The BLADDER is a hollow, balloon like organ lying in your pelvis, which collects URINE from your KIDNEYS via tubes called URETERS and stores it until it is full enough to empty through the URETHRA.
Showing posts with label Bladder Cancer. Show all posts
Showing posts with label Bladder Cancer. Show all posts
Friday, 6 March 2009
Causes of Bladder Cancer
Tobacco smoking is the main known cause of urinary bladder cancer: in most populations, smoking causes over half of bladder cancer cases in men and a sizeable proportion in women. There is a linear relationship between smoking and risk, and quitting smoking reduces the risk. In a 10-year study involving almost 48,000 men, researchers found that men who drank 1.5L of water a day had a significantly reduced incidence of bladder cancer when compared with men who drank less than 240mL (around 1 cup) per day. The authors proposed that bladder cancer might partly be caused by the bladder directly contacting carcinogens that are excreted in urine. It is postulated, therefore, that by drinking higher quantities of water, urine is more dilute, thereby reducing the chance of disease. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine which is found is cigarette smoke has also been shown to increase bladder cancer risk. Occupations at risk are metal industry workers, rubber industry workers, workers in the textile industry and people who work in printing. Some studies also suggest that auto mechanics have an elevated risk of bladder cancer due to their frequent exposure to hydrocarbons and petroleum-based chemicals. Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes. It has been proposed that hair dyes are a risk factor, and some have shown an odds ratio of 2.1 to 3.3 for risk of developing bladder cancer among women who use permanent hair dyes, while others have shown no correlation between the use of hair dyes and bladder cancer. Certain drugs such as cyclophosphamide and phenacetin are known to predispose to bladder TCC. Chronic bladder irritation (infection, bladder stones, catheters, bilharzia) predisposes to squamous cell carcinoma of the bladder. Approximately 20% of bladder cancers occur in patients without predisposing risk factors.
Epidemiology
In the United States, bladder cancer is the fourth most common type of cancer in men and the ninth most common cancer in women. More than 47,000 men and 16,000 women are diagnosed with bladder cancer each year. One reason for its higher incidence in men is that the androgen receptor, which is much more active in men than in women, plays a major part in the development of the cancer.
Replacing the Bladder
If the bladder has been completely removed, a new reservoir for the urine will have to be created. The most common method is by the formation of an ILEAL CONDUIT or UROSTOMY. A small section of the bowel is used to join the ureters from the kidney to the skin of the abdominal wall. The remaining bowel is joined together again. The opening or STOMA or UROSTOMY drains the urine into a flat, changeable, a watertight bag which is attached to the side of your abdomen. This will fill up in the same way as your bladder did and will need to be emptied regularly by a small tap on the bottom of the bag.
Sometimes it is possible to replace the bladder inside the abdomen (BLADDER RECONSTRUCTION) by using bowel made into a balloon-shaped sac and stitching it to the top of the urethra. It may be possible to empty the bladder normally, but you may have to learn to use a small tube (catheter) to drain the urine several times a day.
Sometimes it is possible to replace the bladder inside the abdomen (BLADDER RECONSTRUCTION) by using bowel made into a balloon-shaped sac and stitching it to the top of the urethra. It may be possible to empty the bladder normally, but you may have to learn to use a small tube (catheter) to drain the urine several times a day.
If the urethra has to be removed a CONTINENT POUCH can be formed, again using a piece of bowel. This meatis thilt although you do not pass urine out through the urethra, you do not have to wear a bag. Instead you will be taught how to dram the urine by passing a small catheter into the new bladder everv three hours through the umbilicus or navel.
Types of Bladder Cancer
Superficial Bladder Tumours
Most bladder cancers are SUPERFICIAL, and look like tiny sea anemones growing on the inside lining of the bladder. They are sometimes known as PAPILLARY tumours; in the past they were sometimes called PAPILLOMAS or BLADDER WARTS. They can be single or multiple.
