
People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
Treating Stage 1 Bladder Cancer
Stage I bladder cancers stay in situ upto mucosa and connective tissue layer of the bladder wall. However, they have not spread to the muscle layer.
Usually, transurethral resection with cystoscopy is the first treatment for these cancers. However, it helps determine the extent of the cancer and is part of cure as well. The creation of a new bladder cancer is a procedure gaining popularity today. This is likely to happen if the first cancer is high-grade and fast-growing.
A TURBT is a procedure in which there is removal of bladder tumor from the bladder wall. In this procedure, there is an insertion of a scope through the urethra into the bladder. An outpatient hospital setting can perform this procedure under anesthesia.
Even if there are traces of cancer , oncologists recommend a second TURBT several weeks later. If the doctor then feels that the cancer cells do not remain, intravesical BCG or intravesical chemo are options. Sometimes, a close follow-up is essential. If there are traces of cancer cells, options are intravesical BCG or cystectomy .
If the cancer is high grade, or many tumors are present, or even if the tumor is very large at the initial occurrence, oncologists recommend a radical cystectomy. For people who arent healthy enough for a cystectomy, radiation therapy might be an option along with the chemo, but the chances for cure are not as favorable.
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Bladder Cancer Treatment Symptoms: Constipation
Constipation is another symptom those with bladder cancer may experience. Try to keep your liquid intake up by drinking at least eight cups of fluids a day. Fill up a jug with eight cups of liquid and finish the jug each day so you can track your fluid volume. Hot liquids like tea, coffee, broths and soup can move the contents through your gut more quickly.
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Cellular Classification Of Bladder Cancer
More than 90% of bladder cancers are transitional cell carcinomas derived from the uroepithelium. About 2% to 7% are squamous cell carcinomas, and 2% are adenocarcinomas. Adenocarcinomas may be of urachal origin or nonurachal origin the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium. Small cell carcinomas also may develop in the bladder. Sarcomas of the bladder are very rare.
Pathologic grade of transitional cell carcinomas, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures, is of great prognostic importance.
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Tests For 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.
Are There Any Effective Natural Remedies
Natural remedies are effective supports and go hand-in-hand with traditional medical treatment to treat bladder cancer safely and effectively. Some of the best natural remedies include baking soda, blackstrap molasses, and lemon. However, you may also benefit from a treatment known as the Budwig Diet this is a treatment plan that focuses on feeding your body electron-rich foods to eradicate cancer cells.
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What Affects Survival Rate And What Treatment Options Are Available
After diagnosing bladder cancer, your doctor will try to determine if it has advanced and if it has, how far. Doctors use a staging process to describe how far the tumor has penetrated the surrounding tissue and muscle, and to what extent it has spread to other parts of the body or metastasized. The staging process helps the doctor decide on the best way to treat it.
The American Joint Committee on Cancer TNM system is the most widely used staging system for bladder cancer. It relies on three critical factors:
- T: The letter “T” stands for “tumor” and describes the degree to which the tumor has grown through the wall of your bladder and into neighboring tissue and muscles.
- N: The letter “N” stands for “nodes” and notes if the cancer has spread to nearby lymph nodes. Lymph nodes are groups of immune system cells about the size of beans. When cancer starts to spread, it frequently spreads to the lymph nodes nearest the bladder first.
- M: The letter “M” stands for “metastasized,” which means the cancer has spread to other parts of the body, such as the liver, lungs or other lymph nodes farther from the bladder.
The American Cancer Society provides a detailed breakdown of the TNM system. Letters or numbers after T, N and M offer more detail related to the progression of the cancer.
Stage I Bladder Cancer
Patients with Stage I bladder cancer have a cancer that invades the subepithelial connective tissue, but does not invade the muscle of the bladder and has not spread to lymph nodes. Stage I disease is classified as a âsuperficialâ bladder cancer.
Standard initial treatment for all patients with Stage I bladder cancer is also a transurethral resection with electrical or laser thermal destruction of all visualized cancer.
Rarely, for more extensive or multiple superficial cancers, a segmental cystectomy is necessary. Even more rarely, radical cystectomy is used for extensive multiple superficial cancers. To learn more about TUR, go toSurgery for Bladder Cancer.
Surgery alone is effective in preventing recurrences in approximately 50% of patients with superficial bladder cancer. Failure of treatment is usually due to the appearance of new superficial cancers, which can be retreated with TUR and cautery or laser therapies. Within 15 or 20 years, more than half of surviving patients will have experienced progressive cancer or, more commonly, will develop new cancers, including cancers of the upper urinary tract . Approximately 20-30% of these cancers will require treatment with a cystectomy.
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