Bladder cancer is typically a disease that strikes older people, with some 90% of newly diagnosed cases appearing in adults, the median age of diagnosis is 55 years old. Cigarette smoking and exposure to certain chemicals all factor into increasing a persons likelihood of developing bladder cancer, as does certain gene mutations and a family history of the disease.
What is the Urinary Bladder?
The urinary bladder is a solid, muscular organ that is situated on the pelvic floor. The bladder is the organ that collects urine made by the kidneys, prior to elimination by the process of urination. Urine enters the bladder via the ureters and exits through the urethra.
Signs and Symptoms of Bladder Cancer
In a majority of cases, blood in the urine can be one of the first signs of bladder cancer and depending upon the amount of blood, urine may have a pale-yellow, yellow-red or dark red tint. More often blood in the urine signifies another condition such as kidney or bladder stones, an infection, benign tumors or another condition. With bladder cancer, there is a chance blood in the urine could disappear for a period of days or even weeks.
Other signs and symptoms of bladder cancer could include urinary urgency or pain upon urination, pain in the lower back or abdomen and loss of appetite and weight. In the early stages, bladder cancer will cause little to no pain, which makes it difficult to diagnose in some people.
How is Bladder Cancer Diagnosed?
The first step in diagnosing any condition is for a physician to take a complete medical history from a patient. Upon doing a physical examination the doctor will check a womans rectum and vagina to determine the size of a tumor and detect if it has spread or is localized to one area.
If a physician suspects a person has bladder cancer some recommend performing a cystoscopy. In this procedure a slender lighted tube is inserted into the bladder via the urethra, which allows a view of the bladder.
Fluorescent cytoscopy is something a physician might order in conjunction with a cystoscopy. In the procedure, substances known as porphyrins are injected into the bladder during a cystoscopy. The substances are absorbed by cancer cells and the physician will then place a blue light onto the surface of the cells and this will allow a view of any cancer cells that may have been missed when using a white light.
There are also certain laboratory tests that can be done to indicate the presence of bladder cancer, which include, but not limited to the following:
• Urine Cytology: urine is examined with a microscope to detect the presence of cancer or precancerous cells. The test is not 100% effective, and there may actually be cancer even if the test shows the opposite.
• Urine Culture: a urine sample is placed into a batch incubator in a lab and any bacteria present would be allowed a chance to grow under certain conditions. This type of test is most commonly used to detect infections rather than cancer, but certain infections can mimic bladder cancer symptoms.
• Bladder Biopsy: a portion of tissue is obtained from the bladder and checked to see if cancer cells are present. The test is done by a pathologist, a doctor who specializes in diagnosing diseases using a tissue sample and microscope.
• Needle Biopsy: is done using a needle to abstract a sample of tissue without having to operate. Some needle biopsies are done using a Computed Tomography (CT) scan and or ultrasound to guide the needle into the correct location.
• Tumor Marker Studies: these tests search for specific substances released by bladder cancer cells. Such tests include: NMP22, ImmunoCyt test, BTA stat test and UroVysion test.
• Image Tests: if a person is diagnosed with bladder cancer, a physician might order an imaging test to check whether the cancer cells have spread to other tissues near the bladder, lymph nodes or other areas. At times, a biopsy will be taken from the patient during an imaging test.
• Intravenous Pyelogram (IVP): an X-ray of the urinary system is taken after a special dye is injected into the veins, the procedure allows for a more clear picture of the organs on X-ray and helps find urinary tract tumors.
• Retrograde Pyelogram: a catheter (tube) is inserted into the bladder or ureter. A dye is then injected and outlines the organs and allows for easier viewing over an X-ray, and is used to detect tumors in the upper portion of the bladder.
• Chest X-ray: can be done to allow a physician to view a possible tumor or a spot on the lungs that could indicate the spread of bladder cancer.
• Computed Tomography (CT): a CT scan takes pictures of the entire body in slices and in some cases a patient will be advised to drink a large amount of water, ingest a special dye or receive dye over an intravenous line into the veins. CT scans can show size, shape and location of any possible tumors and if necessary can be used during a needle biopsy.
• Magnetic Resonance Imaging Scans (MRI): uses powerful magnetic rays and radio waves instead of an X-ray, to take pictures of the body. MRI is a useful tool to give a physician a chance to see if the cancer has spread to other parts of the body and a special type MRI, an MRI urogram can be used to view the upper portion of the urinary bladder.
