WHAT IS BLADDER CANCER? CANCER IS THE GROWTH OF ABNORMAL CELLS IN THE BODY.

BLADDER CANCER TYPICALLY BEGINS IN THE INNER LINING OF THE BLADDER, THE ORGAN THAT STORES URINE AFTER IT PASSES FROM THE KIDNEYS. MOST BLADDER CANCERS ARE CAUGHT EARLY, WHEN
TREATMENTS ARE HIGHLY SUCCESSFUL AND THE DISEASE HAS NOT SPREAD BEYOND THE BLADDER. CHECK-UPS ARE IMPORTANT.

BUT

BLADDER CANCER TENDS TO COME BACK, SO REGULAR

WARNING SIGN: BLOOD IN URINE BLOOD IN THE URINE CAN BE A SIGN OF BLADDER CANCER, EITHER VISIBLE TO THE EYE OR PICKED UP BY ROUTINE TESTING. THE URINE MAY LOOK DARKER THAN USUAL, BROWNISH, OR (RARELY) BRIGHT RED. MOST COMMONLY, BLOOD IN THE URINE IS NOT CAUSED BY CANCER, BUT BY OTHER CAUSES. THESE INCLUDE EXERCISE, TRAUMA, INFECTIONS, BLOOD OR KIDNEY DISORDERS, OR DRUGS, SUCH AS BLOOD THINNERS.

WARNING SIGN: BLADDER CHANGES BLADDER SYMPTOMS ARE MORE LIKELY TO COME FROM CONDITIONS OTHER THAN CANCER. BUT BLADDER
CANCER CAN SOMETIMES CAUSE CHANGES TO BLADDER
HABITS, INCLUDING:

NEEDING TO GO, WITH LITTLE OR NO RESULTS HAVING TO GO MORE OFTEN THAN USUAL PAINFUL URINATION DIFFICULTY URINATING URINARY TRACT INFECTIONS OR BLADDER STONES CAN CAUSE SIMILAR SYMPTOMS, BUT REQUIRE DIFFERENT TREATMENTS.

CANCER OCCURS WHEN NORMAL CELLS UNDERGO A TRANSFORMATION WHEREBY THEY GROW AND MULTIPLY WITHOUT NORMAL CONTROLS. AS THE CELLS MULTIPLY, THEY FORM AN AREA OF ABNORMAL CELLS. MEDICAL PROFESSIONALS CALL THIS A TUMOR. AS MORE AND MORE CELLS ARE PRODUCED, THE TUMOR INCREASES IN SIZE. TUMORS OVERWHELM SURROUNDING TISSUES BY INVADING THEIR SPACE AND TAKING THE OXYGEN AND NUTRIENTS THEY NEED TO SURVIVE AND FUNCTION. TUMORS ARE CANCEROUS ONLY IF THEY ARE MALIGNANT. THIS MEANS THAT, BECAUSE OF THEIR UNCONTROLLED GROWTH, THEY ENCROACH ON AND INVADE NEIGHBORING TISSUES. MALIGNANT TUMORS MAY ALSO TRAVEL TO REMOTE ORGANS VIA THE BLOODSTREAM OR THE LYMPHATIC SYSTEM. THIS PROCESS OF INVADING AND SPREADING TO OTHER ORGANS IS CALLED METASTASIS. BLADDER CANCERS ARE MOST LIKELY TO SPREAD TO
NEIGHBORING ORGANS AND LYMPH NODES PRIOR TO SPREADING THROUGH THE BLOOD STREAM TO THE LUNGS, LIVER, BONES, OR OTHER ORGANS.