Most bladder cancers are SUPERFICIAL, and look like tiny sea anemones growing on the inside lining of the bladder. They are sometimes known as PAPILLARY tumours; in the past they were sometimes called PAPILLOMAS or BLADDER WARTS. They can be single or multiple.
They can be completely removed very simply by cutting them off with a probe passed up the cystoscope and CAUTERISING the bladder wall to prevent bleeding. The tumours are then removed through the cystoscope for microscopic examination. Small tumours are destroyed completely by this treatment but unfortunately the bladder may develop other tumours with time. It is therefore very important to have regular cystoscopies every few months to check that the bladder remains healthy and tumour free. Your urologist will be able to discuss with you how often you will need to come to hospital for cystoscopies once he has looked at your bladder and seen the laboratory result from your biopsies.
Intravesical Chemotherapy
In addition to the cystoscopic removal of the tumour and regular cystoscopies you may be asked to attend hospital as an outpatient to have intravesical chemotherapy. Studies have shown that in some patients the likelihood of developing more tumours may be lessened by washing your bladder out regularly with one of several drugs. This treatment is usually given on a weekly basis for 6-8 weeks.The drug is put into your bladder through a small tube (CATHETER) gently passed into the bladder. The catheter is then removed and you are asked to hold the drug in your bladder for at least I hour, emptying your bladder before leaving the hospital. (It is not a good idea to pass these drugs at home or in a public toilet.)If one drug is not completely successful, other drugs may be effective and will be recommended as the specialist considers appropriate.There are separate information sheets for each drug, and you will be given the appropriate one when your treatment is discussed with you.If the bladder cancer has grown deeper into the bladder wall and extends into the muscle layer or its surrounding tissues it is described as INVASIVE. This happens in only a small percentage of patients by the time it is diagnosed. Very rarely the tumours may have given rise to metastases or secondary deposits elsewhere in the body, as explained in the introduction.For most patients the longer term future will involve regular, but less frequent cystoscopies and occasional admissions to hospital for extra treatment.
Invasive Bladder Cancer
In addition to the cystoscopic removal of the tumour and regular cystoscopies you may be asked to attend hospital as an outpatient to have intravesical chemotherapy. Studies have shown that in some patients the likelihood of developing more tumours may be lessened by washing your bladder out regularly with one of several drugs. This treatment is usually given on a weekly basis for 6-8 weeks.The drug is put into your bladder through a small tube (CATHETER) gently passed into the bladder. The catheter is then removed and you are asked to hold the drug in your bladder for at least I hour, emptying your bladder before leaving the hospital. (It is not a good idea to pass these drugs at home or in a public toilet.)If one drug is not completely successful, other drugs may be effective and will be recommended as the specialist considers appropriate.There are separate information sheets for each drug, and you will be given the appropriate one when your treatment is discussed with you.If the bladder cancer has grown deeper into the bladder wall and extends into the muscle layer or its surrounding tissues it is described as INVASIVE. This happens in only a small percentage of patients by the time it is diagnosed. Very rarely the tumours may have given rise to metastases or secondary deposits elsewhere in the body, as explained in the introduction.For most patients the longer term future will involve regular, but less frequent cystoscopies and occasional admissions to hospital for extra treatment.
Invasive Bladder Cancer
Treatment
Surgery, radiotherapy and chemotherapy can be used alone or in combination to treat invasive bladder cancer. The treatment is planned and discussed with each individual patient, taking into account your age, general health, type and size of tumour and where it has spread, if at all.
Surgery
TRANSURETHRAL RESECTION OF TUMOUR - PARTIAL CYSTECTOMY
If the tumour is confined to the bladder wall, it may be possible to remove the tumour and just the section of the bladder involved. 'This may be done either as a telescopic procedure (cystoscopic RESECTION) or as a cutting operation through the abdomen (PARTIAL CYSTECTOMY). After the operation you will be able to pass urine normally.
