Bladder

he bladder is the organ in the body where urine is stored before it is expelled through urination. There are several different kinds of bladder cancer:

* Transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder) are the most common.

* Squamous cell carcinoma is cancer that begins in thin, flat cells.

* Adenocarcinoma is cancer that begins in cells that make and release mucus and other fluids.

The cells that cause squamous cell carcinoma and adenocarcinoma grow in the inner lining of the bladder and are caused by chronic irritation and inflammation.

Cancer that is in cells in the lining of the bladder is called superficial bladder cancer. Your doctor might call it carcinoma in situ. This kind of bladder cancer comes back many times, even after treatment. When the cancer returns, it is usually as another superficial cancer in the bladder.

Prevent Gall Bladder Cancer

Gall bladder cancer is a rare type of digestive disease that can develop to be a serious form of cancer. More women get afflicted than men. In most cases, gall bladder cancer is not detected until it has developed to an advanced state. Because of the difficulty in diagnosing gall bladder cancer until it has become advanced, the treatment options can lead to a disheartening prognosis. As such, it is better to prevent gall bladder cancer in the first place before it becomes too late. Prevention can be made with liver cleansing and diet changes.

Gall bladder cancer symptoms include abdominal pain, nausea and vomiting, yellowing of the eyes and skin, and unexplained weight loss and loss of appetite.

There are 4 stages to cancer of the gall bladder. These include:

Stage 1: Gall bladder cancer has an affect on the wall of the gall bladder.

Stage 2: The cancer has spread through the wall of the gall bladder, but has not spread to nearby lymph nodes or organs.

Stage 3: The cancer has spread to nearby lymph nodes and organs, such as the stomach, liver, colon, or the small intestines.

Bladder Cancer Treatment

There are many different treatments available for people diagnosed with bladder cancer. Treatment depends mainly on the stage of cancer. A cancer caught early enough will require less dramatic measures than more advanced cancers. The most common treatment options are surgery, radiation therapy, chemotherapy and immunotherapy. In certain cases, your doctor may combine two or more treatment options, most commonly combining surgery with chemotherapy or radiation therapy.

Once bladder cancer has spread, the surgical treatment usually involves complete or partial bladder removal. A partial bladder removal (cystectomy) is often reserved for patients with less invasive types of bladder cancer (usually cancers that start in cells associated with frequent infections or irritations) that occur near the top of the bladder. A complete, or radical, cystectomy may also involve removal of nearby tissues. For men, a radical cystectomy often includes removal of the prostate, the lymph nodes near the hip and the semen conducting tubes. For a woman, a radical cystectomy also includes removing the reproductive organs (uterus, ovaries and fallopian tubes), part of the vagina and the urethra. If you do undergo surgery to remove your bladder cancer, you may require an opening for urine discharge (urostomy). Recent advances in surgical procedures are decreasing the number of people with urostomies.

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To begin with, each year, about 67,000 new cases of bladder cancer are expected, and about 13,000 people will die of the disease in the U.S. Bladder cancer affects three times as many men as women. Women, however, often have more advanced tumors than men at the time of diagnosis.


Bladder cancer can occur at any age, but it is most common in people older than 50 years of age. The average age at the time of diagnosis is in the 60s. However, it clearly appears to be a disease of aging, with people in their 80s and 90s developing bladder cancer as well.


Firstly, the bladder is a hollow organ in the lower abdomen (pelvis). It collects and stores urine produced by the kidneys. Cancer occurs when normal cells undergo a transformation whereby they grow and multiply without normal controls.


As the cells multiply, they form an area of abnormal cells. Medical professionals call this a tumor. As more and more cells are produced, the tumor increases in size. Tumors overwhelm surrounding tissues by invading their space and taking the oxygen and nutrients they need to survive and function.


Of all types of cancer, bladder cancer has an unusually high propensity for recurring after treatment. Bladder cancer has a recurrence rate of 50%-80%. The recurring cancer is usually, but not always, of the same type as the first (primary) cancer. It may be in the bladder or in another part of the urinary tract (kidneys or ureters).


