Bladder cancer begins when cells in the urinary bladder start to grow uncontrollably. As more cancer cells develop, they can form a tumor and spread to other areas of the body.
The bladder is a hollow organ in the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. Urine is made by the kidneys and is then carried to the bladder through tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra.
OTHER CANCERS THAT START IN THE BLADDER
Several other types of cancer can start in the bladder, but these are all much less common than urothelial (transitional cell) cancer.
- Squamous cell carcinoma: In the United States, only about 1% to 2% of bladder cancers are squamous cell carcinomas. Under a microscope, the cells look much like the flat cells that are found on the surface of the skin. Nearly all squamous cell carcinomas are invasive.
- Adenocarcinoma: Only about 1% of bladder cancers are adenocarcinomas. The cancer cells have a lot in common with gland-forming cells of colon cancers. Nearly all adenocarcinomas of the bladder are invasive.
- Small cell carcinoma: Less than 1% of bladder cancers are small-cell carcinomas, which start in nerve-like cells called neuroendocrine cells. These cancers often grow quickly and typically need to be treated with chemotherapy like that used for small cell carcinoma of the lung.
- Sarcoma: Sarcomas start in the muscle cells of the bladder, but they are rare. More information can be found in Soft Tissue Sarcoma and Rhabdomyosarcoma.
These less common types of bladder cancer (other than sarcoma) are treated similar to TCCs, especially for early stage tumors, but if chemotherapy is needed, different drugs might be used.
BLADDER CANCER TREATMENT
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Surgical options to treat bladder cancer include:
- Transurethral bladder tumor resection (TURBT). This procedure is used for diagnosis and staging, as well as treatment. During TURBT, a surgeon inserts a cystoscope through the urethra into the bladder. The surgeon then removes the tumor using a tool with a small wire loop, a laser, or fulguration (high-energy electricity).
- Cystectomy. A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. In addition, lymph nodes in the pelvis are removed for both men and women.
- Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.
Living without a bladder can affect a patient’s quality of life. Finding ways to keep all or part of the bladder is an important treatment goal. For some patients with muscle-invasive bladder cancer, certain treatment plans involving chemotherapy and radiation therapy (see below) may be used as an alternative to removing the bladder.
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. A chemotherapy regimen typically consists of a specific number of cycles given over a set period of time.
There are 2 types of chemotherapy that may be used to treat bladder cancer.
- Intravesical chemotherapy. Intravesical (local) chemotherapy is usually given by a urologist. During this type of therapy, drugs are delivered into the bladder through a catheter that has been inserted through the urethra.
- Systemic chemotherapy. Systemic (whole body) chemotherapy is usually prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body.
Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
The standard immunotherapy drug for bladder cancer is a weakened bacterium called bacillus Calmette-Guerin (BCG), which is similar to the bacteria that causes tuberculosis. BCG is placed directly into the bladder through a catheter. This is called intravesical therapy. BCG attaches to the inside lining of the bladder and stimulates the immune system to destroy the tumor. BCG can cause flu-like symptoms, chills, mild fever, fatigue, a burning sensation in the bladder, and bleeding from the bladder.
Interferon (Roferon-A, Intron A, Alferon) is another type of immunotherapy that can be given as intravesical therapy. It is sometimes combined with BCG if using BCG alone does not help treat the cancer.
4. RADIATION THERAPY
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.
Radiation therapy is usually not used by itself as a primary treatment for bladder cancer, but it may be given in combination with chemotherapy. Some people who cannot receive chemotherapy might receive radiation therapy alone. The following reasons describe why a combination of radiation therapy and chemotherapy may be used to treat cancer that is located only in the bladder:
- To destroy any cancer cells that may remain after TURBT so all or part of the bladder does not have to be removed
- To relieve symptoms caused by a tumor, such as pain, bleeding, or blockage
- To treat a metastasis located in 1 area, such as the brain or bone
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