Cystectomy
If the tumour is more extensive total removal of the bladder (COMPLETE or RADICAL CYSTECTOMY) may be necessary. In women this involves the removal of the whole bladder, the urethra, the lower end of the ureters, the front wall of the vagina, the womb (HYSTERECTOMY), fallopian tubes and ovaries. In younger women the ovaries may be preserved. As a result the vagina will be shorter and narrower following the operation.
In men the whole of the bladder, the prostate gland, the lower ends of the ureters and sometimes the urethra is removed. It is sometimes impossible to avoid damage to the nerves in the pelvis with the result that men will be unable to achieve an erection, and sexual feeling and orgasm (climax) may be impossible for both male and female patents. In some men inability to obtain and erection can be helped by an injection or an operation.
It can be difficult or embarrassing to discuss sex with the doctors or nurses, but remember, they deal with situations like this every day and are used to discussing personal matters. If you have a partner it may be very helpful for them to see the specialist with you - if possible before the operation is performed.
Surgery, radiotherapy and chemotherapy can be used alone or in combination to treat invasive bladder cancer. The treatment is planned and discussed with each individual patient, taking into account your age, general health, type and size of tumour and where it has spread, if at all.
Surgery
TRANSURETHRAL RESECTION OF TUMOUR - PARTIAL CYSTECTOMY
If the tumour is confined to the bladder wall, it may be possible to remove the tumour and just the section of the bladder involved. 'This may be done either as a telescopic procedure (cystoscopic RESECTION) or as a cutting operation through the abdomen (PARTIAL CYSTECTOMY). After the operation you will be able to pass urine normally.
Cystectomy
If the tumour is more extensive total removal of the bladder (COMPLETE or RADICAL CYSTECTOMY) may be necessary. In women this involves the removal of the whole bladder, the urethra, the lower end of the ureters, the front wall of the vagina, the womb (HYSTERECTOMY), fallopian tubes and ovaries. In younger women the ovaries may be preserved. As a result the vagina will be shorter and narrower following the operation.
In men the whole of the bladder, the prostate gland, the lower ends of the ureters and sometimes the urethra is removed. It is sometimes impossible to avoid damage to the nerves in the pelvis with the result that men will be unable to achieve an erection, and sexual feeling and orgasm (climax) may be impossible for both male and female patents. In some men inability to obtain and erection can be helped by an injection or an operation.
It can be difficult or embarrassing to discuss sex with the doctors or nurses, but remember, they deal with situations like this every day and are used to discussing personal matters. If you have a partner it may be very helpful for them to see the specialist with you - if possible before the operation is performed.
The operation of cystectomy is obviously very extensive and removes most of tke the structures in the pelvis, but this is done to give the best chance of cure and make the risk of cancer recurrence as low as possible.
Possible Further Tests
CT or CAT SCAN is a type of X-ray during which a large number of cross-section pictures of your body are taken and together build up a three dimensional image of the issues and organs inside. You may be asked to take a drink containing special dye to help outline the organs that are being examined and improve the quality of the pictures.
You will probably be in the department about an hour and a half and can normally go home immediately afterwards.
RADIOACTIVE BONE SCANS may be performed to check if any cancer has spread from the bladder to the bones. A tiny amount of radioactive liquid is injected into a vein, and then you will have a scan two to three hours later. The test does NOT make you radioactive as the amount used is so minute, and the scan is painless. Any areas of bone that are abnormal pick up the dye,and these areas can be X-rayed to give more detail,
ULTRASOUND SCANS produce a picture of the inside of the abdomen by using sound waves. You will be asked to drink plenty of fluids so that your bladder is full and the picture is clear. The scan takes about 15 minutes and is completely painless.
You will probably be in the department about an hour and a half and can normally go home immediately afterwards.
