21st Century Adult Cancer Sourcebook: Bladder Cancer, Urinary Bladder Neoplasms - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - September 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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PART ONE
Chapter 1A: Bladder Cancer Patient Information
Chapter 2A: Bladder Cancer Health Professional Information
Chapter 3A: Bladder Cancer NCI Drugs
Chapter 4A: Bladder Cancer Background Information
Chapter 5A: Bladder Cancer Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Bladder Cancer Patient Information
Bladder Cancer Treatment
Last Modified: 07/20/2011
Patient Version
General Information About Bladder Cancer
Key Points for This Section
* Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.
* Smoking, gender, and diet can affect the risk of developing bladder cancer.
* Possible signs of bladder cancer include blood in the urine or pain during urination.
* Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.
* Certain factors affect prognosis (chance of recovery) and treatment options.
Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.
The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through two tubes called ureters. When the bladder is emptied during urination, the urine goes from the bladder to the outside of the body through another tube called the urethra.
Anatomy of the female urinary system; shows the right and left kidneys, the ureters, the bladder filled with urine, and the urethra. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine. The uterus is also shown.
Anatomy of the male urinary system (left) and female urinary system (right) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.
There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):
* Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
* Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
* Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.
Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.
Smoking, gender, and diet can affect the risk of developing bladder cancer.
Anything that increases your chance of getting a disease is called a risk factor. Risk factors for bladder cancer include the following:
* Smoking.
* Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies.
* A diet high in fried meats and fat.
* Being older, male, or white.
* Having an infection caused by a certain parasite.
Possible signs of bladder cancer include blood in the urine or pain during urination.
These and other symptoms may be caused by bladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
* Blood in the urine (slightly rusty to bright red in color).
* Frequent urination, or feeling the need to urinate without being able to do so.
* Pain during urination.
* Lower back pain.
Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.
The following tests and procedures may be used:
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
* Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
* Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
* Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
* Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
* Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor.
* Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
* Urine cytology: Examination of urine under a microscope to check for abnormal cells.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
* The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
* The type of bladder cancer cells and how they look under a microscope.
* The patient’s age and general health.
Treatment options depend on the stage of bladder cancer.
Glossary Terms
abdomen (AB-doh-men) * The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul) * Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
adenocarcinoma (A-den-oh-KAR-sih-NOH-muh) * Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.
bladder (BLA-der) * The organ that stores urine.
bladder cancer (BLA-der KAN-ser) * Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.
blood (blud) * A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
cancer (KAN-ser) * A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cell (sel) * The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
contrast material (KON-trast muh-TEER-ee-ul) * A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan) * A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
cystoscope (SIS-toh-SKOPE) * A thin, tube-like instrument used to look inside the bladder and urethra. A cystoscope has a light and a lens for viewing and may have a tool to remove tissue.
cystoscopy (sis-TOS-koh-pee) * Examination of the bladder and urethra using a cystoscope, inserted into the urethra. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
gland * An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.
infection (in-FEK-shun) * Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
inflammation (IN-fluh-MAY-shun) * Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
injection (in-JEK-shun) * Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
intravenous pyelogram (IN-truh-VEE-nus PY-eh-loh-GRAM) * An x-ray image of the kidneys, ureters, and bladder. It is made after a substance that shows up on x-rays is injected into a blood vessel. The substance outlines the kidneys, ureters, and bladder as it flows through the system and collects in the urine. An intravenous pyelogram is usually made to look for a block in the flow of urine.
invasive cancer (in-VAY-siv KAN-ser) * Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
kidney (KID-nee) * One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.
lymph node (limf node) * A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
malignant (muh-LIG-nunt) * Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
organ (OR-gun) * A part of the body that performs a specific function. For example, the heart is an organ.
parasite (PAYR-uh-SITE) * An animal or plant that gets nutrients by living on or in an organism of another species. A complete parasite gets all of its nutrients from the host organism, but a semi-parasite gets only some of its nutrients from the host.
pathologist (puh-THAH-loh-jist) * A doctor who identifies diseases by studying cells and tissues under a microscope.
prognosis (prog-NO-sis) * The likely outcome or course of a disease; the chance of recovery or recurrence.
protein (PROH-teen) * A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
rectum (REK-tum) * The last several inches of the large intestine closest to the anus.
red blood cell (red blud sel) * A cell that carries oxygen to all parts of the body. Also called erythrocyte and RBC.
risk factor (... FAK-ter) * Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
squamous cell (SKWAY-mus sel) * Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.
squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh) * Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
stage * The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
superficial (SOO-per-FIH-shul) * Affecting cells on the surface. Not invasive.
