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Bladder Cancer | |
Main Page on Bladder Cancer |
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Overview of Bladder Cancer |
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FAQ on Bladder Cancer |
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ImmunoCyt™ / uCyt+™ |
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Summary of Procedure |
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FAQ on ImmunoCyt™ / uCyt+™ |
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Certification |
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FAQ on Bladder Cancer
This section answers the most frequently asked questions by patients with bladder cancer. Click on a question below to access the corresponding answer.
What is bladder cancer?
Bladder cancer begins in the bladder, the organ that stores urine. The wall of the bladder has several layers, and cancer may appear on the surface layer, penetrate into the muscle layers, or even invade the surrounding organs.
The three most common types of tumors that can develop in bladder are:
- Over 90% of bladder cancers are Transitional Cell Carcinomas (TCC),
so called because these cells have the capability to undergo changes
in size from cubical (when the bladder is empty) to flat (when the bladder
is full). TCC can sometimes originate in the upper urinary tract (ureters),
though only rarely (5% of the cases)[1].
- Squamous cell carcinomas account for 8% of bladder cancer cases. This
type of cancer resembles those that develop from the flat, scale-like
cells on the surface of the skin called squamous cells. It is often
caused by chronic inflammation, and in certain geographic regions such
as Egypt, it is caused by an infection by a parasite and is called urinary
schistosomiasis or bilharziosis.
- 2% of all diagnosis are adenocarcinomas, and involve cells from the lining of the walls of many different organs of the body, and have glandular characteristics.
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How
many people suffer from bladder cancer?
Bladder cancer is the most common tumor of the urinary system and the
fifth most common cancer in North America. It is estimated that 75,000
new cases of bladder cancer will be diagnosed in 2008, and that 16,000
individuals will die from it. The World Health Organization (WHO) estimates
that there are 330,000 new cases annually worldwide. Bladder cancer prevalence
is steadily increasing and its projected rise is 28% by 2010 for both
men and women.
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What
are the most common symptoms for bladder cancer?
Many early stage bladder cancer patients do not show any symptoms. The
most common clinical presentation is blood in the urine or hematuria.
Usually this is painless and the blood may be visible to the naked eye
(gross hematuria) or can be seen only under the microscope (microscopic
hematuria). Frequently the diagnosis of bladder cancer is delayed because
bleeding is intermittent or attributed to other causes such as urinary
tract infection or the intake of anticoagulants (drugs that block blood
coagulation). However, a substantial proportion of these patients will
have a significant problem such as kidney stones or tumors, urinary tract
obstruction and bladder cancer.
What
are the risk factors for getting bladder cancer?
Although the exact steps that lead to bladder cancer are not clear, there
are some known risk factors. Here are the most important risk factors
for bladder cancer:
- Smoking: Smokers are more than twice as likely to get bladder cancer as those who do not.
- Chemicals: Working in the dye, rubber, leather, textile, paint or print industries, or working with organic chemicals or chemicals called aromatic amines, increases a person’s chances of developing cancer if appropriate safety measures are not followed.
- Race: Caucasians are twice as likely to develop bladder cancer as African-Americans.
- Age: Most people found to have this disease are in their late 60’s.
- Long-standing (chronic) bladder problems: Bladder infections and kidney or bladder stones have been linked with bladder cancer, although they are not causes of the cancer.
- Previously diagnosed with bladder cancer: Recurrence of bladder cancer occurs in 60% of patients. For this reason, follow-up is very important.
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How
is bladder cancer diagnosed?
If there is reason to suspect that a patient might have bladder cancer,
a doctor will use one or more of the following methods to make a diagnosis:
- Medical history and physical examination Urinalysis/Cytology: Urinalysis can detect blood that raises suspicion of bladder cancer. Cytologic examination of urine cells can be of more help as a diagnostic tool. However, many bladder tumors are not detected by this exam.
- ImmunoCyt™/uCyt+™: This novel test uses a urine sample that contains cells from the bladder walls. The cells are isolated and put in contact with monoclonal antibodies to which fluorescent markers have been attached. These same antibodies will bind to the antigens found on the surface of cancer cells, thus allowing their identification using a fluorescence microscope. Studies have shown that ImmunoCyt™/uCyt+™ and urine cytology, when used together, have a rate of bladder cancer detection greater than 90%.
- Bladder tumor markers: These tests look for certain substances released by cancer cells into the urine.
- Cystoscopy: A cystoscope is an endoscope inserted into the bladder through the urethra. The characteristics of the bladder are inspected visually, noting any abnormalities and where they are located. The procedure is considered by patients to be uncomfortable. Cystoscopy is the most reliable tool used in diagnosing the presence of tumors. If anything looks abnormal, a small piece of tissue will be removed for a biopsy.