• Ultrasound: can be used to determine the size of the bladder cancer and to see if the condition has spread to other locations.
• Bone Scan: a minuscule amount of radioactive dye is injected into a vein, and the substance will build up into the area of the bone that contains cancer. A scanner will then be used to spot the cancerous area. A bone infection or arthritis can yield a false-positive test result in the procedure.
• Positron Emission Tomography Scan (PET): a scan that uses radioactive glucose to search for cancer cells. The glucose is injected into the vein and because cancer uses glucose at a higher rate than normal tissue, the radioactivity will concentrate into the area containing cancer. Though PET scans are used in researching bladder cancer, the procedure has not yet been approved for standard protocol in the work-up of patients with bladder cancer.
Treatment for Bladder Cancer
Once a diagnosis of bladder cancer has been confirmed and the disease has been staged, the patient and physician will discuss which treatment options are available. Which treatment option would work best will depend upon the following factors: age of patient, cell type and stage of cancer, overall health of the patient and personal preferences.
Surgical Treatment of Bladder Cancer
Which type of surgery will work best for patient will depend upon the stage of the bladder cancer.
• Transurethral Surgery (TUR): used for the treatment of early stage or superficial bladder cancer, and since 70-80% of patients have superficial cancer when first diagnosed, this type of treatment is the first option. The procedure does not involve cutting of the abdomen, and after surgery more steps are necessary to ensure the tumor is completely removed. Such methods would include: burning the base of the tumor (fulguration), or using cytoscopy and a high-energy laser.
• Cystectomy: the procedure is used when the cancer is invasive, and all or a portion of the bladder must be removed. A partial cystectomy can be done if the cancer is not very large, however, if the cancer has spread and calls for the removal of the bladder and lymph nodes, the procedure is called a radical cystectomy.
• Bladder Preservation: procedure requires careful consideration and patients should be fully evaluated. A urologist will use transurethral resection of the bladder cancer, combined with radiation and chemotherapy. This is a more conservative approach to bladder cancer, though if the patient does not respond favorably, can have the bladder removed at a later time.
• Reconstructive Surgery: type of procedure done on patients who have had their bladders removed due to cancer. There are several methods of reconstructive surgery that can be done, depending upon the medical situation and personal preference of the patient.
Intravesical Therapy for Bladder Cancer
Intravesical therapy involves a treatment that is directly inserted into the bladder via a catheter, rather than having it administered orally or intravenously. The most common types of intravesical therapy treatments for bladder cancer are as follows:
• Bacillus Calmette-Guerin (BCG): thought to be one of the most effective intravesical therapy treatments available for low-stage bladder cancer. A BCG is a bacterium that is related to the virus that causes tuberculosis. To treat bladder cancer, BCG is injected directly into the patients bladder using a catheter. The body will respond to BCG, and cells released by the immune system are attracted to the bladder and activated by BCG, which in turn affects the bladder cancer cells. The treatment is usually given one time per week for a period of 6 weeks, BCG therapy may also be administered in conjunction with the patient undergoing a transurethral resection of the tumor.
• Interferon: a substance that stimulates the immune system. Interferons are produced naturally by the body and can also be made in a laboratory for medicinal uses. The treatment can be useful in intravesical treatment of bladder cancer. Other medications may be given with interferon to reduce the side effects a patient might experience.
• Intravesical Chemotherapy: procedure involves inserting anticancer medications into the bladder through a urinary catheter. One advantage of the treatment is that the medications reach the cancer directly and do not effect the surrounding tissues or cells elsewhere. Intravesical chemotherapy is only given in cases of noninvasive or minimally invasive forms of bladder cancer and because the medication goes directly to the source of cancer, it is not absorbed by the bloodstream, which lessens side effects.
Chemotherapy for Bladder Cancer Treatment
Chemotherapy is a protocol that utilizes drugs for the treatment of cancer. Local chemotherapy involves inserting or administering cancer drugs directly to the area affected by cancer. Intravesical therapy, which was discussed above, involves inserting the drug directly into the bladder, and is another form of local chemotherapy.
Other chemotherapy treatments can be given in a pill form, or as an intravenous or intramuscular injection, when medications are delivered in this way it is called systemic chemotherapy. Systemic chemotherapy enters the bloodstream and treats cancers that spread away from the main tumor, this method is good for the treatment of bladder cancer which has migrated to the lymph nodes.