symptom (SIMP-tum) * An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tissue (TIH-shoo) * A group or layer of cells that work together to perform a specific function.
transitional cell (tran-ZIH-shuh-nul sel) * A cell that varies in shape depending on whether the tissue is being stretched. Transitional cells may be stretched without breaking apart. They line hollow organs such as the bladder.
transitional cell cancer (tran-ZIH-shuh-nul sel KAN-ser) * Cancer that forms in transitional cells in the lining of the bladder, ureter, or renal pelvis (the part of the kidney that collects, holds, and drains urine). Transitional cells are cells that can change shape and stretch without breaking apart.
tumor (TOO-mer) * An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ureter (YER-eh-ter) * The tube that carries urine from the kidney to the bladder.
urethra (yoo-REE-thruh) * The tube through which urine leaves the body. It empties urine from the bladder.
urinalysis (YOOR-ih-NA-lih-sis) * A test that determines the content of the urine.
urine (YOOR-in) * Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.
urine cytology (YOOR-in sy-TAH-loh-jee) * Tests performed on cells in urine to detect disease.
vagina (vuh-JY-nuh) * The muscular canal that goes from the uterus to the outside of the body. During birth, the baby passes through the vagina. Also called birth canal.
white blood cell (hwite blud sel) * A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.
x-ray (EX-ray) * A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Table of Links
1 http://www.cancer.gov/cancertopics/pdq/treatment/bladder/Patient/Table1
2 http://www.cancer.gov/cancertopics/pdq/screening/bladder/Patient
3 http://www.cancer.gov/cancertopics/pdq/treatment/unusual-cancers-childhood/Patient/Page6#Section 126
Stages of Bladder Cancer
Key Points for This Section
* After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body.
* There are three ways that cancer spreads in the body.
* The following stages are used for bladder cancer:
* Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
* Stage I
* Stage II
* Stage III
* Stage IV
After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body.
The process used to find out if cancer has spread within the bladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
* Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
* Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
* MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
* Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for bladder cancer:
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:
* Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
* Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.
Stage I
In stage I, cancer has formed and spread to the layer of tissue under the inner lining of the bladder.
Stage II
In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.
Stage III
In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina).
Stage IV
In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.
Glossary Terms
abdomen (AB-doh-men) * The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul) * Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
bladder (BLA-der) * The organ that stores urine.
blood (blud) * A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
bone cancer (bone KAN-ser) * Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
bone scan (bone skan) * A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
breast cancer (brest KAN-ser) * Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
capillary (KA-pih-layr-ee) * The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
carcinoma in situ (KAR-sih-NOH-muh in SY-too) * A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
cell (sel) * The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray (chest EX-ray) * An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
contrast material (KON-trast muh-TEER-ee-ul) * A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan) * A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
cystoscope (SIS-toh-SKOPE) * A thin, tube-like instrument used to look inside the bladder and urethra. A cystoscope has a light and a lens for viewing and may have a tool to remove tissue.
cystoscopy (sis-TOS-koh-pee) * Examination of the bladder and urethra using a cystoscope, inserted into the urethra. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
injection (in-JEK-shun) * Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
invasive cancer (in-VAY-siv KAN-ser) * Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
lymph (limf) * The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph vessel (limf ...) * A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem) * The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
metastasis (meh-TAS-tuh-sis) * The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
MRI * A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
organ (OR-gun) * A part of the body that performs a specific function. For example, the heart is an organ.
papillary tumor (PA-pih-LAYR-ee TOO-mer) * A tumor shaped like a small mushroom, with its stem attached to the epithelial layer (inner lining) of an organ.
pelvis (PEL-vus) * The lower part of the abdomen, located between the hip bones.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun) * An exam of the body to check for general signs of disease.
primary tumor (PRY-mayr-ee TOO-mer) * The original tumor.
prostate (PROS-tayt) * A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.
radioactive (RAY-dee-oh-AK-tiv) * Giving off radiation.
scanner (SKA-ner) * In medicine, an instrument that takes pictures of the inside of the body.
seminal vesicle (SEH-mih-nul VEH-sih-kul) * A gland that helps produce semen.
stage * The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage 0 bladder carcinoma in situ (... BLA-der KAR-sih-NOH-muh in SY-too) * Abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a (papillary carcinoma) and stage 0is (carcinoma in situ), depending on the type of tumor. Stage 0a may look like tiny mushrooms growing from the lining of the bladder. Stage 0is is a flat tumor in the tissue lining the inside of the bladder.
stage I bladder cancer (... BLA-der KAN-ser) * Cancer has spread to the layer of tissue under the inner lining of the bladder.
