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 Bladder Cancer
What is bladder cancer?
Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumors. In bladder cancer, these growths happen in the bladder.

The bladder is the part of your urinary tract that stores your urine until you are ready to let it out. See a picture of the female urinary system or male urinary system .




Bladder cancer can usually be successfully treated if it is found and treated early. And most bladder cancer is found early.

What causes bladder cancer?
We don't know what causes bladder cancer. But smoking cigarettes or being exposed to certain chemicals raises your risk. And like other cancers, changes in the DNA of your cells seem to play a role.

What are the symptoms?
Blood in the urine is the main symptom. Other symptoms may include having to urinate often or feeling pain when you urinate.

These symptoms can be caused by other problems, including a urinary tract infection. Always call your doctor if you see blood in your urine.

How is bladder cancer diagnosed?

To diagnose bladder cancer, your doctor will:

Ask about your medical history and do a physical exam, including a vaginal or rectal exam.
Test your urine to look for blood or abnormal cells.
Do a cystoscopy, a test that lets your doctor look into your bladder with a thin, lighted viewing tool. Small tissue samples (biopsies) are taken and looked at under a microscope to find out if there are cancer cells.

What increases your chances of getting bladder cancer?

Anything that increases your chances of getting a disease is called a risk factor. The main risk factors for bladderHow is it treated?
Treatment choices for bladder cancer include:

Surgery to remove any cancer. Sometimes lasers or other methods can be used to get rid of tumors.
Chemotherapy, which uses medicine to destroy cancer cells.
Immunotherapy, which causes your body's natural defense system to attack bladder cancer cells.
Radiation therapy, which uses high-dose X-rays to kill cancer cells.
The treatment depends a lot on how much the cancer has grown. Most bladder cancers are treated without having to remove the bladder.

Sometimes doctors do have to remove the bladder. For some people, this means having urine flow into a bag outside of the body. But in many cases, doctors can make a new bladder-using other body tissue-that works very much like the old one.

Bladder cancer often comes back. The new tumors can often be treated successfully if they are caught early. So it’s very important to have regular checkups after your treatment is done.

It’s common to feel scared, sad, or angry after finding out that you have bladder cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. 
cancer include:

Smoking. Cigarette smokers are much more likely than other people to get bladder cancer.
Being older than 40, being male, or being white (Caucasian).
Being exposed to cancer-causing chemicals, such as those used in the wood, rubber, and textile industries.
What you eat. A diet high in fried meats and fats increases your risk for bladder cancer.
Parasites. There is a parasite that causes schistosomiasis, which can increase your risk. This condition is sometimes found in developing countries and rarely occurs in North America.


.The cause of bladder cancer is not known. Changes in the genetic material (DNA) of bladder cells may play a role. Chemicals in the environment and cigarette smoking also may play a role. And when the lining of the bladder is irritated for a long time, cell changes that lead to cancer may occur. Some things that cause this are radiation treatment, having catheters in place for a long time, or having the parasite that causes schistosomiasis.

Bladder cancer is twice as likely to develop in smokers than in nonsmokers. Experts believe that smoking causes about half of bladder cancer in men and more than one-fourth of bladder cancer in women. 
Exposure to chemicals and other substances at work-including dyes, paints, leather dust, and others-may also cause bladder cancer

Symptoms

The most common symptoms of bladder cancer include:

Blood or blood clots in the urine (hematuria). Hematuria occurs in 8 or 9 out of 10 people who have bladder cancer and is the most common symptom. Usually it is not painful.
Pain during urination (dysuria).
Urinating small amounts frequently.
Frequent urinary tract infections (UTIs).

Symptoms that may indicate more advanced bladder cancer include:

Pain in the lower back around the kidneys (flank pain).
Swelling in the lower legs.
A growth in the pelvis near the bladder (pelvic mass).
Other symptoms that may develop when bladder cancer has spread include:

Weight loss.
Bone pain or pain in the rectal, anal, or pelvic area.
Anemia.
The symptoms of bladder cancer may be similar to symptoms of other bladder conditions

When to call a Doctor

If you have been diagnosed with bladder cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse. call your doctor if you:

Have blood in your urine.
Feel pain when you urinate.
Are urinating small amounts frequently.
Have back or flank pain.
 
Watchful waiting

If you are concerned about your symptoms or about your risk for bladder cancer, make an appointment with your doctor. Watchful waiting is not appropriate if you have symptoms that do not go away.

