Bladder Cancer

The diagnosis of bladder cancer, like other cancers, is dependent mostly on physical examinations and an eventual biopsy. There are a number of diagnostic tools that doctors use for bladder cancer diagnosis, including radiology and cystoscopy.

If certain symptoms are present, an individual is recommended to see a doctor for future diagnostic tests.

Clinical Examination: When a doctor is searching for a bladder cancer diagnosis, he or she will always compile a complete medical history to determine the risk factors and symptoms of a patient For example, if a patient has a parent who has suffered from a bladder cancer in the past, he or she is at higher risk for bladder cancer. After taking a medical history, a doctor will conduct a physical examination for bladder cancer. The doctor will feel the abdomen and pelvis for tumors, including a possible rectal or vaginal examination.

Urinalysis: The urine of a patient is examined under a microscope to see whether it contains any cancerous cells. This is called urine cytology. The doctor will also take a urine culture, where a sample of urine is put into a dish to allow any bacteria to grow. These tests are done to ensure that the urine is not infected. Urine tests are also capable to affirming symptoms, such as blood in the urine.

Imaging Tests: Bladder cancer diagnosis can be found through the use of imaging tests. These tests may show whether the cancer has spread to other areas, as well as the need (or lack thereof) of a possible biopsy.

Intravenous pyelogram (IVP): An intravenous pyelogram is an x-ray test that uses dye to examine the kidneys, ureters, and bladder. The dye helps to outline these organs and helps to find tumors in the urinary tract. It also can help to diagnose symptoms such as blood in the urine or pain in the side or back. This particular type of examination is used by radiologists to detect other problems in the urinary tract, including kidney stones or enlarged prostate.
Intravenous pyelograms is minimally invasive and can provide enough information to suggest treatment with medication, avoiding more invasive surgical procedures. It also does not leave radiation on the body and has little to no side effects.

Retrograde pyelography: Like IVP, retrograde pyelography is used to find tumors in the urinary tract. The procedure involves a tube being placed into the bladder where a dye is then injected to highlight the bladder, kidneys, and ureters on x-rays. It is often performed to identify defects, and requires cystoscopy to place the tube.

Computer Tomography: Also known as CT scanning, this procedure produces a detailed x-ray of the body with cross-sections that allow the radiologist to see extreme details of the anatomy usually unseen. A CT scan provides more detailed information about the shape, size, and location of a tumor. It also examines the lymph nodes and assists in guiding a biopsy needle into a tumor.

Magnetic Resonance Imaging: Also known as an MRI, this test uses magnets and radio waves to take images of the body. They are especially useful in finding signs of cancer that has spread outside of the bladder.

Cystoscopy: A cystoscopy is a test used to look inside of the bladder and urethra using a lighted instrument named a cystoscope. Cystoscopy allows the doctors to examine the bladder and urethra. It also allows doctors to remove samples of tissue (biopsy) through the insertion of surgical instruments.

Biopsy: Bladder cancer diagnosis is completely dependent on a biopsy and subsequent finding of cancerous cells. The examination of cells from the bladder is done by a pathologist, who then determines the presence and type of bladder cancer. As each type of bladder cancer responds differently to different treatments, the correct diagnosis is imperative. While a diagnosis can be made by examining urine cytology, this method is not as accurate as a proper biopsy. A biopsy of the bladder is performed through the cystoscope during a cystoscopy. The doctor will insert surgical instruments into the cystoscope, removing a small sample of the bladder tissue and analyzing it under a microscope. After examining the cells, the pathologist determines whether the tumor is malignant as well as the type of tumor. As such, the bladder cancer diagnosis following the biopsy will determine the proper treatment of the disease. If an individual is diagnosed with bladder cancer, the doctor likely has categorized the cancer into a specific type. There are three main types of bladder cancer, each categorized by the type of cells that are affected and the location of the cancer:

Transitional Cell Carcinoma (TCC): Transitional cell carcinoma, also known as urothelial carcinoma, accounts for over 90 percent of all bladder cancers. This type of bladder cancer is separated into superficial tumors and muscle invasive tumors.

Superficial bladder cancer: Superficial bladder cancer is an early stage of cancer that has not yet spread to other tissue outside of the bladder. As such, over 70% of patients have superficial bladder cancer at initial diagnosis. Superficial bladder cancer is also known as cacinoma in situ. This type of bladder cancer has a high recurrence rate, typically between 60 and 80 percent, and usually comes back as another superficial bladder treatment.

Invasive bladder cancer: Invasive bladder cancer occurs when superficial bladder cancer spreads into the bladder wall, causing cancer that is more serious and harder to treat. These cancers make up roughly 30% of transitional cell carcinomas and typically invade the detrusor muscle and may spread to the lymph nodes, bone, liver, and lungs.

