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How Is Bladder Cancer Diagnosed? Treatment Options


By Prev Info - February 10, 2022

How Is Bladder Cancer Diagnosed?


Bladder Cancer Overview


The bladder, an expandable sac-like organ in the pelvic region, stores urine. Bladder cancer usually develops in cells that are located in the lining of the bladder. Although there are different types of bladder cancer, most of the cases diagnosed are of transitional cells (transitional cell carcinoma). The American Cancer Society reports that over 97 percent of bladder cancer diagnosed is of this type.



Some factors that can increase a person's risk of this disease are smoking, exposure to certain toxic chemicals, repeated bladder infections and age. When detected in its early stages, bladder cancer is very treatable.


Signs and Symptoms


Blood in the urine may be a warning sign of bladder cancer. However, there are other health problems such as kidney stones that can present similar symptoms. Other symptoms are a frequent need to urinate, pain and burning during urination. Because many of the symptoms of bladder cancer may be similar to those of other medical conditions, it's important to see a doctor.


When these signs are present, a doctor takes a complete medical history and performs a physical exam. During a physical examination, a doctor checks the rectum or vagina for signs of a bladder tumor. If a doctor suspects that a patient has bladder cancer, she can recommend certain tests. There are a variety of tests and procedures used to diagnose bladder cancer. These can include cystoscopy, biopsy, urine testing and imaging tests.


Cystoscopy/Biopsy


Usually performed under anesthesia, cystoscopy is a procedure in which an instrument called a cystoscope is guided through the urethra and into the bladder. Cystoscopy is one of the main procedures doctors use to detect bladder cancer. With this fiber-optic instrument, a urologist can examine the bladder for signs of abnormal growths or suspicious cell formations. During cystoscopy, the doctor can perform other procedures such as bladder washing, biopsy and fluorescence cystoscopy.


A biopsy may be necessary to remove a tissue sample for microscopic examination. Biopsies can determine if malignant cancerous cells are present and the specific grade of cancer . In some cases, a needle biopsy is recommended to take a tissue sample.


Urine Tests


Urine tests may also be performed to find bladder cancer. Urine cytology involves the examination of urine under a microscope to determine whether there are cancer cells present. However, urine cytology is not foolproof. Urine culture tests are also used to check whether there is a urine infection. Because bladder cancer and urine infection can present similar symptoms, urine culture tests are useful in differentiating between these two conditions. Some tumor marker studies can also require the testing of urine samples. Some of these tests include the NPM22 test and the BTA stat test.


Imaging Tests


If bladder cancer is detected by cystoscopy and other tests mentioned above, doctors can order various imaging tests. These tests can check for signs of spreading cancer in nearby bladder tissue, lymph nodes or other body organs. Intravenous pyelogram and retrograde pyelograph are two procedures utilized to detect urinary tract tumors. In both of these procedures, dyes are injected and X-rays are taken to find any tumors. Other imaging tests that may be useful to check or confirm the spreading of cancer to other areas of the body are chest X-ray, computed tomography (CT), ultrasound, bone scan and magnetic resonance imaging scan (MRI). Although a CT scan can detect the size and shape of a tumor, an MRI scan may show that the cancer has spread outside the bladder. CT scans and MRI scans can give doctors information on the stages of the cancer and treatment options.


Bladder Cancer Treatment Options


Bladder cancer is a form of cancer that affects the tissues of the bladder. It can occur in anyone of any age but is most commonly found in older adults. The treatment for bladder cancer greatly depends on the severity of the cancer when diagnosed. When diagnosed early, bladder cancer is highly treatable.


Transurethral Resection


The kind of surgery performed to treat bladder cancer depends on what kind of bladder cancer the patient has. Non-invasive bladder cancer, or bladder cancer that has not penetrated the deeper layers within the bladder wall, is typically treated with a transurethral resection. This involves removing only the tumor using a cytoscope, a thin tube-like instrument. Once inside the bladder, the cytoscope burns away the tumor with a high energy light beam.


Radical Cystectomy


A radical cystectomy is commonly performed with bladder cancer has permeated the inner walls of the bladder and potentially muscles and organs around the bladder. A surgeon will remove the bladder and any other organs or lymph nodes that contain cancer. In men, some of the organs that could be removed are the seminal vesicles and prostate. In women, the uterus and ovaries may be removed if affected by the cancer.


Chemotherapy


Chemotherapy is a drug used to either kill cancer cells or cease their reproduction. Chemotherapy may be administered intravenously by injecting it into a vein or muscle or directly into the bladder by entering through the urethra using a catheter. Chemotherapy is sometimes used to kill any remaining cancer cells after surgery or to shrink any tumors that may be too large for surgery. Chemotherapy is also often used along with radiation therapy.