RADIOACTIVE BONE SCANS may be performed to check if any cancer has spread from the bladder to the bones. A tiny amount of radioactive liquid is injected into a vein, and then you will have a scan two to three hours later. The test does NOT make you radioactive as the amount used is so minute, and the scan is painless. Any areas of bone that are abnormal pick up the dye,and these areas can be X-rayed to give more detail,
ULTRASOUND SCANS produce a picture of the inside of the abdomen by using sound waves. You will be asked to drink plenty of fluids so that your bladder is full and the picture is clear. The scan takes about 15 minutes and is completely painless.
Preliminary Tests may include
BLOOD TESTS will give the doctor an indication of your general health and how well your kidneys are working.
A CHEST-XRAY will examine your heart and lungs to check that they are healthy.
INTRAVENOUS UROGRAM or PYELOGRAM (IVU or IVP) is an X-ray examination that looks at your kidneys, ureters and bladder. The doctor can recognise on the X-ray film any abnormalities in the outline of the urinary system.
The IVU is carried out in the X-ray department, takes about an hour, and you can normally go home immediately afterwards. The injection of dye may make you feel hot and flushed initially but this soon passes.
CYSTOSCOPY is a telescopic examination that allows the urologist to inspect the inside of your bladder. Using the flexible cystoscope the examination is not painful, and does not require a general anaesthefic, so you you may return home afterwards. Under some circumstances it may be recommended that you have a general anaesthetic, for example if issue samples (BIOPSIES) need to be taken.
Biopsies are examined under a microscope to establish whether there are any cancerous cells, and if so, what kind they are.
A CHEST-XRAY will examine your heart and lungs to check that they are healthy.
INTRAVENOUS UROGRAM or PYELOGRAM (IVU or IVP) is an X-ray examination that looks at your kidneys, ureters and bladder. The doctor can recognise on the X-ray film any abnormalities in the outline of the urinary system.
The IVU is carried out in the X-ray department, takes about an hour, and you can normally go home immediately afterwards. The injection of dye may make you feel hot and flushed initially but this soon passes.
CYSTOSCOPY is a telescopic examination that allows the urologist to inspect the inside of your bladder. Using the flexible cystoscope the examination is not painful, and does not require a general anaesthefic, so you you may return home afterwards. Under some circumstances it may be recommended that you have a general anaesthetic, for example if issue samples (BIOPSIES) need to be taken.
Biopsies are examined under a microscope to establish whether there are any cancerous cells, and if so, what kind they are.
Diagnosis of Bladder Cancer
Normally, the first person you will see will be your own family doctor. You will be asked for a urine sample to test for blood and infection. You will also probably be examined, including an internal examination of the back passage (RECTUM) in men, and birth canal (VAGINA) in women.
Depending on the results of the examinations your GP may then refer you to a bladder specialist (UROLOGIST) at the hospital, who will want you to have further tests to determine whether you do have cancer, and if so, its exact type and extent. The most effective treatment can then be discussed with you.
Depending on the results of the examinations your GP may then refer you to a bladder specialist (UROLOGIST) at the hospital, who will want you to have further tests to determine whether you do have cancer, and if so, its exact type and extent. The most effective treatment can then be discussed with you.
Symptoms of Bladder Cancer
The most common symptom is blood in the urine, known as HAEMATURIA. This may appear suddenly with no apparent cause, and there is unlikely to be any pain associated with it. The urine may vary from rusty brown to deep red, depending on the amount of blood. It may be present some days and not others, and may disappear for weeks or months. The amount of blood is not related to the extent of the cancer. Sometimes blood clots can form and cause pain or obstruction to the flow of urine.
It should be remembered that there are other, more likely reasons why you might have haematuria, such as an infection in your bladder, or kidney stones. It does NOT necessarily indicate bladder cancer. It is, however, important to have it checked by your GP as soon as possible so that a diagnosis can be made and appropriate treatment started.
It should be remembered that there are other, more likely reasons why you might have haematuria, such as an infection in your bladder, or kidney stones. It does NOT necessarily indicate bladder cancer. It is, however, important to have it checked by your GP as soon as possible so that a diagnosis can be made and appropriate treatment started.
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