Chemotherapy can be given either before or after surgery. Administering chemotherapy prior to surgery is done to shrink the tumors, making them easier for removal, and is known as neoadjuvant chemotherapy. When chemotherapy is given after surgery, the goal is to kill off any cancer cells that might not have been removed during surgery. This particular form is called adjuvant chemotherapy, and it also ensures that the cancer has a smaller chance of recurring.
Sometimes chemotherapy can be used in combination with radiation to make the radiation work better. The most common chemotherapy drugs used in the treatment of bladder cancer are as follows:
• Methotrexate, Vinblastine, Doxorubicin and Cisplatin called M-VAC
• Germcitabine and Cisplatin called GermCIS
• Carboplatin and Taxane
Medications used in systemic treatment of bladder cancer are cyclophosphamide, fluorouracil and mytocin C.
Prior to receiving chemotherapy treatment, a patient will be completely assessed to see if it would be advantageous. Factors that would be considered prior to treatment would be the age and health of patient, stage of cancer and the evaluation of certain blood tests.
Radiation Therapy for Bladder Cancer Treatment
Radiation is a therapy which involves using high-energy radiation to kill cancer cells. Radiation can be either external or internal, depending upon the type of cancer the patient has.
Radiation is sometimes combined with chemotherapy medications after a person has undergone bladder cancer surgery. After surgery, chemotherapy and radiation are sometimes able to completely destroy cancer cells that might otherwise have to be treated using cystectomy.
Complementary and Alternative Treatment Options for Bladder Cancer
Amino Acid Therapy
This type of protocol involves actually reducing amino acids, carbohydrates and glucose. Utilizing the chemical reactions produced by amino acids, foods and nutritional supplements are administered to impede the development of cancer cells, effectively starving them to death. The treatment is more than just a dietary change, it is a course designed to control a persons amino acid intake levels.
Amino acid treatment involves removing certain foods from the persons diet for a short period of time, and to replace the foods with a scientifically approved supplement. Amino acid treatment is by no means a replacement of traditional chemotherapy or radiation treatment, but rather to be used in a synergistic manner, to enhance the benefits of each.
Good nutrition plays a vital role in the life of the average person, and is never more important than during cancer treatment. Before a patient can be placed on a nutritional therapy program the following information must be obtained:
• Blood analysis: to determine the condition of patients immune system function and protein stores.
• Medical history and dietary interview: a physician will review a patients medical history and conduct a physical examination. A nutritionist will ask questions to gain insight into appetite, food preferences, digestive system function and any potential or preexisting complications.
• Computerized dietary profile
• Nutrition Anthropometrics: a procedure that involves taking precise body measurements to determine body fat and loss of lean tissue percentages.
• Indirect calorimetry: a breathing test done to determine a persons caloric requirements.
• Nitrogen balance: a measurement of protein loss, used to determine if protein is being properly utilized by the body.
A physician will prescribe vitamins and minerals supplements to help provide cancer patients a nutritional boost. Nutrients that may be recommended include: beta carotene, selenium, vitamin C and E and eicosapentaenoic acid (EPA).
Naturopathic Medicine is a distinct line of primary health care, it is the art of diagnosing, treating and preventing diseases. Naturopathic medicine is the least invasive of all medical treatments, but the most psychologically supportive for patients. The methods used with naturopathy are chosen uniquely based upon the needs of the patient and provide techniques combining modern and traditional medicine with empirical methodology.
Naturopathic medicine utilizes medicinal substances and methods to minimize the effects cancer has upon the patient. Any type of therapeutic healing method should be used in a synergistic manner with traditional medical treatments, and not as a replacement or substitution.
The entire premise of naturopathic medicine is to prevent diseases. This occurs when the patient is educated and promotive of a healthy lifestyle that will foster good health. The emphasis of natural medicine is build good health rather than fighting a specific disease.
The branches of naturopathic medicine include, but are not limited to the following areas:
• Clinical nutrition: this area is the cornerstone of naturopathic medicine and practitioners believe that certain medical conditions can be treated with special foods and nutritional supplements. The science uses diet, natural hygiene, nutritional supplements and fasting in practice.
• Botanical medicine: certain plant substances are used as powerful medications. Botanical medicine includes using botanical compounds combined with the body's own chemistry, to be effective in producing fewer toxic side effects that can come from chemotherapy and radiation treatments.