Bladder cancer is most common in industrialized countries. It is the fifth most common type of cancer in the United States the fourth most common in men and the ninth in women.


Important to mention, Tumors are cancerous only if they are malignant. This means that, because of their uncontrolled growth, they encroach on and invade neighboring tissues. Malignant tumors may also travel to remote organs via the bloodstream or the lymphatic system.


This process of invading and spreading to other organs is called metastasis. Bladder cancers are most likely to spread to neighboring organs and lymph nodes prior to spreading through the blood stream to the lungs, liver, bones, or other organs.


Bladder cancers are classified (staged) by how deeply they invade into the bladder wall, which has several layers. Many physicians subdivide bladder cancer into superficial and invasive disease. Superficial bladder cancer is limited to the innermost linings of the bladder (known as the mucosa and lamina propria). Invasive bladder cancer has at least penetrated the muscular layer of the bladder wall.


Nearly all adenocarcinomas and squamous cell carcinomas are invasive. Thus, by the time these cancers are detected, they have usually already invaded the bladder wall.


Many urothelial cell carcinomas are not invasive. This means that they go no deeper than the superficial layer (mucosa) of the bladder.


Of the different types of cells that form the bladder, the cells lining the inside of the bladder wall are most likely to develop cancer. Any of three different cell types can become cancerous. The resulting cancers are named after the cell types.


In the United States, urothelial carcinomas account for more than 90% of all bladder cancers. Squamous cell carcinomas make up 3%-8%, and adenocarcinomas make up 1%-2%.


Urothelial carcinoma (transitional cell carcinoma) is by far the most common type of bladder cancer in the United States. The so-called transitional cells are normal cells that form the innermost lining of the bladder wall.


In transitional cell carcinoma, these normal lining cells undergo changes that lead to the uncontrolled cell growth characteristic of cancer.


Squamous cell carcinoma originate from the thin, flat cells that typically form as a result of bladder inflammation or irritation that has taken place for many months or years.


Adenocarcinoma cancers form from cells that make up glands. Glands are specialized structures that produce and release fluids such as mucus.


These three types of cancer can develop anywhere in the urinary tract. If abnormal cells are found anywhere in the urinary tract, a search for other areas of abnormal cells is warranted. For example, if cancerous cells are found in the bladder, an evaluation of the kidneys and ureters is essential.


Furthermore, a tumor grade is based on the degree of abnormality observed in a microscopic evaluation of the tumor. Cells from a high-grade cancer have more changes in form and have a greater degree of abnormality when viewed microscopically than do cells from a low-grade tumor.


This information is provided by the pathologist, a physician trained in the science of tissue diagnosis. Low-grade tumors are less aggressive, whereas high-grade tumors are more dangerous and have a propensity to become invasive.


Papillary tumors are urothelial carcinomas that grow narrow, finger-like projections. Benign (noncancerous) papillary tumors (papillomas) grow projections out into the hollow part of the bladder. These can be easily removed, but they sometimes grow back.


These tumors vary greatly in their potential to come back (recur). Some types rarely recur after treatment; other types are very likely to do so. Papillary tumors also vary greatly in their potential to be malignant (invasive). A small percentage (15%) do invade the bladder wall. Some invasive papillary tumors grow projections both into the bladder wall and into the hollow part of the bladder.


In addition, bladder cancer can develop in the form of a flat, red (erythematous) patch on the mucosal surface. This is called carcinoma-in-situ (CIS).


Although these tumors are superficial, they are high-grade and have a high risk for becoming invasive.

Interesting fact about bladder cancer is that, white men and women, develop bladder cancers twice as often as other ethnic groups. In the United States, African Americans and Hispanics have similar rates of this cancer. Rates are lowest in Asians.