stage II bladder cancer (... BLA-der KAN-ser) * Cancer has spread to either the inner half or outer half of the muscle wall of the bladder.
stage III bladder cancer (... BLA-der KAN-ser) * Cancer has spread from the bladder to the fatty layer of tissue surrounding it and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina).
stage IV bladder cancer (... BLA-der KAN-ser) * Cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.
staging (STAY-jing) * Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
tissue (TIH-shoo) * A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer) * An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
urethra (yoo-REE-thruh) * The tube through which urine leaves the body. It empties urine from the bladder.
uterus (YOO-teh-rus) * The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called womb.
vagina (vuh-JY-nuh) * The muscular canal that goes from the uterus to the outside of the body. During birth, the baby passes through the vagina. Also called birth canal.
Recurrent Bladder Cancer
Recurrent bladder cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bladder or in other parts of the body.
Key Points for This Section
* There are different types of treatment for patients with bladder cancer.
* Four types of standard treatment are used:
* Surgery
* Radiation therapy
* Chemotherapy
* Biologic therapy
* New types of treatment are being tested in clinical trials.
* Chemoprevention
* Photodynamic therapy
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatment for patients with bladder cancer.
Different types of treatment are available for patients with bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
One of the following types of surgery may be done:
* Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
* Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
* Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
* Urinary diversion: Surgery to make a new way for the body to store and pass urine.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site 2.
Chemoprevention
Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk that cancer will recur (come back).
Photodynamic therapy
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options by Stage
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
Stage I Bladder Cancer
Stage II Bladder Cancer
Stage III Bladder Cancer
Stage IV Bladder Cancer
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
Treatment of stage 0 may include the following:
* Transurethral resection with fulguration.
* Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
* Segmental cystectomy.
* Radical cystectomy.
* A clinical trial of photodynamic therapy.
* A clinical trial of biologic therapy.
* A clinical trial of chemoprevention therapy given after treatment so the condition will not recur (come back).
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 bladder cancer 1. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage I Bladder Cancer
Treatment of stage I bladder cancer may include the following:
* Transurethral resection with fulguration.
* Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
* Segmental or radical cystectomy.
* Radiation implants with or without external radiation therapy.
* A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).
* A clinical trial of intravesical therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I bladder cancer 3. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage II Bladder Cancer
Treatment of stage II bladder cancer may include the following:
* Radical cystectomy with or without surgery to remove pelvic lymph nodes.
* Combination chemotherapy followed by radical cystectomy.
* External radiation therapy combined with chemotherapy.
* Radiation implants before or after external radiation therapy.
* Transurethral resection with fulguration.
* Segmental cystectomy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II bladder cancer 4. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage III Bladder Cancer
Treatment of stage III bladder cancer may include the following:
* Radical cystectomy with or without surgery to remove pelvic lymph nodes.
* Combination chemotherapy followed by radical cystectomy.
* External radiation therapy combined with chemotherapy.
* External radiation therapy with radiation implants.
* Segmental cystectomy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III bladder cancer 5. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage IV Bladder Cancer
Treatment of stage IV bladder cancer may include the following:
* Radical cystectomy with surgery to remove pelvic lymph nodes.
* External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
* Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.
* Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
* Chemotherapy alone or after local treatment (surgery or radiation therapy).
* A clinical trial of chemotherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV bladder cancer 6. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Treatment Options for Recurrent Bladder Cancer
Treatment of recurrent bladder cancer depends on previous treatment and where the cancer has recurred. Treatment for recurrent bladder cancer may include the following:
* Surgery.
* Chemotherapy.
* Radiation therapy.
* A clinical trial of chemotherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
* * * * * * * * * * * *
Chapter 2A: Bladder Cancer Health Professional Information
General Information About Bladder Cancer
Statistics
Note: Estimated new cases and deaths from bladder cancer in the United States in 2010:[1]
• New cases: 70,530.
• Deaths: 14,680.
Prognosis
Approximately 70% to 80% of patients with newly diagnosed bladder cancer will present with superficial bladder tumors (i.e., stage Ta, Tis, or T1). Those who do present with superficial, noninvasive bladder cancer can often be cured, and those with deeply invasive disease can sometimes be cured by surgery, radiation therapy, or a combination of modalities that include chemotherapy. Studies have demonstrated that some patients with distant metastases have achieved long-term complete response following treatment with combination chemotherapy regimens. There are clinical trials suitable for patients with all stages of bladder cancer; whenever possible, patients should be included in clinical trials designed to improve on standard therapy.
