Bladder Cancer

What is Bladder Cancer?

Cancer is a disease characterized by cells that divide and grow without regulation. Cancer cells form a tumor that can interfere with organ function, invade and damage nearby tissues, and spread to other parts of the body. Bladder cancer is cancer that begins in the bladder, which is an organ that stores your body’s liquid waste (urine.) Bladder cancer is the fourth most common type of cancer in men and the eighth most common type in women today.

The causes of bladder cancer are not known, but it is clearly not a contagious disease. Some people are at higher risk for developing bladder cancer. It is found primarily in people over the age of 40. Men are twice as likely to develop bladder cancer as women. Cigarette smokers are more like to develop bladder cancer, as are people whose occupations regularly expose them to cancer-causing agents—occupations such as hairdressers, painters, metal workers, truck drivers, and workers in the chemical industry.

Certain parasitic infections, a previous bout of bladder cancer, and having a family member diagnosed with bladder cancer also indicate an increased risk for developing the disease.

Symptoms of Bladder Cancer

The primary symptoms of bladder cancer are:

• Blood in the urine
  
• Painful urination
  
• Feeling the need to urinate frequently
  
• Feeling the need to urinate with the inability to do so

Note that these symptoms don’t always indicate bladder cancer. A doctor’s exam is necessary to identify what’s causing the symptoms.

Treatment Options

The type of treatment for bladder cancer depends on several factors: the type of bladder cancer, how far the disease has progressed (the cancer “stage,”) and how much the cancer cells still look like normal cells (the tumor “grade.”) Bladder cancer can be treated using surgery, radiation therapy, chemotherapy, or biological therapy. Sometimes people receive a combination of these treatments.

Surgery

Bladder surgery is a frequent bladder cancer treatment. The simplest surgery is called a transurethral resection, in which a doctor inserts a tool through the urethra into the bladder and uses it to remove cancer cells. This is used only for early stages of cancer. It’s often used in combination with chemotherapy or biological therapy.

Radical cystectomy is a type of bladder surgery where the doctor removes the entire bladder, along with nearby lymph nodes, a portion of the urethra, and other organs that may contain cancer cells. This surgery is used when a large portion of the bladder is affected by cancer. In bladder surgery for women, this means that the uterus, ovaries, and part of the vagina may be removed. In bladder surgery for men, the prostate, seminal vesicles, and a portion of the vas deferens are removed.

Segmental cystectomy is similar to radical cystectomy, but only a portion of the bladder is removed. This type of bladder surgery allows the surgeon to remove only the affected portion of the bladder.

Radiation Therapy

Radiation therapy, like surgery, only affects the body in the targeted area of the bladder. It uses high-energy rays to kill cancer cells. Radiation can be applied externally, using an external machine, or internally, using radioactive material placed directly in or near the tumor.

Chemotherapy

Chemotherapy is a treatment for cancer using anticancer drugs. In some instances, chemotherapy for bladder cancer can be administered locally. The doctor inserts drugs directly into the bladder via a tube through the urethra.
Other chemotherapy treatments are systemic treatment, meaning that they affect cells and tissues throughout the body and not just in the cancerous area. Because chemotherapy harms normal cells that divide rapidly as well as cancer cells, it can cause a number of side effects, including hair loss, increased susceptibility to infection, nausea, vomiting, diarrhea, and mouth and lip sores.

Biological Therapy

Biological therapy is sometimes used in combination with transurethral resection surgery. In one type of biological therapy, the patient receives a solution of bacteria that stimulate the body’s immune system to attack cancer cells. All biological therapies activate the body’s natural immune reaction to help destroy cancer cells.

Living with a Urostomy

If your entire bladder has to be removed, the surgeon performs urostomy surgery to detour liquid waste from the bladder area and provide an alternate way for it to leave the body. Urine exits the body through a surgically created opening in the abdominal wall called a stoma.

After urostomy surgery, you need to watch for the following possible complications:

• Blockage of the stoma
  
• Excessive bleeding of the stoma
  
• Stoma injury
  
• Severe skin irritation around the stoma
  
• Infection is a common side effect of urostomy surgery. Antibiotics are used to treat urostomy infection.
  
• Urinary crystals: These occur when the urine is too alkaline. They can cause stomal irritation and/or bleeding.
  

Urinary crystals can be prevented by keeping the stoma clean and maintaining acidic urine. If urinary crystals form, you can apply a compress dampened with equal parts white vinegar and water for a few minutes when changing the pouch.

Post-surgery recovery time will vary from patient to patient—and the recovery process is not just physical. Urostomy patients will need to learn to care for their new stoma and learn to deal with the practical issues surrounding the pouching system. At the same time, it’s normal for a urostomy patient to feel grief or anger at their body changes. Many support resources are available after urostomy surgery to help people deal with physical, emotional, and social stresses. Remember: you’re not alone. Here are a few organizations available to help:

• The United Ostomy Associations of America, Inc. (www.uoaa.org) provides information, support and advocacy for people who require ostomy surgery. They also host discussion boards where ostomates can find others for advice, encouragement, and camaraderie. 
  
• The International Ostomy Association (www.ostomyinternational.org) provides information about different ostomy associations worldwide. 
  
• Wound, Ostomy and Continence Nurses Society (www.wocn.org) can give you local referrals for nurses who specialize in ostomy care.