Lastly, because of its high recurrence rate and the need for lifelong surveillance, bladder cancer is the most expensive cancer to treat on a per patient basis.

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Bladder cancer is a type of cancer that occurs in your bladder, a balloon-shaped organ in your pelvic area that stores urine. It is the fourth most common type of cancer in men and the eighth most common type in women. Tumors can develop on the surface of the bladder wall or in more severe cases, within the wall and into the underlying muscles. Cancer in the bladder typically affects older adults, though it can occur at any age. Bladder tumors are 2 to 3 times more common in men.


Causes of Bladder Cancer

Smoking, gender, and diet can affect the risk of developing bladder cancer. Bladder carcinomas are also associated with industrial exposure to aromatic amines in dyes, paints, benzedine, nitrates, solvents, leather dust, inks, combustion products, rubber, and textiles. The period between exposure to the carcinogen and development of symptoms is about 18 years.


There is currently limited evidence that diet plays a part in the development of bladder cancer, but a diet high in fruit and vegetables and low in fat may help reduce the risk. Urinary infections, kidney and bladder stones, and other causes of chronic bladder irritation have been linked with bladder cancer (especially squamous cell carcinoma of the bladder), but they do not necessarily cause bladder cancer.


Signs of Bladder Cancer

In early cases around 25% of patients have no symptoms. Commonly the first sign of bladder tumours is blood in the urine, pain after urination, urinary frequency and dribbling. However, these signs and symptoms are not specific to bladder cancer, and may also be caused by non-cancerous conditions, including prostate infections and cystitis.


Types of Bladder Cancer

Cancers are divided into superficial and invasive disease. Superficial bladder cancer is limited to the innermost linings of the bladder. Invasive bladder cancer has at least penetrated the muscular layer of the bladder wall. Less than 5% of bladder cancers in the United States are squamous cell carcinomas, however, worldwide this is the most common form, accounting for 75% of bladder carcinoma in underdeveloped nations. Urothelial carcinoma (transitional cell carcinoma) is by far the most common type of bladder cancer in the United States.


Diagnosis of Bladder Cancer

Cancer in the bladder is usually curable if it is diagnosed while the cancer is still contained in the bladder, and up to 80% of tumors are diagnosed at this early stage. A biopsy for bladder cancer is usually done during cystoscopy. CT and Ultrasound scans, urinalysis and arteriography may also be done.


Treatment for Bladder Cancer

Treatments include bladder cancer surgery, radiation, chemotherapy and biologic therapy. The stage and grade of the cancer provides important information and can help guide treatment. Superficial bladder tumors are surgically removed with chemotherapy being added to the treatment regime to help prevent recurrence. Radical cystectomy and urinary diversion (an external bag) is usually undertaken for invasive bladder cancer.


Several new compounds have shown activity against transitional cell bladder cancer and are now being tested in combination chemotherapy trials. BCG immunotherapy is the most effective intravesical therapy and involves a live attenuated strain of Mycobacterium bovis. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors. Alternative bladder cancer treatments such as herbal treatment may also be of some benefit.


Risk Reduction

Stopping smoking can reduce the risk of getting bladder cancer and if you have been diagnosed with superficial bladder cancer, stopping smoking will reduce the risk of developing more tumours in the future. Bladder cancer has a recurrence rate of 50%-80% and therefore, doctors recommend cystoscopy screening every three months for the first two years after treatment. People who drink a lot of fluids each day have a lower rate of bladder cancer.


Survival Rates

The prognosis depends on the stage of the cancer, whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body. Superficial bladder cancer has a good prognosis, with 5-year survival rates of 82-100%. If a tumor has grown into the wall of the bladder but has not spread to other organs, treatment usually involves surgical removal of the tumor, or combined chemotherapy and radiation therapy, with a five-year survival rate of 60% to 75%. Patients with more deeply invasive tumors,which are also usually less well differentiated, and those with lymphovascular invasion experience 5-year survival rates of 30% to 50% following radical cystectomy.

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