The major prognostic factors in carcinoma of the bladder are the depth of invasion into the bladder wall and the degree of differentiation of the tumor. Most superficial tumors are well differentiated. Patients in whom superficial tumors are less differentiated, large, multiple, or associated with carcinoma in situ (Tis) in other areas of the bladder mucosa are at greatest risk for recurrence and the development of invasive cancer. Such patients may be considered to have the entire urothelial surface at risk for the development of cancer. Tis may exist for variable durations. Adverse prognostic features associated with a greater risk of disease progression include the presence of multiple aneuploid cell lines, nuclear p53 overexpression, and expression of the Lewis-x blood group antigen.[2-5] Patients with Tis who have a complete response to bacillus Calmette-Guerin have approximately a 20% risk of disease progression at 5 years; patients with incomplete response have approximately a 95% risk of disease progression.[2] Several treatment methods (i.e., transurethral surgery, intravesical medications, and cystectomy) have been used in the management of patients with superficial tumors, and each method can be associated with 5-year survival in 55% to 80% of patients treated.[2,3,6]
Invasive tumors that are confined to the bladder muscle on pathologic staging after radical cystectomy are associated with approximately a 75% 5-year progression-free survival rate. Patients with more deeply invasive tumors, which are also usually less well differentiated, and those with lymphovascular invasion experience 5-year survival rates of 30% to 50% following radical cystectomy.[7] When the patient presents with locally extensive tumor that invades pelvic viscera or with metastases to lymph nodes or distant sites, 5-year survival is uncommon, but considerable symptomatic palliation can still be achieved.[8]
Expression of the tumor suppressor gene p53 also has been associated with an adverse prognosis for patients with invasive bladder cancer. A retrospective study of 243 patients treated by radical cystectomy found that the presence of nuclear p53 was an independent predictor for recurrence among patients with stage T1, T2, or T3 tumors.[9] Another retrospective study showed p53 expression to be of prognostic value when considered with stage or labeling index.[10]
References
1. American Cancer Society.: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010. Also available online. Last accessed June 16, 2011.
2. Hudson MA, Herr HW: Carcinoma in situ of the bladder. J Urol 153 (3 Pt 1): 564-72, 1995. [PUBMED Abstract]
3. Torti FM, Lum BL: The biology and treatment of superficial bladder cancer. J Clin Oncol 2 (5): 50531, 1984. [PUBMED Abstract]
4. Lacombe L, Dalbagni G, Zhang ZF, et al.: Overexpression of p53 protein in a high-risk population of patients with superficial bladder cancer before and after bacillus Calmette-Guerin therapy: correlation to clinical outcome. J Clin Oncol 14 (10): 2646-52, 1996. [PUBMED Abstract]
5. Stein JP, Grossfeld GD, Ginsberg DA, et al.: Prognostic markers in bladder cancer: a contemporary review of the literature. J Urol 160 (3 Pt 1): 645-59, 1998. [PUBMED Abstract]
6. Witjes JA, Caris CT, Mungan NA, et al.: Results of a randomized phase III trial of sequential intravesical therapy with mitomycin C and bacillus Calmette-Guerin versus mitomycin C alone in patients with superficial bladder cancer. J Urol 160 (5): 1668-71; discussion 1671-2, 1998. [PUBMED Abstract]
7. Quek ML, Stein JP, Nichols PW, et al.: Prognostic significance of lymphovascular invasion of bladder cancer treated with radical cystectomy. J Urol 174 (1): 103-6, 2005. [PUBMED Abstract]
8. Thrasher JB, Crawford ED: Current management of invasive and metastatic transitional cell carcinoma of the bladder. J Urol 149 (5): 957-72, 1993. [PUBMED Abstract]
9. Esrig D, Elmajian D, Groshen S, et al.: Accumulation of nuclear p53 and tumor progression in bladder cancer. N Engl J Med 331 (19): 1259-64, 1994. [PUBMED Abstract]
10. Lipponen PK: Over-expression of p53 nuclear oncoprotein in transitional-cell bladder cancer and its prognostic value. Int J Cancer 53 (3): 365-70, 1993. [PUBMED Abstract]
Cellular Classification of Bladder Cancer
More than 90% of bladder carcinomas are transitional cell carcinomas derived from the uroepithelium. About 6% to 8% are squamous cell carcinomas, and 2% are adenocarcinomas.Q] Adenocarcinomas may be either of urachal origin or of nonurachal origin; the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium.[2] Pathologic grade, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures is of great prognostic importance.
References
1. Mostofi FK, Davis CJ, Sesterhenn IA: Pathology of tumors of the urinary tract. In: Skinner DG, Lieskovsky G, eds.: Diagnosis and Management of Genitourinary Cancer. Philadelphia, Pa: WB Saunders, 1988, pp 83-117.
