Introduction

This page is designed to answer some of the questions you may have about your illness and its treatment. It is important to remember that your relationship with your doctor is the foundation of your treatment. This booklet is meant to help you understand urinary bladder cancer; it does not and should not take the place of discussions between you and your doctor.

How frequently does bladder cancer occur?

It has been estimated that approximately 49,000 new cases of bladder cancer are reported annually in the United States. Bladder cancer occurs three times more frequently in men than women and is more likely to occur in people who are over 60 years of age.

What causes bladder cancer?

There are a number of risk factors that have been associated with bladder cancer, including cigarette smoking and chronic exposure to certain industrial chemicals and dyes.

What are the signs and symptoms of bladder cancer?

Most frequently, the initial symptoms of bladder cancer are blood in the urine, a burning sensation when urinating, or a feeling of having to urinate often. It is important to note that these symptoms can also be characteristic of a urinary tract infection.

The bladder and Its location

A hollow, muscular organ, the bladder is part of the urinary tract and is located in the lower abdomen. The bladder may be seen as an upside down bottle with muscles in its neck that keep urine from leaking out. These muscles relax when you urinate.
Urine is formed in the kidneys and travels down to the bladder through tubes called ureters: one enters the bladder on the left, the other on the right. Depending upon the amount of urine the bladder contains, it has the ability to expand or contract in size.
The bladder acts as a holding tank for urine until it leaves the body through another tube called the urethra. In women, the urethra is a rather short tube that is located in front of the vagina. In men, the urethra is a long tube that passes first through the center of the prostate and then through the penis.

URINARY TRACT

Are there different types of tumors in the bladder?

Yes, but the most frequently seen tumors are called superficial transitional cell tumors that occur on the lining of the bladder.
There are two types of superficial transitional cell tumors:

• PAPILLARY TUMORS look like mushrooms with tiny stems that are attached to the lining of the bladder wall.

• CARCINOMA IN SITU (pronounced "in sigh-to") are tumors that are flat and solid, without the telltale stem of the papillary tumor. They appear to be growing directly on the lining of the bladder wall.

After a careful evaluation, your doctor will classify your tumor and recommend the type of treatment that is appropriate for you.

TYPES OF TRANSITIONAL CELL TUMORS

How is bladder cancer diagnosed?

If there is blood in the urine, the first step is to determine whether it is caused by bladder cancer or another urinary tract condition, such as an infection. In addition to a physical examination, your doctor may want to perform a number of tests.

One of these, a urine culture, will determine whether or not the bleeding could be the result of an infection. Depending on the result of the urine culture, your doctor may order one or more of the following tests:

AN INTRAVENOUS PYELOGRAM (IVP) is an x-ray of the urinary tract that includes the bladder. A special dye is injected into the arm and travels through the bloodstream to the urinary tract where it shows up on the x-ray, highlighting the urinary tract and bladder. The x-ray allows your doctor to see if there are any abnormalities that might be causing the problem.

A CYSTOSCOPY allows your doctor to exam the inside of the bladder. First a thin, flexible tube with a light and lens is inserted through the urethra into the bladder. Your doctor can then look at the inner lining of the bladder and check for any abnormal tissue. Suspicious looking tissue can be removed in the hospital -- or in your doctor's office -- and examined more closely in the laboratory.

How is bladder cancer treated?

Your doctor will make a decision about the best treatment for your condition based on the type of tumor, its location, and the stage of disease. Some of the treatments that your physician may consider are:

TRANSURETHRAL RESECTION (also called TUR) is a procedure in which a thin tube (resectoscope) is inserted through the urethra and into the bladder to remove the tumor. TUR, which eliminates the need for an external incision, is sometimes followed by a special form of cancer treatment described below.

INTRAVESICAL THERAPY is a treatment in which an anti-cancer medication is placed directly into the bladder to eliminate your tumor(s) or prevent them from recurring or invading the deeper layers of your bladder wall. This treatment is most often used for people who have a number of tumors, for tumors that could not be removed during the TUR because of their location, or for people who have carcinoma in situ.

What can I expect after treatment?

After treatment, your doctor will want you to come in for checkups periodically to monitor your progress. During these visits be sure to discuss with your doctor anything that you are unsure about, such as

• When you can get back to your normal routine

• When you can resume sexual activity

• What other activities are okay

• What foods you may eat or should avoid

• Whether or not you should climb stairs

• Any other concerns that you may have.

IF YOU SMOKE, IT IS IMPORTANT FOR YOU TO QUIT. YOUR DOCTOR MAY OFFER SUGGESTIONS TO HELP YOU.

While you are healing, it is important to listen to your body and to stop any activity when you feel tired.

Remember, too, that there is no such thing as a "silly question" when it comes to your health. Your doctor will be more than happy to answer any questions you have about your condition, treatment and recovery.