Radiation Treatment for Bladder Cancer


Radiation therapy is a form of treatment that uses a high energy beam targeted directly at the affected area. Radiation therapy can be administered one of two ways: using beams from an external machine or external radiation therapy and internal radiation therapy that uses seeds that are inserted in or near the cancer. Seeds are small pellets that are made of radioactive material that gives off energy as the materials break down, killing cancerous cells.


The exact treatment for bladder cancer depends upon the stage of the cancer and if it has metastasized. Radiation therapy is often used for treatment. With bladder cancer, both external and internal radiation can be utilized. Radiation may be combined with surgery and chemotherapy in hopes of obtaining the best results.


Internal Radiation


Internal radiation therapy is also known as brachytherapy. It involves inserting radioactive seeds into your bladder. This usually requires a hospital stay where you will be allowed limited contact with visitors to limit their radiation exposure. Internal radiation is sometimes used along with external radiation. Radiation kills cancer cells by stopping them from multiplying. Once they have died, they are eliminated from the body. Radiation also damages healthy cells, but they are able to repair themselves and recover.


External Radiation


External radiation is a common treatment for bladder cancer, especially when combined with chemotherapy. It involves the use of a machine somewhat like an x-ray machine that directs a precise beam of radiation to the exact location of your bladder cancer. This precision helps to avoid damaging nearby healthy skin. External radiation can be done on an outpatient basis. Treatments are typically given daily, 5 days a week for up to 7 weeks.


Combination


Radiation treatments are often given along with other types of cancer treatments. Surgery may be given to remove part of the bladder. Biologic therapy may also be used. This is also known as immunotherapy, and it acts to fight cancer by stimulating your immune system. Chemotherapy is an often-used option for treating bladder cancer. Chemotherapy uses drugs given orally, through IV or inserted directly into your bladder. To achieve successful results with late-stage and recurrent bladder cancer, one or more of these treatments are often combined with radiation treatments.


Side Effects


Side effects to radiation therapy to the bladder are highly variable and are usually not severe. Potential side effects are diarrhea, cramps, nausea and increased urination. These side effects usually pass once treatment is completed.


Precautions


While undergoing radiation treatments, use caution when going out in the sun. Protect the skin that is exposed to the radiation treatments. Clean your skin with mild soap and water. Do not use hot packs or cold compresses unless directed to do so by your doctor. Let your doctor know if you are taking any supplements or herbs during the time you are undergoing radiation to make sure there will be no undesired interactions. Try to eat a healthy, well-balanced diet during your cancer treatment. If you lose your appetite or experience nausea that interferes with eating, let you doctor know so he can arrange for you to see a nutritionist who can help you get the nutrition your body needs when undergoing radiation treatments.


Biological Therapy


Biological therapy, also known as immunotherapy, uses the body's own immune system to aid in fighting cancer cells. Biological therapy for bladder cancer is usually given by going through the urethra and drugs are put directly into the bladder. The drug Bacille Calmette-Guerin (BCG) is administered to stimulate the immune system while interferon alfa is a synthetic immune system cell. Sometimes these drugs are used simultaneously in combination therapy or are given after a transurethral resection to lessen the chance of a cancer recurrence.


BCG Therapy for Bladder Cancer


BCG is a bacterium called Bacillus Calmette-Guerin. It is marketed under the brand names TICE BCG and TheraCys. It is used to treat bladder cancer. BCG is often used after the cancer has been removed through bladder surgery to prevent a recurrence. BCG is also used to treat the early stages of superficial bladder cancer that do not require surgery.


How it Works


According to the University of Michigan Health System, it is not fully understood how BCG works to treat bladder cancer. It is thought it might trigger an immune response or cause an inflammation in the bladder that kills cancer cells. This type of cancer treatment is called immunotherapy or biotherapy.


Administration


BCG therapy is administered in a doctor's office. It is delivered directly into the bladder through flexible tubing called a catheter. The BCG solution is held in the bladder for 2 hours. During that time, the patient is instructed to lay on his back, stomach and each side for 15 minutes at a time in an effort to coat the entire bladder with the solution. BCG treatments are usually given weekly for 6 weeks.


Patients should drink extra fluids for several hours after treatment in order to flush the bladder.  patients should dilute their urine with household bleach for 6 hours after treatment in order to kill any live BCG bacteria. Bleach should be added to the toilet after urinating and allowed to sit for 15 minutes before flushing.


Side Effects


The possible side effects of BCG therapy include increased frequency of urination, nausea, diarrhea, stomach pain, loss of appetite, fatigue, painful urination, chills, fever and joint aches. According to the University of Michigan Health System, BCG may also cause serious side effects like hepatitis, pneumonitis, allergic reaction, lowered white blood cell count, blood in the urine, bladder contractions and abscess.


Precautions


BCG is used with caution in patients with weakened immune systems. This includes patients with HIV and AIDS, as well as those receiving treatments that compromise the immune system like radiation therapy and certain cancer medications. health care workers should handle BCG with care so they do not become infected with the bacteria.






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