Dr. M.J. Bazos, MD
Patient Handout
BLADDER
NEOPLASMS
About Your
Diagnosis
The bladder is an organ made
of muscle; it stores urine before excretion. The inner lining of the bladder is
made of cells called transitional cells. Nearly 95% of all bladder
cancers originate from these transitional cells. Approximately 53,000 new cases
of bladder cancer were diagnosed in 1996. No specific cause is known, but
certain exposures place people at risk. The two main risk factors for bladder
cancer are cigarette smoking and work exposure to certain chemicals. Additional
risks are radiation therapy to the pelvic area and infestation by Schistosoma
parasites. The only sure way to diagnose bladder cancer is with a tissue
biopsy. This procedure usually is performed with a lighted scope placed into the
bladder (cystoscopy). The bladder is examined for any abnormal areas. If
abnormal areas are found, a biopsy specimen is obtained and examined with a
microscope. Sometimes the diagnosis can be made by means of examination of three
consecutive morning
urine samples for
cancerous cells (urine cytology). Bladder cancer detected early has an excellent
prognosis.
Living With Your
Diagnosis
Blood in the urine is
generally the first sign of bladder cancer. Whether the blood is grossly visible
or seen with routine microscopic analysis, further evaluation is needed. Other
symptoms are frequency, urgency, hesitancy, and pain with urination. Bladder
cancer tends to spread locally. The cancer starts off superficially and invades
the bladder wall to local structures. This may lead to pain in the pelvic area,
obstruction of the ureters (tubes connecting the kidney with bladder), and leg
swelling from affected veins and lymph
glands.
Treatment
Treatment
depends on the extent or stage of the cancer. When cystoscopy is performed to
detect and diagnose bladder cancer, tissue that extends beyond the superficial
layer to the muscle layer is removed. This tells you the depth of invasion of
the cancer. A cystoscope can be used to examine the structures that enter the
bladder (ureters) and leave the bladder (urethra) for spread of cancer. Computed
tomography (CT) or magnetic resonance imaging (MRI) of the abdomen and pelvis is
performed to look for spread beyond the bladder. This staging tells whether the
bladder cancer is superficial, invasive, or metastatic (has spread). Superficial
bladder cancer is treated by means of removal of the cancer with a cystoscope
and placement of an agent called bacille Calmette-Guérin (BCG) or
chemotherapeutic drug directly into the bladder. Side effects are burning with
urination, bladder irritation, and urinary frequency. Invasive bladder cancer
(cancer that has invaded beyond the superficial layer to the muscle layer) is
managed by means of removal of the entire bladder and surrounding organs
(radical cystectomy). Removal of the bladder makes it necessary to form an
artificial bladder. In this procedure a piece of small intestine called the
ileum is attached to the ureters (tubes that connect the kidney to the
bladder). The other end of the ileum is attached to an opening in the abdominal
wall near the naval where the urine can drain into a pouch. Side effects and
complications are infection, kidney stones, blockage or narrowing at the
connecting sites, metabolic problems, and impotence. Metastatic bladder cancer
is managed with chemotherapy. Various combinations of drugs are available and
are recommended by an oncologist (cancer physician). Side effects of
chemotherapy are easy bruising, bleeding, infection, hair loss, nausea, and
vomiting.
The
DOs
• Remember industries in
leather, paint, and rubber may expose you to chemicals that can put you at risk
for bladder cancer. Take precautions by wearing protective
clothing.
• Ask about environmental
safety.
• Remember other occupations
such as chimney sweep and dry cleaner also can expose you to chemicals that
place you at risk.
The
DON’Ts
• Do not
smoke.
• Do not be frustrated if
superficial cancer returns. This happens often, but the cancer can be controlled
with close follow-up care and removal of the lesion with a cystoscope (Fig
1).
• Do not miss follow-up
appointments. After superficial cancer is diagnosed, you undergo cystoscopy
every 3 months for the first year to see if the cancer returned. Patients who
undergo surgical treatment undergo examinations every 3 months to look for
recurrence of cancer.
When to Call
Your Doctor
• If you have blood
in your urine or urinary symptoms of frequency, urgency, hesitancy, or
pain.
• If you have pain after your
operation.
• If you have excess
bleeding, fever, and chills after
cystoscopy.
• If you have pain after
your operation.
• If you have an
abnormal amount of drainage around the urinary diversion
site.
• If you have trouble with
erections after your operation.
• If
you need emotional support.