Bladder Cancer Treatment
What is bladder cancer?
Bladder cancer occurs in the tissues of the bladder, which is the organ in the body that holds urine. Approximately 45,000 men and 17,000 women per year are diagnosed with the disease.
Types of bladder cancer
There are three types of bladder cancer:
Transitional cell carcinoma
Transitional cell carcinoma is the most common type of bladder cancer. It begins in the transitional cells in the inner layer of the bladder. Transitional cells are cells that change shape without becoming damaged when the tissue is stretched.
Squamous cell carcinoma
Squamous cell carcinoma is a rare cancer in the United States. It begins when thin, flat squamous cells form in the bladder after a long-term infection or irritation in the bladder.
Adenocarcinoma is also a rare cancer in the United States. It begins when glandular cells form in the bladder after long-term bladder irritation and inflammation. Glandular cells are what make up the mucus-secreting glands in the body.
What are the symptoms of bladder cancer?
Many people with bladder cancer can have blood in their urine but no pain while urinating. There are a number of symptoms that might indicate bladder cancer like fatigue, weight loss, and bone tenderness, and these can indicate more advanced disease. You should pay particular attention to the following symptoms:
- blood in the urine
- painful urination
- frequent urination
- urgent urination
- urinary incontinence
- pain in the abdominal area
- pain in the lower back
What causes bladder cancer?
The exact cause of bladder cancer is unknown. It occurs when abnormal cells grow and multiply quickly and uncontrollably, and invade other tissues.
How is bladder cancer diagnosed?
Your doctor may diagnose bladder cancer using one or more of the following methods:
- a urinalysis
- an internal examination, which involves your doctor inserting gloved fingers into your vagina or rectum to feel for lumps that may indicate a cancerous growth
- a cystoscopy, which involves your doctor inserting a narrow tube that has a small camera on it through your urethra to see inside your bladder
- a biopsy in which your doctor inserts a small tool through your urethra and takes a small sample of tissue from your bladder to test for cancer
- a CT scan to view the bladder
- an intravenous pyelogram (IVP)
Dr. Mario Delgadillo can rate bladder cancer with a staging system that goes from stages 0 to 4 to identify how far the cancer has spread. The stages of bladder cancer mean the following:
- Stage 0 bladder cancer hasn’t spread past the lining of the bladder.
- Stage 1 bladder cancer has spread past the lining of the bladder, but it hasn’t reached the layer of muscle in the bladder.
- Stage 2 bladder cancer has spread to the layer of muscle in the bladder.
- Stage 3 bladder cancer has spread into the tissues that surround the bladder.
- Stage 4 bladder cancer has spread past the bladder to the neighboring areas of the body.
Urinary tract anatomy
The urinary tract consists of two kidneys, two ureters, a urinary bladder, and a urethra:
- The kidneys filter your blood and remove water and waste through the urine.
- The urine travels from the kidney to the bladder through tubes called ureters.
- The urine is stored in the urinary bladder, and then moves through the urethra to be passed out of the body when you urinate.
When the bladder is removed, urine needs to exit the body in a new way, through a urinary diversion. In all of the types of urinary diversions, a part of the intestine is surgically converted to either 1) a passage tube for urine to exit the body, or 2) a reservoir to store urine (like a normal bladder).
Regardless of surgical method, urine and stool remain completely separate from each other. (They are two different systems–the urinary and digestive systems–respectively.)
Urinary diversion with Ileal Conduit Method
For this procedure, a portion of the small and/or large bowel is disconnected from the fecal stream and used for reconstruction.
A segment of the intestine directs urine through a stoma into an external collecting bag.
With this procedure, the ureters (the tubes that carry urine from the kidneys to the bladder) drain freely into part of the ileum (the last segment of the small intestine). The end of the ileum into which the ureters drain is then brought out through an opening in the abdominal wall. This opening, called a stoma, is covered with a bag that gathers the urine as it drains from the ileal conduit.
Ileal conduit surgery consists of open abdominal surgery that proceeds in the following three stages:
- Isolating the ileum, which is the last section of small bowel. The segment used is about 5.9–7.8 in (15–20 cm) in length.
- The segment is then anastomosed, or grafted, to the ureters with absorbable sutures.
- A stoma, or opening in skin, is created on the right side of the abdomen.
- The other end of the bowel segment is attached to the stoma, which drains into a ostomy bag.
Stents are used to bypass the surgical site and divert urine externally, ensuring that the anastomotic site has adequate healing time. Continent surgeries are more extensive than the ileal conduit surgery and are not described here. Both types of surgery require an extensive hospitalization with careful monitoring of the patient for infections, removal of stents placed in the bowel during surgery, and removal of catheters.