- Biopsy: If abnormal tissue is found during the cystoscopy, the doctor will need to cut out a small piece and send it to the pathology laboratory for microscopic examination. Samples for the biopsy are obtained by surgical removal through the cystoscope. Histopathological analysis confirms the diagnosis of bladder cancer.
- Bladder mapping or random biopsy: This is when tissues are removed from several different places in the bladder to better determine extent of cancer or dysplasia (abnormal or pre-cancerous cells) present.
- Intravenous urography: In this test, a dye is put into the bloodstream and then X-rays are taken. The X-rays will show a clear picture of the kidneys, ureters, the bladder and tumors that may be present.
- CT, MRI and other imaging studies: These are done to see if the tumor has spread to other organs.
- Biomarkers: There are many new biomarkers being studied, which can give an indication not only of the potential aggressiveness but also of the probable response to treatment. However, these markers are neither in common use, nor yet an exact science. Although great headway is being made in the field of biomarker studies, at this point in time histological assessment of stage and grade is still the best index of prognosis in common use.
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is the seriousness of bladder cancer determined?
Stage refers to how far a cancer has progressed anatomically, while the
grade refers to the aggressiveness of the cancer and is defined by cell
appearance (differentiation) and the make-up of their nucleus. Stage is
determined by the depth to which the tumor has penetrated the bladder
wall, and assessment of the invasion of lymph nodes and other surrounding
organs or tissues. Grade is determined by pathology tests, showing how
abnormal or aggressive the cells of biopsy specimens appear, and how closely
a tumor resembles normal tissue of its same type. Out of all patients
with bladder cancer, about 50% belong to the low-risk group, 35% to the
intermediate group, and 15% to the high-risk group.
What
are the current treatment options for bladder cancer?
The choice of treatment depends on the type of tumor and the stage of
disease when it is found; however, age, health, and personal preferences
are also factors. The four main types of treatments for bladder cancer
are surgery, chemotherapy, immunotherapy and radiation.
- Surgery:
- TUR: Transurethral resection is the primary treatment for most tumors. It is a minimally invasive surgical technique where tumors are removed through the urethra via an endoscope equipped with a special tool on the end for excision of tissue. Cauterization prevents excessive bleeding.
- Radical cystectomy: In dangerous forms of bladder cancer, extensive surgery to excise the bladder and replace it by a new bladder made of bowel or urinary diversion to the skin (stoma) where it is collected in a bag.
- Radiation therapy: Primary radiation therapy generally involves a radiation dose of 6,000 to 7,000 rad to the bladder, with or without corresponding lymph node treatment. High-dose, external beam radiation therapy may be an alternative to bladder surgery in patients with stage T2 to T3 muscle-invading cancers.
- Chemotherapy: Chemotherapy used to treat bladder
cancer can be either local or systemic.
- Intravesical chemotherapy is placed directly into the bladder and is therefore considered local chemotherapy. This type of chemotherapy is typically used to treat earlier stages of bladder cancer and mitomycin and adriamycin (doxorubin) are the most frequently used drugs.
- A combination of chemotherapy drugs injected in the veins (systemic chemotherapy) is used in the treatment of more advanced bladder cancers. The combination used most often for bladder cancer is M-VAC [methotrexate, vinblastine, adriamycin (doxorubicin), and cisplatin] and GC (gemcitabine and cisplatin).
- Immunotherapy: BCG is the most commonly prescribed immunotherapeutic agent for use in bladder cancer treatment. Data suggest that, in addition to a cellular immune response, BCG may induce a cytokine-mediated antiangiogenic environment that aids in inhibiting future tumor growth and progression. One of the cytokines, Interferon α, is also used in combination with BCG. Other immunotherapies are currently under investigation.
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How effective
are standard treatments in eliminating the cancer and preventing recurrence?
When found and treated early, the five-year survival[2] rate for bladder
cancer is 92%. If the cancer has spread to nearby pelvic organs, the rate
is 45%, and if distant organs are involved it drops to 6%.
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What
will happen after treatment for bladder cancer?
Follow-up care: An important part of any treatment plan is a schedule
of follow-up exams. Exams that could include urinary cytology, ImmunoCyt™/uCyt+™,
and cystoscopy among others are necessary to see if cancer has come back,
or if there is a new cancer.
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How
often does bladder cancer recur?
The common papillary form of bladder cancer (Ta and T1) recurs in approximately
60% of patients. Multiple recurrences may occur over the years in the
same patients.
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Useful
links*
American Urological Association
(http://www.auanet.org/)
Canadian Urological Association
(http://www.cua.org/)
* Scimedx is not responsible for content
on external websites.
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[1] Detection of upper urinary tract transitional cell carcinoma with ImmunoCyt: a preliminary report. M. Lodde, C. Mian, H. Wiener, A. Haitel, A. Pycha, M. Marberger. Urology, 2001
[2] Source: American Cancer Society.
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