bladder cancer support and counseling

Living with cancer presents many new challenges for you and for your family and friends.

• You will probably have many worries about how the cancer will affect you and your ability to live a normal life, that is, to care for your family and home, to hold your job, and to continue the friendships and activities you enjoy.
  
  
• Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.

For most people with cancer, talking about their feelings and concerns helps.

• Your friends and family members can be very supportive. They may be hesitant to offer support until they see how you are coping. Don't wait for them to bring it up. If you want to talk about your concerns, let them know.
  
  
• Some people don't want to "burden" their loved ones, or they prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful if you want to discuss your feelings and concerns about having cancer. Your urologist or oncologist should be able to recommend someone.

bladder cancer prognosis

Prospects of human bladder cancer varies considerably, depending on the tumor stage at diagnosis.

Almost 90% of patients treated for superficial bladder cancer (Ta, T1, CIS) to survive for at least five years after treatment.

Only about 5% of people with metastatic bladder cancer survive at least two years after diagnosis.

Recurrent tumors more aggressive and show a poor outlook for long-term survival for patients with high stage bladder cancer or higher. Recurrent low-grade superficial bladder cancer is rarely fatal.

bladder cancer Follow-up

When you have finished your treatment you will undergo a series of tests to determine how well your treatment has worked to get rid of your cancer.

If the results show that the remaining cancer, your oncologist will recommend a urological further treatment.

If the results show no cancer remains, he or she will recommend a schedule of visits. These visits will include tests to see if the cancer has returned. Will be frequent at first because of the risk of recurrence after treatment.

If you still have your native bladder, cystoscopy include a range of monitoring and urinalysis.

If you have had a radical cystectomy, monitoring will include imaging tests of your chest and abdomen.

therapy of bladder cancer

Bladder cancer is a relatively high rate of recurrence. Researchers are trying to find ways to prevent relapse. One strategy that has been extensively studied is chemoprevention.

The idea is to use an agent that is safe and has few, if any, side effects, but is active in the changing environment of the bladder and other cancers can not grow so easily there.

The most widely tested agents as chemopreventive and some vitamins are relatively safe medications.

No agent has not yet been proven to work in a broad prophylactic treatment of bladder cancer.

Another treatment of bladder cancer is still under study is called photodynamic therapy. This treatment uses a special type of laser light to destroy tumors.

For a few days before treatment is given a substance that sensitizes tumor cells to this light. The substance is injected into the bloodstream through a vein. Then spreads to the bladder and accumulates in the tumor.

The light is directed to the tumor and kill tumor cells.

The advantage of this treatment is that only kills tumor cells and not surrounding healthy tissue. The disadvantage is that it works only for tumors that did not invade deep into the wall of the bladder or other organs. This treatment is not readily available in most centers in the United States and not widely used.

surgery

Surgery is by far the most commonly used to treat bladder cancer. It is used for all types and stages of bladder cancer. Several types of surgery are used. What is needed in any situation depends largely on the stage of cancer. Many surgical procedures are available today that has not been widely accepted. Can be difficult to perform, and results are best achieved by those who run many of these operations per year. Types of surgery include the following:

Transurethral resection with fulguration: In this operation, the instrument (resectoscope) is inserted through the urethra and bladder. A thin wire loop by instrument, then remove the tumor by cutting or burning is an electrical current (shock). This usually happens for the initial diagnosis of bladder cancer and the treatment of stage Ta and T1 tumors. Often, after transurethral resection, treatment is given (for example, intravesical therapy) to help treat cancer of the bladder.

Radical cystectomy: In this operation, the entire bladder is removed and nearby lymph nodes and other structures that may contain cancer. This is usually done for cancer that has invaded at least the muscular layer of the wall of the bladder or the most superficial cancers, which covers much of the bladder, or have not responded to more conservative treatments. Occasionally, the bladder is removed to relieve severe urinary symptoms.

Partial cystectomy or partial: In this operation is part of the bladder removed. This is usually done for solitary low-grade tumors that invaded the bladder wall, but it is limited to a small area of ​​the bladder.

As its name suggests, radical cystectomy is major surgery. Not only the entire bladder, but also other structures are removed.

For men, the prostate and seminal vesicles (small tubes that carry sperm to the prostate penis) is removed. This will stop the production of sperm and may affect sexual function. However, nerve sparing technique can save you an erection in some men after surgery.

In women, the uterus (womb), ovaries, and part of the vagina are removed. It ceases to menstruation, and you can not get pregnant. The transaction may also interfere with sexual function and urinary.

Removal of the bladder is complicated because it requires the creation of a new way for urine to leave the body. This is called urinary diversion. Some people use a bag outside the body to collect urine. Others have a small pocket inside the body to collect urine. The bag is usually performed by a surgeon for a small part of the intestine. Most patients (men and women) are candidates for reconstruction of the continent urinary tract so that voluntary (voluntary) voiding can be restored.

Surgeons and medical oncologists work together to find ways to avoid radical cystectomy. A combination of chemotherapy and radiation can cause some patients to preserve their bladder, but the toxicity of treatment is important, with many patients requiring surgery to remove the bladder at a later date.

If your urologist recommends surgery as a treatment for bladder cancer, make sure you understand the type of operation you want, and what effect the surgery will have on your life.

Even if the surgeon believes that all the cancer removed by surgery, many people who undergo surgery for bladder cancer receive chemotherapy after surgery. This "adjuvant" chemotherapy is designed to eliminate the remaining cancer cells after surgery and increase the chances of recovery.

Some patients may receive chemotherapy before radical cystectomy. This is called "neoadjuvant" chemotherapy and can be recommended by the surgeon and oncologist. Neoadjuvant chemotherapy can kill microscopic cancer cells have spread to other parts of the body and can also shrink the tumor in the bladder before surgery.

If you decide that you need chemotherapy, radical cystectomy with our own, the choice of adjuvant or neoadjuvant chemotherapy, the decision is made on a case by case basis with each patient case, the medical oncology, and urologic oncologist.

Medical treatment

Standard therapies for bladder cancer include surgery, radiation, chemotherapy and immunotherapy or biological therapy.

Surgery and radiotherapy are local treatments. This means getting rid of cancer cells in the treated area.

Chemotherapy is a systemic treatment. This means it can kill cancer cells almost everywhere in the body.

For more information about the surgery.

Radiotherapy

Radiation is a high-energy rays to kill cancer cells and normal cells in its path. Radiation can be given a small muscle-invasive bladder cancer. It 'is commonly used as an alternative approach to surgery. One of the two types of radiation may be used. However, the largest therapeutic effect, it must be administered in combination with chemotherapy:

External radiation is produced by a machine outside the body. The team target a narrow beam of radiation directly to the tumor. This form of therapy is usually spread in the short-five days a week for five to seven weeks. Helping spread this way to protect the surrounding healthy tissue by reducing the dose of each treatment. Radiation is administered in the hospital or medical center. Who attend the center every day for outpatient radiotherapy.

Internal radiation is given by placing a small pellet of radioactive material inside the bladder. The pill can be inserted into the urethra or by making a small incision in the lower abdominal wall. You must stay in the hospital throughout the treatment, which lasts several days. Visits to family and friends are limited to protect against the effects of radiation. When treatment is completed, the pellet removed, and you get to go home. This type of radiation is rarely used for bladder cancer in the United States.

Unfortunately, the radiation is not only cancer cells but also everything that touches the healthy tissue. With external radiation, covering the healthy tissue near the tumor or may be damaged. Side effects of radiotherapy depend on the dose and the area of ​​the body where radiation is concentrated.

An area in which the radiation passes through the skin may become red, sore, dry or itchy. The effect is not unlike a sunburn. Although these effects can be serious, but usually are not permanent. The skin in this area can become permanent darker, though. Internal organs, bones and other tissues may be damaged. Internal radiation has been developed to avoid these complications.

You may feel very tired during radiation therapy.

Radiation in this area, because the need for bladder cancer, can affect the production of blood cells in the bone marrow. Common effects are extreme tiredness, increased susceptibility to infections, and bruising or bleeding.

Radiation to the pelvis can also cause nausea, diarrhea, urinary problems and sexual problems such as vaginal dryness in women and impotence in men.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer. Bladder cancer, chemotherapy can be administered alone or with surgery or radiotherapy or both. It can be administered before or after other treatments. Chemotherapy is usually given oncologist's office, but it may require hospitalization.

Stage Ta, T1 bladder cancer and CIS can be treated with intravesical chemotherapy. After removal of the tumor, one or more liquid medicine into the bladder through a thin plastic tube called a catheter. The drugs remain in the bladder for several hours and then drained, commonly with urination. This treatment is usually repeated once a week for several weeks.

The cancer that has invaded deep into the bladder, lymph nodes or other organs, requires systemic chemotherapy or intravenously. Combating cancer drug is injected into the bloodstream through a vein. This drug to reach almost the entire body and, ideally, to kill cancer cells wherever they are.

Chemotherapy is well known for its unpleasant side effects. Side effects depend on the drugs you receive and how medications are administered.

The severity of these effects varies from one person. For unknown reasons, some people tolerate chemotherapy much better than others.

Some common side effects of chemotherapy are nausea and vomiting, loss of appetite, hair loss, sores inside the mouth or gut, fatigue or lack of energy (due to anemia or low red blood count) , increased susceptibility to infection (due to the low number of white blood cells), and easy bruising or bleeding (because the low platelet count). Ask your oncologist about the actual effects can be expected.

These side effects are usually temporary and disappear at the end of chemotherapy.

Several studies have shown that intravesical chemotherapy is effective in reducing the recurrence rate of superficial bladder cancer in the short term.

Intravesical chemotherapy such as mitomycin C, is often given as a single dose in the bladder immediately after removal of the tumor by cystoscopy.

Intravesical chemotherapy can irritate the bladder or kidneys.

Intravesical chemotherapy is not effective in bladder cancer has already invaded the muscle wall of the bladder or spread to lymph nodes or other organs.

Immunotherapy or biological therapy

Biological therapy uses the body's natural defenses of cancer.

Your immune system are substances in the blood, work against the "invaders" such as abnormal cells (cancerous cells for example).

Sometimes the immune system is overwhelmed by aggressive cancer cells.

Biologic therapy, or immunotherapy helps strengthen the immune system to fight cancer.

Biologic therapy is usually given in stages Ta, T1 bladder cancer and CIS.

Immunotherapy or biological therapy widely used in cancer of the bladder is intravesical BCG therapy.

Fluid containing BCG, attenuated vaccine (Mycobacterium changed), are exported into the bladder through a thin catheter, which is through the urethra.

Mycobacterium in the fluid stimulates the immune system to produce anti-cancer substances.

The solution is stored in the bladder for a few hours, then drained. This treatment is repeated every week for six weeks and is repeated several times over several months or even longer in some cases. Researchers are still working to determine the best time of these treatments. Time of treatments may be needed less often.

BCG can irritate the bladder and cause minor bleeding in the bladder. The bleeding is usually invisible in the urine. You may feel the need to urinate more often than usual, or pain or burning when urinating. Other side effects include nausea, fever and chills. These result from the stimulation of the immune system. These effects are almost always temporary.

treatment

Even if the treatments are fairly standardized, different doctors have different philosophies and practices of care for patients.

You can talk to over a urologist to find the person with whom you feel most comfortable. Clinical experience in the treatment of bladder cancer is of paramount importance.

Talk with family, friends and the doctor to get referrals. Many organizations, medical societies and cancer centers provide telephone services or the Internet.

After choosing a urologist to treat your cancer, you will have the opportunity to ask questions and discuss treatment options.

Your physician will discuss each type of treatment, given the advantages and disadvantages, and make recommendations based on published treatment guidelines and experience.

The treatment of bladder cancer depends on the type and stage of cancer. Factors such as your age, overall health, and if you ever been treated for cancer before treatment is included in the decision-making.

The decision, which will continue to be care with your doctor (feedback through the other members of the support team) and family members, but the decision is ultimately yours.

Be sure you understand exactly what should happen and why, and what you can expect of your choice. With bladder cancer, is to understand the side effects of treatment especially important.

Like all cancers, bladder cancer is likely to be cured if diagnosed early and treated promptly.

The most common treatments are surgery, radiotherapy and chemotherapy, alone or in combination.

Immunotherapy or biological therapy, which uses body's innate anti-cancer ability that is used in some cases, especially for patients with stage Ta, T1 and CIS.

Your individualized treatment plan will be to your specific situation.

Your treatment team also includes one or more nurses, a dietitian, social worker and other professionals when appropriate

exams and tests

Like all cancers, bladder cancer is most likely to be successfully treated if detected early when it is small and has not invaded surrounding tissue. The following actions can increase the chances of finding a cancer of the bladder at the beginning:

If you have no risk factors, special attention to urinary symptoms or changes in your urinary habits. If you experience symptoms that last more than a few days, consult your doctor for evaluation.

If you have risk factors, talk to your doctor about screening tests, even if you have any symptoms. These tests are not performed to diagnose cancer, but for abnormalities suggestive of early cancer. If these tests to detect abnormalities that must be followed by other more specific tests for bladder cancer.

Screening tests: screening tests typically performed periodically, eg once a year or once every five years. The screening test most commonly used is a medical interview, physical examination, urinalysis, urine cytology and cystoscopy.

Healthcare: Your provider will ask many questions about your health (past and present), medication, work history, and habits and lifestyle. From there, he or she will develop an idea of ​​your risk of bladder cancer.

Physical exam: Your health care provider may insert a gloved finger into the vagina, rectum, or both, to feel any lumps that may indicate a tumor or other cause of bleeding.

Urinalysis: This test is actually a collection of tests for abnormalities in urine, such as blood, protein and sugar (glucose). Any abnormal result should be examined with more definitive tests.

Urine cytology: cells that form the inner wall of the bladder regularly stolen and suspended in the urine and is excreted by the body during urination. In this test, a urine sample is examined under a microscope for abnormal cells that may indicate cancer.

Cystoscopy: This is a type of endoscopy. A very narrow tube with a light and a camera on the end (cystoscope) is used to look inside the bladder to look for abnormalities such as tumors. The cystoscope is inserted into the bladder through the urethra. The camera sends images to a video monitor, allowing direct visualization of the interior of the bladder wall.

These tests are also used to diagnose bladder cancer in people who have symptoms. The following test can occur if the bladder is suspected:

CT: This is similar to X-ray images, but shows much more detail. Gives a three dimensional view of the bladder, the rest of your urinary tract (especially kidney), and find the pelvic masses and other abnormalities.

Pyelogram: is a series of x-ray of your urinary system after you have taken a special dye is injected into a vein (intravenous pyelography [IVP]) or into your urethra (retrograde pyelogram). The dye highlights your urinary system organs and allows the recognition of certain anomalies easy. However, CT with three-dimensional reconstruction to replace pyelography in many centers in the United States.

Biopsy: small samples of your bladder wall is removed, usually during cystoscopy. The samples were examined by a doctor who specializes in diagnosing diseases by looking at tissues and cells (pathologist). Small tumors are often completely removed during the biopsy process.

Urine tests: Urine may be performed to rule out other conditions, or to acquire more of the urinary abnormalities. For example, the culture of the urine can be done to eliminate the infection. The presence of certain substances and other signs may indicate cancer. Some of these tests can be useful in identifying recurrent cancer at a very early age.

If the tumor is located in the bladder, other tests may be conducted either at the time of diagnosis or later if the cancer has spread to other parts of the body.

Ultrasound: This is the same technique used to examine the fetus in the uterus of a pregnant woman. In this painless test, a handheld computer to run across the skin's surface using sound waves to examine the contours of the bladder and other pelvic structures. This can show the entire tumor, and can show if it has spread to other organs.

Chest X-ray films: A single chest X-ray can sometimes show whether the bladder cancer has spread to the lungs.

CT scan: This technique is used to detect metastatic disease of the lungs, liver, abdomen or pelvis, and to assess whether the obstruction of the kidneys has occurred.

Bone scan: This test is to have a small amount of a radioactive substance is injected into the veins. A full body scan shows the areas where the cancer may have affected the bones.

prevention

The best way to prevent bladder cancer is to avoid exposure to agents that cause the disease. People who don't smoke are three to four times less likely to get bladder cancer as compared to smokers. Continuing to smoke after the diagnosis of bladder cancer portends a poorer outcome and increases the chance of the disease coming back after treatment. Avoidance of occupational exposure to cancer-causing chemicals such as aniline dyes may also be important. Despite research in this area no medication or dietary supplement has been conclusively demonstrated to decrease the risk of bladder cancer in normal individuals

stages

The stage of bladder cancer is a summary of the rule that the cancer has spread. One of the most important factors in choosing treatment options and estimate the prospects of a person for the recovery and survival (prognosis). If you have bladder cancer, ask your health care team to explain their point of view. This can help you make informed decisions about their treatment.

There are actually two different stages of bladder cancer.

In the clinical phase of the tumor, the doctor best estimate of the extent of the cancer, which is based on the results of physical examination, cystoscopy, biopsy, and all imaging tests that are made (eg, CT). These experiments and tests have been described in the section "How is bladder cancer diagnosed?" Doctors watching biopsy specimens are particularly interested to see if cancer cells have spread to the bladder muscle layers.

If surgery is done, the pathologic stage, determined from the test results as used in the clinical phase, as well as what is found during surgery to remove the bladder and nearby lymph nodes.

Clinical stage is used to help plan treatment. Sometimes, however, the cancer has spread beyond the clinical phase of the estimates. As the stage of disease according to what was found in surgery, can still accurately predict the patient's prospects for survival.

Symptoms of Bladder Cancer

The most common symptoms of bladder cancer are as follows:

* Blood in the urine (hematuria)

* Pain or burning during urination without evidence of urinary tract infection

* Change of bladder habits, such as the need to urinate more often or feel a strong need to urinate without producing much urine

These symptoms are nonspecific. This means that these symptoms are also associated with many other conditions that have nothing to do with cancer.

* Having these symptoms does not necessarily mean you have cancer of the bladder.

* If you have any of these symptoms, consult your healthcare provider immediately. People who can see the blood in the urine, especially older men who smoke, are considered to have a high probability of bladder cancer until proven otherwise.

Blood in the urine is usually the first warning sign of bladder cancer.

* Unfortunately, blood is often invisible to the eye. This is known as microscopic hematuria and can be detected with a simple urine test.

* In some cases, enough blood in the urine is a significant change in urine color. Urine may be slightly pink or orange hue, or it can be bright red, with or without lumps.

* If the urine color changes, you should consult a doctor.

Bladder cancer often causes no symptoms until it reaches the extent that it is difficult to improve. This is why you should ask your health care provider about screening tests, if you have risk factors for bladder cancer. Screening is the testing of cancer for people who have never had the disease and causes no symptoms, but with one or more risk factors.

Bladder Cancer Causes

We do not know exactly what causes bladder cancer, but the number of cancer were identified, which are the possible causes, particularly cigarette smoking. The study focuses on the conditions that alter the genetic structure of cells and cause the abnormal proliferation of cells. We know that the following factors increase the human risk of developing cancer of the bladder:

* Smoking: Smoking is a risk factor for the simple bladder cancer. Smokers are twice as likely to develop bladder cancer than non-smokers.

Exposure to chemicals at work *: People who regularly work with certain chemicals or certain industries have a higher risk of bladder cancer than the general population. Organic chemicals called aromatic amines are particularly associated with bladder cancer. These chemicals are used in the dye industry. Other industries associated with bladder cancer include the processing of leather and rubber, textiles, dyes, paints, and printing. Strict employment protection can avoid much of the exposure is believed to cause cancer.

* Source: People whose diet includes large amounts of fried meats and animal fats are considered at high risk of bladder cancer.

* Aristolochia fangchi: This herb has been used in some Chinese herbal remedies and dietary supplements. People who took this herb as part of a program of weight loss was greater in bladder cancer and kidney failure than the general population. Scientific studies on this plant have shown that it contains chemicals that can cause cancer in rats.

These are things you can do something. You can quit smoking, learn to avoid exposure to chemicals at work, or change your diet. You can not do something about the risk factors for bladder cancer:

* Age: older people are more at risk of developing bladder cancer.

* Gender: Men are three times more likely than women who have cancer of the bladder.

* Race: Whites have a much higher risk of developing bladder cancer than other races.

* History of bladder cancer: If you had bladder cancer in the past, the risk of developing another cancer of the bladder is greater than if they had never had cancer of the bladder.

Chronic bladder infection: frequent bladder infections, bladder stones and other urinary problems that irritate the bladder increases the risk of developing cancer is more common squamous cell carcinoma.

* Birth defects: Some people are born with visible or invisible bugs that connects the bladder to their abdomen or other organs from the bladder continuously exposed to infection. This increases the risk of bladder cell abnormalities that can lead to cancer.