Exams and Tests

To find out whether bladder cancer may be the cause of your urinary symptoms, your doctor will:

Do a physical exam. This may include a rectal exam, a prostate exam for men, or a pelvic exam for women.
Ask questions about your medical history, including:
Your smoking history.
Your possible exposure to cancer-causing chemicals.
Your family history of cancer.
Order a urine test and urine culture to check for the presence of blood, infection, and other abnormal cells.

Cystoscopy

You will have a cystoscopy, a test that allows your doctor to look at your bladder with a thin, lighted tube. The doctor can use the same tube to take small tissue samples (biopsies) of any abnormal areas. The samples will be looked at under a microscope to find out whether cancer cells are present and what the cells look like. Tests to determine stage and grade
Bladder cancer is classified by stage and grade. The stage is determined by the cancer growth in the bladder wall and how far it has spread to nearby tissues and other organs, such as the lungs, the liver, or the bones. The grade of bladder cancer is determined by how the cancer cells look in comparison with normal bladder cells.

Your doctor finds out the stage and grade of your bladder cancer by gathering information from several tests, including:

Biopsies from the cystoscopy.
CT scan or MRI. These help find out if the cancer has spread to lymph nodes, the lungs, the liver, or other abdominal organs.
Chest X-ray. This finds out if the cancer has spread to the lungs.
Bone scan. This finds out if the cancer has spread to the bones.
The stage and grade of your cancer are important in choosing the right treatments.

Other tests
Other diagnostic tests that may be done include:

A complete blood count (CBC) to find out if you have anemia.
A chemistry screen to evaluate kidney, liver, and bone functions.
An intravenous pyelogram or computed tomography (CT urogram) to look for a mass near the kidneys, ureters, or bladder.
 
Early detection of returning cancer
Bladder cancer often comes back, so it's important to have regular checkups. Then, if the cancer does come back, you have a better chance of finding it early enough for successful treatment.

Treatment

The choice of treatment and the long-term outcome (prognosis) for people who have bladder cancer depend on the stage and grade of cancer. When deciding about your treatment, your doctor also considers your age, overall health, and quality of life.

Bladder cancer has a better chance of being treated successfully if it is found early.

Treatment choices for bladder cancer may include:

Surgery to remove the cancer. Surgery, either alone or along with other treatments, is used in more than 9 out of 10 cases.

Chemotherapy to destroy cancer cells using medicines. Chemotherapy may be given before or after surgery.

Radiation therapy to destroy cancer cells using high-dose X-rays or other high-energy rays. Radiation therapy may also be given before or after surgery and may be given at the same time as chemotherapy.

Immunotherapy . This treatment causes your body's natural defenses, known as your immune system, to attack bladder cancer cells. For more information, see Medications.

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.

If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.

Side effects of treatment

Most treatments for bladder cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health.

Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss. There is also an increased chance of getting a serious infection during chemotherapy treatment. Mitomycin may cause skin peeling or a rash.
Side effects of surgery depend on how extensive your surgery was to treat the stage of your cancer. Men may have erection problems after surgery if the bladder is removed (cystectomy). If you choose a surgeon who does many of these procedures, you will have fewer side effects and you will recover faster.
Side effects of radiation may include nausea, vomiting, diarrhea, pain or discomfort when urinating, and bladder inflammation and scarring (radiation cystitis). You may also have an increased risk of infection.
Side effects of immunotherapy vary depending on the medicine. Bacillus Calmette-Guerin (BCG) is a tuberculosis vaccine used in countries outside the United States. With BCG, the side effects may include fever, joint pain, inflammation of the prostate, or disseminated tuberculosis.
Home treatment measures may help you manage the side effects. For more information, see Home Treatment.

Body image and sexual problems
Sexual problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.

Women who have the bladder removed (radical cystectomy) will also have the ovaries and uterus removed. They cannot become pregnant and may experience menopause soon after having the cystectomy.
Men who have their prostate glands and seminal vesicles removed may have erection problems and will no longer produce semen.
Your feelings about your body may change following treatment for cancer. Managing body image issues may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Bladder cancer that comes back

After initial treatment for bladder cancer, it is important to receive follow-up care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.

Bladder cancer may recur in the bladder, or it may spread (metastasize) to other parts of the body. Recurrent bladder cancer may be treated with surgery or chemotherapy to slow cancer growth and relieve symptoms.

Participation in a clinical trial may be recommended if you have been diagnosed with recurrent bladder cancer.

Palliative care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.

For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.