Squamous Cell Carcinoma (SCC): While the overwhelming majority of bladder cancers are transitional cell carcinomas, there are a few non-transitional cell carcinoma bladder cancers that may be diagnosed. Squamous cell carcinoma may cause more transitional cells to become squamous cells, flat cells that are more prone to cancer. Squamous cell carcinoma often forms after other infections, especially chronic urinary infections or irritation of the bladder (bladder stones). This type makes up only 2% of bladder cancers.

Adenocarcinoma: Even though only 1 to 3 percent of bladder cancers are adenocarcinoma, it is a very dangerous form of bladder cancer. Adenocarcinoma tumors are very aggressive, either beginning in the bladder or spreading to the bladder from the gland cells of other organs. There are also other rare types of bladder cancer, including small cell bladder cancer and sarcoma of the bladder. These rare types of bladder cancer may require immediate chemotherapy or other treatment. Each of these different types of bladder cancer, ranging from transitional cell carcinoma to adenocarcinoma may respond differently to different forms of treatment. Radiation therapy is often used in bladder cancer treatment to destroy cancer cells. Often used as an adjuvant therapy after a surgery to destroy small deposits of cancer cells that may still remain. Some patients prefer a treatment of radiation therapy and chemotherapy to avoid otherwise invasive surgeries (including cystectomy, the removal of the bladder). There are two main types of radiation therapy used in bladder cancer treatment. The type of radiation used for treatment is dependent on the type and location of the cancer:

External Radiation Therapy: In external radiation therapy, the doctor will conduct a review of the patient's medical history and test results. Afterward, the doctor will determine the area to receive the radiation therapy. When the doctor determines the amount of radiation and how it will be given, treatment begins. In most cases, radiation is not capable of destroying a tumor within one session. Therefore, external radiation is usually given in fractions, most often on a daily basis, five days a week for 5 to 8 weeks. The amount of therapy a patient undergoes is dependent on the size, location, and type of the cancer as well as the specifications of the patient.

Procedure: The procedure of external radiation therapy is painless, much like a normal x-ray. The patient is often require to undress and lie on the treatment table near the radiation machine, called a linear accelerator. Before the treatment begins, the doctor may place shields between the radiation and healthy tissue, as to avoid unnecessary damage. During the treatment, the doctor will enter another room and begin operating the machine. The patient is advised to remain still and breathe normally as the machine begins to aim radiation on the targeted area. There are a number of new machines that allow doctors to shape the radiation to match the tumor. Additionally, there are newer forms of radiation that do not damage normal tissue as much. In three-dimensional conformal radiation therapy (3D-CRT), shaped beams are directed at the targeted area from different angles. Intensity modulated radiation therapy is much like the 3D-CRT, as it conforms to the tumor shape. It also, however, allows for changes of the strength of the radiation.

Side Effects and Risks: External radiation therapy is relatively safe, but may procure certain side effects and risks. The most common side effects are fatigue and changes in the skin. These side effects typically subside within a week after treatment. Other side effects include diarrhea, hair loss, and mouth problems.

Internal Radiation Therapy: Also known as brachytherapy, internal radiation therapy consists of inserting an implant of a radiation source into the bladder. The proximity to the bladder allows the radiation to reach the tumor without unnecessarily damaging too many normal, healthy cells. There are two main types of internal radiation therapy commonly used in bladder cancer treatment: intracavitary radiation and interstitial radiation. In intracavity radiation, the radioactive material is placed inside a space in the body. In interstitial radiation, the radioactive implant is placed in or near the cancer.

Procedure: The procedure for placing implants in the body is done through a catheter. The patient receives anesthesia, which may be general or local. The doctor uses an MRI or x-ray to pinpoint where to insert the implant. During the actual treatment, the implants are placed through the catheter. Some implants may be left in for a few minutes, while others may be permanent, depending on the type of bladder cancer.After the procedure, discomfort may linger in the affected area. Otherwise, patients are usually capable of returning to normal activities within a day.

Side Effects and Risks: The side effects of internal radiation therapy are similar to that of external radiation therapy. As there is general anesthesia involved, there are risks and side effects associated with the anesthesia. During the therapy, the patient may feel significant amount of pain and sickness. Other common side effects include changes in the skin, nausea, fatigue, diarrhea, and bladder symptoms such as painful urination. The side effects of radiation therapy are relatively harmless and temporary. However, the long-term problems associated with radiation therapy may prove to be more harmful. A discussion with the doctor can determine what type of radiation therapy to choose, if any at all, and the amount required to cure bladder cancer. While radiation therapy is generally used with another type of treatment, it can prove to be a relatively harmless but effective bladder cancer treatment.