HOWEVER, THESE THREE TYPES OF CANCER CAN DEVELOP ANYWHERE IN THE URINARY TRACT. IF ABNORMAL CELLS ARE FOUND ANYWHERE IN THE URINARY TRACT, A SEARCH FOR OTHER AREAS OF ABNORMAL CELLS IS WARRANTED. FOR EXAMPLE, IF CANCEROUS CELLS ARE FOUND IN THE BLADDER, AN EVALUATION OF THE KIDNEYS AND URETERS IS ESSENTIAL. BLADDER CANCERS ARE CLASSIFIED (STAGED) BY HOW DEEPLY THEY INVADE INTO THE BLADDER WALL, WHICH HAS SEVERAL LAYERS. MANY PHYSICIANS SUBDIVIDE BLADDER CANCER INTO SUPERFICIAL AND INVASIVE DISEASE. SUPERFICIAL BLADDER CANCER IS LIMITED TO THE INNERMOST LININGS OF THE BLADDER (KNOWN AS THE MUCOSA AND LAMINA PROPRIA). INVASIVE BLADDER CANCER HAS
AT LEAST PENETRATED THE MUSCULAR LAYER OF THE BLADDER WALL. NEARLY ALL ADENOCARCINOMAS AND SQUAMOUS CELL CARCINOMAS ARE INVASIVE. THUS, BY THE TIME THESE CANCERS ARE DETECTED, THEY HAVE USUALLY ALREADY INVADED THE BLADDER WALL. MANY UROTHELIAL CELL CARCINOMAS ARE NOT INVASIVE. THIS MEANS THAT THEY GO NO DEEPER THAN THE SUPERFICIAL LAYER (MUCOSA) OF THE BLADDER.

IN ADDITION

TO STAGE (HOW DEEP THE CANCER PENETRATES IN THE BLADDER WALL), THE GRADE IS BASED ON THE DEGREE OF ABNORMALITY OBSERVED IN

OF THE BLADDER CANCER PROVIDES IMPORTANT INFORMATION AND CAN HELP GUIDE TREATMENT.

THE TUMOR GRADE

A MICROSCOPICEVALUATION OF THE TUMOR.

CELLS FROM A HIGH-GRADE

CANCER HAVE MORE IS PROVIDED BY

CHANGES IN FORM AND HAVE A GREATER DEGREE OF ABNORMALITY WHEN VIEWED MICROSCOPICALLY THAN DO CELLS FROM A LOW-GRADE TUMOR. THE PATHOLOGIST, A PHYSICIAN TRAINED IN THE SCIENCE

THIS INFORMATION OF TISSUE DIAGNOSIS.

LOW-GRADE TUMORS ARE LESS AGGRESSIVE. HIGH-GRADE TUMORS ARE MORE DANGEROUS AND HAVE A PROPENSITY TO BECOME INVASIVE. PAPILLARY TUMORS ARE UROTHELIAL CARCINOMAS THAT GROW NARROW, FINGER-LIKE PROJECTIONS. BENIGN (NONCANCEROUS) PAPILLARY TUMORS (PAPILLOMAS) GROW PROJECTIONS OUT INTO THE HOLLOW PART OF THE BLADDER. THESE CAN BE EASILY REMOVED, BUT THEY SOMETIMES GROW BACK. THESE TUMORS VARY GREATLY IN THEIR POTENTIAL TO COME BACK (RECUR). SOME TYPES RARELY RECUR AFTER TREATMENT; OTHER TYPES ARE VERY LIKELY TO DO SO. PAPILLARY TUMORS ALSO VARY GREATLY IN THEIR POTENTIAL TO BE MALIGNANT (INVASIVE). A SMALL PERCENTAGE (15%) DO INVADE THE BLADDER WALL. SOME INVASIVE PAPILLARY TUMORS
GROW PROJECTIONS BOTH INTO THE BLADDER WALL AND INTO THE HOLLOW PART OF THE BLADDER.

IN ADDITION TO PAPILLARY TUMORS, BLADDER CANCER CAN DEVELOP IN THE FORM OF A FLAT, RED (ERYTHEMATOUS) PATCH ON THE MUCOSAL SURFACE. THIS IS CALLED CARCINOMA-IN-SITU (CIS).

ALTHOUGH OF ALL

THESE TUMORS ARE SUPERFICIAL, THEY ARE HIGH-GRADE AND HAVE A HIGH RISK FOR

BECOMING INVASIVE. TYPES OF CANCER, BLADDER CANCER HAS AN UNUSUALLY HIGH PROPENSITY FOR RECURRING AFTER TREATMENT.

BLADDER CANCER HAS A RECURRENCE RATE OF 50%-80%. THE RECURRING CANCER IS USUALLY, BUT NOT ALWAYS, OF THE SAME TYPE AS THE FIRST (PRIMARY) CANCER. IT MAY BE IN THE BLADDER OR IN ANOTHER PART OF THE URINARY TRACT (KIDNEYS OR URETERS). BLADDER CANCER IS MOST COMMON IN INDUSTRIALIZED COUNTRIES. IT IS THE FIFTH MOST COMMON TYPE OF CANCER IN THE UNITED STATES-THE FOURTH MOST COMMON IN MEN AND THE NINTH IN WOMEN. EACH YEAR, ABOUT 67,000 NEW CASES OF BLADDER CANCER ARE EXPECTED, AND ABOUT 13,000 PEOPLE WILL DIE OF THE DISEASE IN THE U.S. BLADDER CANCER AFFECTS THREE TIMES AS MANY MEN AS WOMEN. WOMEN, HOWEVER, OFTEN HAVE MORE ADVANCED TUMORS THAN MEN AT THE TIME OF DIAGNOSIS. WHITES, BOTH MEN AND WOMEN, DEVELOP BLADDER CANCERS TWICE AS OFTEN AS OTHER ETHNIC GROUPS. IN THE UNITED STATES, AFRICAN AMERICANS AND HISPANICS HAVE SIMILAR RATES OF THIS CANCER. RATES ARE LOWEST IN ASIANS. BLADDER CANCER CAN OCCUR AT ANY AGE, BUT IT IS MOST COMMON IN PEOPLE OLDER THAN 50 YEARS OF AGE. THE AVERAGE AGE AT THE TIME OF DIAGNOSIS IS IN THE 60S. HOWEVER, IT CLEARLY APPEARS TO BE A DISEASE OF AGING, WITH PEOPLE IN THEIR 80S AND 90S DEVELOPING BLADDER CANCER AS WELL. BECAUSE OF ITS HIGH RECURRENCE RATE AND THE NEED FOR LIFELONG SURVEILLANCE, BLADDER CANCER IS THE MOST EXPENSIVE CANCER TO TREAT ON A PER PATIENT BASIS.

OTHER RISK FACTORS ANYONE CAN GET BLADDER CANCER, BUT THESE FACTORS PUT YOU AT GREATER RISK: GENDER: MEN ARE THREE TIMES MORE LIKELY TO GET BLADDER CANCER. AGE: NINE OUT OF 10 CASES OCCUR OVER AGE 55. RACE: WHITES HAVE TWICE THE RISK OF AFRICANAMERICANS. OTHER FACTORS AT PLAY INCLUDE A FAMILY HISTORY OF BLADDER CANCER, PREVIOUS CANCER TREATMENT, CERTAIN BIRTH DEFECTS OF THE BLADDER, AND CHRONIC BLADDER IRRITATION.

DIAGNOSIS: TESTING THERE'S NO ROUTINE TEST FOR BLADDER CANCER. BUT IF YOU'RE AT HIGH RISK OR HAVE SYMPTOMS, YOUR DOCTOR MAY FIRST ORDER A URINE TEST. IF NEEDED, A
PROCEDURE CALLED CYSTOSCOPY LETS YOUR DOCTOR
SEE INSIDE THE BLADDER WITH A SLENDER LIGHTED TUBE WITH A CAMERA ON THE END.

THE CYSTOSCOPE CAN BE USED TO REMOVE SMALL TISSUE SAMPLES (A BIOPSY) TO BE EXAMINED UNDER A MICROSCOPE. A BIOPSY IS THE BEST WAY TO DIAGNOSE CANCER.

DIAGNOSIS: IMAGING IF CANCER IS FOUND, IMAGING TESTS CAN SHOW

WHETHER IT HAS SPREAD BEYOND THE BLADDER.

AN

INTRAVENOUS PYELOGRAM USES DYE TO OUTLINE THE KIDNEYS, BLADDER, AND URETERS, THE TUBES THAT CARRY URINE TO THE BLADDER.

CT AND MRI SCANS GIVE MORE DETAILED IMAGES OF THESE, AND CAN SHOW THE LYMPH NODES NEARBY. AN ULTRASOUND USES SOUND WAVES, INSTEAD OF RADIATION, TO PRODUCE IMAGES. ADDITIONAL IMAGING TESTS LOOK FOR CANCER IN THE LUNGS AND BONE.

TYPES OF BLADDER CANCER THE MAIN TYPES OF BLADDER CANCER

ARE NAMED FOR THE TYPE OF CELLS THAT BECOME CANCEROUS. THE MOST COMMON IS TRANSITIONAL CELL

CARCINOMA, WHICH BEGINS IN THE CELLS THAT LINE THE INSIDE OF THE BLADDER. SQUAMOUS CELL CARCINOMA AND ADENOCARCINOMA ARE MUCH LESS COMMON.

STAGES OF BLADDER CANCER STAGE 0: CANCER STAYS IN THE INNER LINING. STAGE I: CANCER HAS SPREAD TO THE BLADDER WALL. STAGE II: CANCER HAS REACHED THE MUSCLE OF THE BLADDER WALL. STAGE III: CANCER HAS SPREAD TO FATTY TISSUE AROUND THE BLADDER. STAGE IV: CANCER HAS SPREAD TO THE PELVIC OR ABDOMINAL WALL, LYMPH NODES, OR DISTANT SITES SUCH AS BONE, LIVER, OR LUNGS.

TREATMENT: SURGERY TRANSURETHRAL SURGERY IS MOST OFTEN DONE FOR EARLY-STAGE CANCERS. IF CANCER HAS INVADED MORE OF THE BLADDER, THE SURGEON WILL MOST LIKELY PERFORM EITHER A PARTIAL CYSTECTOMY, REMOVING A PORTION OF THE BLADDER, OR A RADICAL CYSTECTOMY, TO REMOVE THE ENTIRE BLADDER. FOR MEN, THE PROSTATE AND URETHRA MAY ALSO BE REMOVED. FOR WOMEN, THE UTERUS, FALLOPIAN TUBES, OVARIES, AND PART OF THE VAGINA MAY ALSO BE REMOVED.

TREATMENT: AFTER SURGERY IF YOUR ENTIRE BLADDER MUST BE REMOVED, YOUR

SURGEON WILL CONSTRUCT ANOTHER MEANS OF
STORING AND PASSING URINE. A PIECE OF YOUR INTESTINE MAY BE USED TO CREATE A TUBE THAT ALLOWS URINE TO FLOW INTO AN EXTERNAL UROSTOMY BAG. IN SOME CASES, AN INTERNAL RESERVOIR DRAINED VIA A CATHETER

--

-- CAN BE CONSTRUCTED.

NEWER SURGERIES OFFER THE POSSIBILITY OF NORMAL

URINATION THROUGH THE CREATION OF AN ARTIFICIAL BLADDER.

TREATMENT: CHEMOTHERAPY CHEMOTHERAPY INVOLVES DRUGS DESIGNED TO KILL CANCER CELLS. THESE DRUGS MAY BE GIVEN BEFORE SURGERY TO SHRINK TUMORS, MAKING THEM EASIER TO REMOVE. CHEMOTHERAPY IS ALSO USED TO DESTROY
ANY CANCER CELLS LEFT AFTER SURGERY AND TO LOWER THE CHANCES THAT THE CANCER WILL RETURN.

HAIR

LOSS, NAUSEA, LOSS OF APPETITE, AND FATIGUE

ARE COMMON SIDE EFFECTS.

THE DRUGS CAN BE GIVEN BY VEIN OR DIRECTLY INTO THE BLADDER.

TREATMENT: IMMUNOTHERAPY THIS TYPE OF TREATMENT IS DELIVERED DIRECTLY TO YOUR BLADDER, SO IT DOESNT TREAT CANCER THAT HAS SPREAD BEYOND IT. ONE TREATMENT, BACILLUS CALMETTE-GUERIN THERAPY, SENDS IN HELPFUL BACTERIA THROUGH A CATHETER. IT TRIGGERS YOUR IMMUNE SYSTEM TO ATTACK THE CANCER. FLU-LIKE
SYMPTOMS ARE A COMMON SIDE EFFECT OF THE ONCEA-WEEK TREATMENT. IMMUNOTHERAPY MAY BE USED AFTER SURGERY TO REDUCE THE RISK OF RECURRENCE.