2. Wilson TG, Pritchett TR, Lieskovsky G, et al.: Primary adenocarcinoma of bladder. Urology 38 (3): 223-6, 1991. [PUBMED Abstract]
Stage Information for Bladder Cancer
Definitions of TNM
Note: This Stage Information section has been updated to include information from the seventh edition (2010) of the American Joint Committee on Cancer's AJCC Cancer Staging Manual. The PDQ Adult Treatment Editorial Board, which is responsible for maintaining this summary, is currently reviewing the new staging categories to determine whether additional changes need to be made to other parts of the summary. Any necessary changes will be made as soon as possible.
The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall by the tumor. This determination requires a cystoscopic examination that includes a biopsy, and examination under anesthesia to assess the size and mobility of palpable masses, the degree of induration of the bladder wall, and the presence of extravesical extension or invasion of adjacent organs. Clinical staging, even when computed tomographic and/or magnetic resonance imaging scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive.[1-3]
Definitions of TNM
The American Joint Committee on Cancer has designated staging by TNM classification to define bladder cancer.[4]
An older, less frequently used staging system was derived by comparing clinical estimates of stage with the pathologic stage of radical cystectomy specimens.[2,3] To better ensure uniform staging and reporting of clinical results, the use of the modern TNM classification described above is recommended.
References
1. Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988. [PUBMED Abstract]
2. Marshall VF: The relationship of the preoperative estimate to the pathologic demonstration of the extent of vesical neoplasms. J Urol 68(4): 714-723, 1952.
3. Skinner DG: Current state of classification and staging of bladder cancer. Cancer Res 37 (8 Pt 2): 2838-42, 1977. [PUBMED Abstract]
4. Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497-505.
Treatment Option Overview
Prolonged survival in most patients with superficial cancers is achieved by transurethral resection (TUR) with or without intravesical chemotherapy. Cure is not possible for the majority of patients with deeply invasive tumors and for most patients with regional or distant metastases. In North America, the standard treatment of patients with invasive bladder cancers is radical cystectomy and urinary diversion. Other treatment approaches include TUR and segmental resection with or without radiation therapy, combined chemotherapy-radiation therapy, or either followed by salvage cystectomy, when needed, for local failure. Many newly diagnosed bladder cancer patients are candidates for participation in a clinical trial. Clinical trials include studies of chemoprevention of superficial disease, adjuvant chemotherapy for advanced local or regional disease, preservation of bladder function with chemotherapy-radiation therapy, and development of more effective systemic therapy and methods of palliation for metastatic tumors.[1-6]
Reconstructive techniques that fashion low-pressure storage reservoirs from the reconfigured small and large bowel eliminate the need for external drainage devices and, in some male patients, allow voiding per urethra. These techniques are designed to improve the quality of life for patients who require cystectomy.[7]
References
1. Thrasher JB, Crawford ED: Current management of invasive and metastatic transitional cell carcinoma of the bladder. J Urol 149 (5): 957-72, 1993. [PUBMED Abstract]
2. Housset M, Maulard C, Chretien Y, et al.: Combined radiation and chemotherapy for invasive transitional-cell carcinoma of the bladder: a prospective study. J Clin Oncol 11 (11): 2150-7, 1993. [PUBMED Abstract]
3. Kachnic LA, Kaufman DS, Heney NM, et al.: Bladder preservation by combined modality therapy for invasive bladder cancer. J Clin Oncol 15 (3): 1022-9, 1997. [PUBMED Abstract]
4. Lamm DL, Riggs DR, Shriver JS, et al.: Megadose vitamins in bladder cancer: a double-blind clinical trial. J Urol 151 (1): 21-6, 1994. [PUBMED Abstract]
5. Raghavan D, Huben R: Management of bladder cancer. Curr Probl Cancer 19 (1): 1-64, 1995 Jan-Feb. [PUBMED Abstract]
6. Sauer R, Birkenhake S, Kuhn R, et al.: Efficacy of radiochemotherapy with platin derivatives compared to radiotherapy alone in organ-sparing treatment of bladder cancer. Int J Radiat Oncol Biol Phys 40 (1): 121-7, 1998. [PUBMED Abstract]
7. Hautmann RE, Miller K, Steiner U, et al.: The ileal neobladder: 6 years of experience with more than 200 patients. J Urol 150 (1): 40-5, 1993. [PUBMED Abstract]
Stage 0 Bladder Cancer
Current Clinical Trials
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy.