Bladder cancer

Definition

Bladder cancer is a disease in which the cells lining the urinary bladder lose the ability to regulate their

An immunofluorescent light micrograph of cells cultured from squamous carcinoma of the bladder. (Photograph by Nancy Kedersha, Photo Researchers, Inc. Reproduced by permission.)

growth and start dividing uncontrollably. This abnormal growth results in a mass of cells that form a tumor.

Description

Bladder cancer attacks the urinary bladder, a hollow, muscular organ that stores the urine received from the kidneys until it is excreted out of the body. Bladder cancer is the fifth most common cancer in the United States, and the development of new cases is on the rise. The disease is almost three times more common among men than women, and the risk of the disease increases with age. Most cases of bladder cancer are found in people in their 60s.

Causes & symptoms

Smoking is considered one of the greatest risk factors for bladder cancer. The risk is probably due to the fact that cancer-promoting substances found in tobacco tend to collect in the urine, and then become concentrated in the bladder while awaiting excretion. Other chemicals, including aniline dyes, beta-napthylamine, benzadine salts, and mixtures of aromatic hydrocarbons also are believed to be cancer-causing agents. These chemicals are widely used in the rubber, leather, textile, chemical, plastics, petroleum, wood, and paint industries. It may take up to 50 years after the original chemical exposure for bladder cancer to develop. In 2003, studies showed that hormone replacement therapy (HRT), a treatment used by many postmenopausal women, significantly increased the risk of bladder and other cancers.

Frequent urinary tract infections, kidney and bladder stones, and other conditions that cause long-term irritation to the bladder may increase the risk of bladder cancer. If there is a past history of tumors in the bladder, there is a strong possibility of their recurrence.

One of the first warning signals of bladder cancer is blood in the urine. Sometimes, there is enough blood to change the color of the urine to a yellow-red or a dark red. However, during the early stages of bladder cancer there are often no observable symptoms of the disease. A change in bladder habits such as painful urination, increased frequency of urination and increased urgency in the need to urinate, are all symptoms of bladder cancer; but they are also common symptoms of less serious diseases of the urinary tract and prostate glands.

Diagnosis

There are several tests to find out whether bladder cancer is present. As a first step, a complete medical history will be taken to check for any risk factors. A thorough physical examination will be conducted to assess all the signs and symptoms. Laboratory testing of a urine sample helps rule out the presence of a bacterial infection.

More in-depth tests are used to make a definite diagnosis. The intravenous pyelogram (IVP) is an x-ray examination that is performed after a dye is injected into the blood stream. It clearly outlines the kidneys, ureters, bladder, and urethra to detect abnormalities in the lining of these organs.

In a procedure known as a cystoscopy, a thin hollow lighted tube is introduced into the bladder. If any suspicious looking masses are seen, a small piece of the tissue can be removed using a pair of biopsy forceps. The tissue is then examined microscopically to verify if cancer is present. Imaging tests such as chest x rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) may be done to determine if the cancer has spread to other organs.

Treatment

Most alternative treatments for cancer should be used in addition to allopathic treatment. A well-developed treatment plan for cancer should be discussed with an oncologist or other physician.

Studies indicate that garlic may be used to stop the spread of bladder cancer. It also can help reduce the body wasting and fatigue that may accompany cancer, as well as reducing the side effects of radiation and chemotherapy. The equivalent of one to two cloves per day is recommended.

European mistletoe (Viscum album L.), is recommended to stimulate the immune system and to kill cancer cells. It also has been reported to reduce tumor size. The most widely available mistletoe extract is sold under the name of Iscador. Iscador is available in Europe only, especially Switzerland. A three-month supply can be purchased and brought back to the United States. Mistletoe often is taken in injectable form and should be administered under a physician's supervision.

High doses of multivitamins have been reported to be useful in decreasing the possibility of the recurrence of bladder cancer. Treatment should be monitored by a qualified healthcare practitioner.

Other complementary and alternative treatments include guided imagery, local and general hyperthermia, and Chinese herbs. These herbs have been shown effective in controlled trials, particularly as a complement to chemotherapy.

Allopathic treatment

Treatment for bladder cancer depends on the stage of the tumor. The standard modes of treatment available for bladder cancer are surgery, immunotherapy, radiation therapy, and chemotherapy. Surgery is considered an option only when the disease is in its early stages. If the tumor is small and has not spread to the inner layers of the bladder, surgery can be done without cutting open the abdomen. A cystoscope is introduced into the bladder through the urethra, and the tumor is removed through it. A high-energy laser beam or other cautery instrument may be introduced through the cystoscope to burn away any remaining cancer.

If cancer has invaded deep into the walls of the bladder, surgery will be done through an incision in the abdomen. Part or all of the bladder and surrounding organs such as the prostate or the uterus, ovaries, and fallopian tubes may have to be removed. If the entire urinary bladder is removed, an alternate place must be created for the urine to be stored before it is excreted. To do this, the ureters are connected to a surgically created opening in the skin, called a stoma. This procedure is called a urostomy. A procedure can create a new bladder (called a neo-bladder) using the patient's intestine.

Radiation therapy uses high-energy rays to kill cancer cells. It generally is used after surgery to destroy any cancer cells that have not been removed during surgery. In addition, if the tumor is large or it is in a location that makes surgery difficult, radiation may be used before surgery to shrink the tumor. Radiation sometimes is used together with chemotherapy in place of surgery. Radiation therapy is used to ease pain, bleeding, and blockages in cases of advanced bladder cancer.

Chemotherapy uses drugs to destroy cancer cells. Generally a combination of drugs is more effective than any single drug in treating bladder cancer. Medications are introduced into the bloodstream by injecting them into a vein in the arm or orally in pill form. Anticancer drugs may also be introduced directly into the bladder to treat superficial tumors. Chemotherapy may be given following surgery to kill any remaining cancer cells. A 2003 report stated that giving patients with bladder cancer chemotherapy followed by surgery may improve their outcomes. In the study of 307 patients, those with this combination of therapy lived two years longer than those treated with surgery only.

Immunotherapy, or biological therapy, uses the body's own immune system to fight the disease. In the case of early-stage bladder cancer, bacille Calmette-Guerin (BCG), a weakened strain of tuberculosis, may be placed directly into the bladder. As the immune system rallies to fight off the tuberculosis, it also attacks and kills cancer cells. This therapy has been shown to be effective in controlling superficial bladder cancer.

New treatments are continuously being investigated. Scientists have made great strides in gene mapping and research in the twenty-first century. In 2003, a type of gene therapy was being tested on patients with bladder cancer with success, but further enhancements were needed.

Expected results

If cancer is detected early and is limited to the inner lining of the bladder, it responds well to treatment. Most bladder cancers are first seen at this stage. At least 90% of patients survive five years or more after an initial diagnosis. However, if the disease has spread to nearby tissues, the survival rates drop to 49%, and if the cancer metastasizes to distant organs only about 6% of patients will survive five years or more.

Bladder cancer has a very high rate of recurrence. Even after tumors are totally removed, there is a high chance that new tumors will develop. Therefore, those who have had bladder cancer should have frequent and thorough follow-up care.

Prevention

Those who have a history of bladder cancer, who have been regularly exposed to cancer-causing chemicals, or who have had conditions that cause long-term irritation to the bladder, should undergo regular screening tests for bladder cancer. This will ensure that the disease can be detected in the early stages and treated appropriately.

Avoiding risk factors whenever possible is the best alternative, particularly tobacco. Appropriate safety precautions should be maintained when working with cancer-causing chemicals. Working with such chemicals should probably be avoided altogether. Women may want to discuss the risks vs. benefits of hormone replacement therapy with their physicians.

Since stress and irritation of the bladder may contribute to bladder cancer, the health of the bladder and urinary tract should be carefully maintained. Caffeine, which is found in coffee, tea, colas, and chocolate, is thought to be a factor for cancer of the lower urinary tract, including the bladder, and should be avoided. It also is important to have a good fluid intake to flush the urinary tract of possible toxins. Six to eight glasses or more of water and fluids such as plain herbal teas and diluted fruit or vegetable juices should be consumed daily. A dropperful (25-30 drops) of a tincture of burdock seed, Artium lappa, will help flush the entire urinary tract, relieve bladder irritation and inflammation, and strengthen the bladder.

Resources

BOOKS

Berkow, MD, Robert, editor-in-chief, et al. The Merck Manual of Medical Information, Home Edition. New York: Pocket Books, 1997.

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Washington: Future Medicine Publishing, 1995.

Murphy, Gerald P., Lois B. Morris, and Dianne Lange. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment and Recovery. New York: Viking, 1997.

Weed, Susan. Healing Wise. New York: Ash Tree Publishing, 1989.

PERIODICALS

Grossman, H. Barton, et al. "Neoadjuvant Chemotherapy Plus Cystectomy Compared With Cystectomy Alone for Locally Advanced Bladder Cancer." The New England Journal of Medicine (August 28, 2003): 859.

"HRT Increases Risk of Gallbladder, Breast, Endometrial, and Bladder Cancer." Women's Health Weekly (July 17, 2003): 31.

"Intravesical Gene Therapy Appears Safe for Those With Local Bladder Cancer." Cancer Weekly (July 8, 2003): 144.

OTHER

AlternativeMedicine.com. http://www.alternativemedicine.com (January 17, 2001).

Lycos Health with WebMD. 1996-2000. http://webmd.lycos.com/content/dmk/dmk_article_58401 (January 17, 2001).

"Mistletoe Summary." May 4, 1999. The University of Texas Center for Alternative Medicine Research. http://www.sph.uth.tmc.edu/utcam/summary/mistletoe.htm (January 17, 2001).

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