TREATMENT: RADIATION RADIATION USES INVISIBLE, HIGH-ENERGY BEAMS, LIKE X-RAYS, TO KILL CANCER CELLS AND SHRINK TUMORS. IT'S MOST OFTEN GIVEN FROM OUTSIDE THE BODY BY MACHINE. RADIATION IS OFTEN USED IN TANDEM WITH OTHER TREATMENTS, SUCH AS CHEMOTHERAPY AND SURGERY. FOR PEOPLE WHO CAN'T UNDERGO SURGERY, IT MAY BE THE MAIN TREATMENT. SIDE EFFECTS CAN INCLUDE NAUSEA, FATIGUE, SKIN IRRITATION, DIARRHEA, AND PAIN WHEN URINATING.

COMPLEMENTARY APPROACHES CURRENTLY, NO COMPLEMENTARY

TREATMENTS ARE KNOWN TO TREAT OR PREVENT BLADDER CANCER, BUT RESEARCH IS ONGOING. STUDIES ARE LOOKING AT WHETHER EXTRACTS OF GREEN TEA OR BROCCOLI SPROUTS MAY HELP IN TREATING PEOPLE WITH BLADDER CANCER.

BLADDER CANCER SURVIVAL RATES SURVIVAL RATES ARE CLOSELY TIED TO THE STAGE AT DIAGNOSIS. ABOUT HALF OF BLADDER CANCERS ARE
CAUGHT WHEN THE DISEASE IS CONFINED TO THE INNER LINING OF THE BLADDER.

NEARLY 100% OF THESE PEOPLE WILL LIVE AT LEAST FIVE YEARS, COMPARED TO PEOPLE WITHOUT BLADDER CANCER. THE MORE ADVANCED THE CANCER, THE LOWER THIS FIGURE BECOMES. BUT KEEP IN MIND THAT THESE RATES ARE BASED ON PEOPLE DIAGNOSED FROM 1988 TO 2001. THE TREATMENTS AND OUTLOOK MAY BE BETTER FOR CANCERS DIAGNOSED TODAY. AND EACH PERSONS CASE IS DIFFERENT.

SEX AFTER BLADDER CANCER TREATMENT SURGERY CAN DAMAGE SENSITIVE NERVES, MAKING SEX MORE DIFFICULT. SOME MEN MAY HAVE TROUBLE HAVING AN ERECTION, THOUGH FOR YOUNGER PATIENTS, THIS OFTEN IMPROVES OVER TIME. WHEN THE PROSTATE GLAND AND SEMINAL VESICLES ARE REMOVED, SEMEN CAN NO LONGER BE MADE. WOMEN MAY ALSO HAVE TROUBLE WITH ORGASM, AND MAY FIND SEX LESS COMFORTABLE. BE SURE
TO DISCUSS TREATMENT OPTIONS WITH YOUR DOCTOR.

LIVING WITH BLADDER CANCER CANCER IS A LIFE-CHANGING EXPERIENCE. AND ALTHOUGH THERE'S NO SUREFIRE WAY OF PREVENTING A RECURRENCE, YOU CAN TAKE STEPS TO FEEL AND STAY HEALTHY. EATING PLENTY OF FRUITS, VEGGIES, WHOLE GRAINS, AND KEEPING TO MODEST PORTIONS OF LEAN MEAT IS A GREAT START. IF YOU SMOKE, STOP. LIMIT ALCOHOL TO ONE OR TWO DRINKS A DAY, IF YOU DRINK. DAILY EXERCISE AND REGULAR
CHECKUPS WILL ALSO SUPPORT YOUR HEALTH AND GIVE YOU PEACE OF MIND.

NEW AND EXPERIMENTAL TREATMENTS SEVERAL NEW TREATMENTS MAY PROVE USEFUL IN TREATING BLADDER CANCER. PHOTODYNAMIC THERAPY, USED IN EARLY STAGE CANCERS, USES A LASER LIGHT TO ACTIVATE A CHEMICAL THAT KILLS CANCER CELLS. SOME GENE THERAPIES USE LAB-CREATED VIRUSES TO FIGHT CANCER. AND TARGETED THERAPIES AIM TO CONTROL THE GROWTH OF CANCER CELLS. YOU MAY BE
ELIGIBLE TO PARTICIPATE IN A CLINICAL TRIAL OF THESE

OR OTHER CUTTING-EDGE TREATMENTS.