Stages of Bladder Cancer
Degrees of cancer are determined according to the aggressiveness of the growth of the cells, and how different they are from the surrounding tissue:
- Stage 0: Cancer stays in the bladder's inner lining.
- Stage I: Cancer has gone past the bladder lining and has spread to the bladder wall.
- Stage II: Cancer has reached the muscle of the bladder wall.
- Stage III: Cancer has grown past the muscle layer and spread to fatty tissue around the bladder.
- Stage IV: Cancer has spread to the pelvic or abdominal wall, lymph nodes, or distant sites (metastatic disease) such as the prostate, uterus, vagina, rectum, liver, lungs, and/or bones.
Treating Bladder Cancer
Treatment for bladder cancer depends on the stage of the tumor, the severity of the symptoms, and the number and degree of secondary conditions.
Bladder cancer at stage 0 or 1 is usually treated by surgically removing the tumor, while leaving as much of the bladder in tact as possible. Surgery is usually followed by chemotherapy or immunotherapy and, since the risk of a recurrence is high, a permanent schedule of follow-ups is required.
Stage II and III bladder cancer is treated by surgically removing the bladder (radical cystectomy) or, in certain cases, partial removal. In almost all cases, removal is followed by radiation and/or chemotherapy. In some cases, chemotherapy or radiation therapy is administered before surgery to shrink the tumor.
Stage IV bladder cancer is treated with chemotherapy only. Surgical resection is almost never an option.
For Stage I tumors, chemotherapy can be administered into veins or directly into the bladder. For Stage II and III tumors, chemotherapy drugs are injected into a vein and can be given before surgery to shrink a tumor or after surgery to try to prevent recurrence of a tumor.
The choice of the particular chemotherapy drug depends on the kind of tumor being treated. Chemotherapy treatment can be given as a single drug or in combination with others drugs.
The side effects of chemotherapy drugs include bladder wall irritation and pain during urination.
Immunotherapy is an attempt to use a medication to trigger the immune system so that it seeks out and kills tumor cells. A frequent choice is Bacille Calmette-Guerin (BCG), which is genetically altered tuberculosis bacteria, which does not produce tuberculosis. Side effects from this type of therapy can include bladder irritability, urinary frequency, urinary urgency, and painful urination.
Transurethral Resection of the Bladder (TURB)
Used mainly in Stage 0 or 1 bladder cancer, this surgical procedure, done under general or spinal anesthesia, removes the tumor with a surgical instrument inserted through the urethra.
Also called a radical cystectomy, this treatment is usually for Stage II or III bladder cancer that may require bladder removal. It is followed by radiation and chemotherapy.
In men, a radical cystectomy can include removal of the bladder, prostate and seminal vesicles. In women, this procedure may also include removal of the urethra, uterus, front vaginal wall, and lymph nodes. In addition to removal of the bladder, a urinary diversion surgery (surgical procedure to create an alternate method for urine storage) is usually performed.
Once the bladder is removed, there are several possible methods of replacing its function.
A small urine reservoir called an ileal conduit is surgically created from a segment of bowel. Ureters to drain urine from the kidneys are attached to one end of the bowel segment, while the other end is brought out through an opening in the skin (a stoma). The urine is drained through the stoma. This procedure requires an external urine collection appliance. The risks include bowel obstruction, blood clots, urinary tract infection, pneumonia, skin breakdown around the stoma, long-term damage to the upper urinary tract.
Continent Urinary Reservoir
A second method is a reconstructive procedure in which a segment of colon is removed and used to create an internal pouch to store urine, which is called a continent urinary reservoir. Urine is drained through a catheter inserted by the patient into a stoma placed flush to the skin. The risks include bowel obstruction, blood clots, pneumonia, urinary tract infection, skin breakdown around the stoma, ureteral reflux, ureteral obstruction.
The third option is to fold over a segment of bowel to make a pouch or neobladder/"new bladder", which is attached to the urethral stump during surgery. This procedure allows patients to maintain a degree of normal urinary control, although rarely the same as before surgery. The risks include night leakage, the necessity of periodic catheterization, bowel obstruction, blood clots, pneumonia, urinary tract infection, skin breakdown around the stoma, ureteral reflux, and ureteral obstruction.
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