• Physical medicine: specialists use special diagnostic tools that involve deep manipulation of muscle tissue beneath the skin, therapies include exercise, massage, hydrotherapy, hot and cold, and electrical therapeutic methods.
• Oriental medicine: a healing philosophy that works in a complementary way with naturopathic medicine. Included in Oriental medicine are a body-mind understanding, which adds to Western understanding of how the body works. Acupuncture helps to unify and harmonize the imbalances that result from a disease, which in turn prompts the immune system into a healing response.
• Psychological medicine: metal and emotional attitude that can influence and sometimes cause physical illness. Through counseling, nutritional balance, managing stress, hypnotherapy and biofeedback, a patient can heal psychologically.
• Homeopathic medicine: is based upon the premise that “like cures like,” and this is an observation that works for a patient in a subtle, yet powerfully energetic level. It provides additional strength to the body's healing and immune system response which triggers healing to begin.
The field of naturopathic medicine also includes using any medical substance that contains elements that can be employed into the life of a patient and repair the areas in the body effected by cancer. Naturopathic medicine also includes the use of diagnostic testing and imaging such as ultrasound and X-ray.
Mind-Body Therapy for Bladder Cancer Treatment
Mind-Body therapy for cancer treatment is a new field which is known as Psychoneuroimmunology, or PNI. The therapy includes all areas of being, mind, body and spirit and covers nutrition, emotional and cognitive thoughts, spiritual needs and relationship issues. PNI covers the following areas:
• Managing stress
• Relaxation and imagery programs
• Support and counseling for patient and family
• Individual, couples and family therapy
• Psychoeducational groups
• Educational resources and information
• Humor therapy
Using a wide variety of therapies and programs, will allow a patient to direct energies toward healing and shows the patient how the mind and emotional state control the immune system and health.
Physical Therapy for Bladder Cancer Treatment
Physical therapy for bladder cancer treatment offers patients a way actively designed to reduce stress, prevent fatigue and improve over all quality of life. Physical therapy can include all forms such as, occupational, speech and message therapies to educate bladder cancer patients about the physical and psychological benefits of therapy used in conjunction with the treatment process.
Being physically fit will allow a patients body to better withstand the rigors of radiation and chemotherapy treatments. Participation in physical activities can in turn boost the immune system response of the body, increase muscle flexion,and can help a patient gain a sense of control over the body as well as provide a physical outlet for anxiety and stress.
Physical therapy programs are design for bladder cancer patients who have the ability of maintaining a certain level of self-care, the programs incorporated in therapy will address the patients individual stamina, strength deficiencies and what they are able to endure. Such therapy considerations would be made after the following criteria is assessed:
• Borg Ratio of Perceived Exertion (RPE): designed to assist therapists to determine which type of exercises will work best for the patient.
• Flexibility Program: stretching the body can be a beneficial activity that results in relieving joint stiffness and pain, while at the same time allows for improvement of mobility and range-of-motion for patients. Benefits that come from stretching include:
• Increased enhancement of daily activities
• Improved mobility and independence
• Improved posture and muscle coordination
• Decreases risk of injuries
• Promotive of physical and mental relaxation
Manual therapy is one way of manual muscle therapy and some forms include: Swedish massage, Lymphedema massage, Myofascial release and Reflexology.
Occupational therapy assists patients with quality-of-life programs to give them aid in daily life. The therapy focuses on ways to assist bladder cancer patients in addressing and adapting to any physical limitations that can result from treatments. Occupational therapy programs can include: showering, dressing, eating and using the restroom.
Speech pathology also plays a dual role in the treatment of bladder cancer, teaching both speech therapy and addressing any problems a patient might have with consumption of food. Teaching patients how to avoid aspiration of food into the lungs which can result from improper swallowing, can reduce risks of infection and choking. Speech pathologists work together with a Dietitian to make sure the patients get the right foods in the proper consistency.
Prognosis for Bladder Cancer Patients
Naturally, anyone who has received a diagnosis of bladder cancer will be concerned about the future prognosis. Many factors will determine the likely outcome of a person suffering from bladder cancer, such factors include:
• Type of cancer and location
• Stage of the bladder cancer
• The grade of cancer
• Age of patient, general health and individual response to treatment
It is important for people with bladder cancer to remember that a prognosis is only a prediction, each persons situation is unique and a physician can only offer speculation and not absolute certainty about the condition. Seeking information and educating oneself about all the different treatments and making informed decisions are all important factors that will directly affect the outcome for a bladder cancer patient.