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COMMON CANCER |
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COMMON CANCER
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BLADDER CANCER |
Welcome to Department of Renal Sciences at Patel Hospital
section on cancer of the bladder. We would like to help you find the information
regarding bladder cancer.
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What are the risks and causes?
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A risk factor is anything that can increase your chance of
developing cancer. For example, smoking is a risk factor for many types of
cancers, including bladder cancer.
Remember -
Having one or more risk factors does not mean that you will definitely get
bladder cancer. Many people who have one or more of the risk factors never get
bladder cancer and some people who have none of the risk factors do develop
bladder cancer. They are only a guide to what may increase risk.
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How common is bladder cancer?
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Bladder cancer is the 4th commonest cancer for men and the
10th commonest cancer for women.More men than women get bladder cancer. This may
just be because more men than women have smoked over the past twenty years or
so. And more men have been exposed to chemicals at work. Most people with
bladder cancer are between 50 and 80 years old. It is rare in people under 40.
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Smoking
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Smoking cigarettes definitely increases the risk of bladder cancer. Your risk if
you smoke is double that of a non smoker. If you smoke heavily or have smoked
for a long time, your risk is even higher. More than half of all bladder cancers
in men and about a third in women are caused by smoking.
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Having had bladder cancer before
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If you have already been successfully treated for a bladder cancer in the past
then your risk of developing another cancer anywhere in the urinary tract is
higher.
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Chemicals at work
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There are some professions that are known to increase the
risk of bladder cancer.
- Dyeing , Leather working.
- Painting and decorating .
- Paper making .
- Dry cleaning .
- Rubber or plastics manufacture .
- Mechanics or lorry driving .
- Metal foundries .
A group of chemicals called Arylamines are known to cause
bladder cancer. They are responsible for the increased risk in many of these
industries. Arylamines that increase risk of bladder cancer include
- Aniline dyes.
- 2-Naphthylamine.
- 4-Aminobiphenyl.
- Xenylamine.
- Benzidine.
Exposure to these chemicals is possible in industries
where there is handling of carbon or crude oil, or substances made from them.
You may also come into contact with them in any industry involving combustion,
such as smelting. If you have a diagnosis of bladder cancer, it is worth finding
out if you have ever been exposed to any of these chemicals. If you have, talk
to your urologist or cancer doctor.
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Repeated bladder infections
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If you have had many bladder infections in the past, or suffer from chronic
bladder infection, you may be more at risk from a type of bladder cancer called
‘squamous cell cancer of the bladder’. People who are prone to bladder infection
are more at risk, for example people who are paralysed.
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Bladder stones
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‘Stones’ are little lumps of calcium that can form in the
urinary system. You can get kidney or bladder stones. If you have stones in the
bladder (sometimes called bladder calculi), you may be more at risk from a type
of bladder cancer called ‘squamous cell bladder cancer’. This is because stones
can cause chronic infection.
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Family history
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Even if someone in your family has bladder cancer, it is very unlikely that you
have an increased risk yourself. You are statistically more at risk if you have
a first degree relative with bladder cancer (a parent, child, sister or
brother).
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Diet
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A healthy diet can lower your risk of bladder cancer. There is good evidence
that eating as little as 100 grams of fruit a day (about 4 ounces) can
significantly lower your bladder cancer risk.Coffee drinking may cause a small
increase in bladder cancer risk.
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Painkillers
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Taking painkillers that reduce inflammation slightly lowers bladder cancer risk.
This includes ibuprofen and aspirin.
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Not drinking enough
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A number of small studies have looked at the association between fluid intake
and bladder cancer. Generally, they have found that if you drink more fluids you
are less likely to develop bladder cancer.
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What are the Symptoms?
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Blood in the urine:
The most common symptom of bladder cancer is blood in the urine. 4 out of 5
people with bladder cancer have some blood in their urine. You may actually see
the blood or it might be there in such small amounts that you cannot see it.
Even if it can’t be seen, blood can be picked up in a urine test. The blood does
not have to be there all the time. It can come and go. So if you ever see blood
in your urine, you should go to your doctor. The bleeding is not usually
painful. But it can help your doctor to diagnose you if you can say whether you
had any pain when you passed the urine with the blood in it. It can also help if
you know whether there is blood just when you start to pass urine or whether the
blood is mixed with all the urine you pass.
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Other symptoms:
There can be other symptoms of bladder cancer. These are
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Frequency - needing to pass urine very often.
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Urgency - needing to pass urine very suddenly.
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Pain when passing urine.
If you have these symptoms you will not necessarily have cancer. You are more
likely to have a urine infection particularly if you do not have blood in your
urine. But you should always tell your doctor straight away if you have these
symptoms. If you have an infection, then it can usually be cleared up with
antibiotics very quickly. If it is cancer, then the sooner it is diagnosed, the
easier it will be to treat.
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Screening and tests for bladder cancer?
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What is screening?
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Screening means looking for early signs of a particular disease in ‘healthy’
people who do not have any symptoms. Screening cannot prevent cancer; only find
it as early as possible. Before you can carry out screening for any type of
cancer, doctors must have an accurate test to use.
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Is there a test?
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At the moment there is no reliable screening test for bladder cancer. Testing
for blood in the urine would not be a useful screening test. Small amounts of
blood in urine can be caused by other conditions apart from cancer. For example,
a urine infection or kidney problems.
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If you are at high risk
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If you think you are at high risk of bladder cancer, talk to your doctor. You
may be able to have regular check ups. But it is very important, to see your
doctor if you develop any bladder symptoms, whether you think you are high risk
or not. This is the best way of finding bladder cancer in its earliest stages,
when it is most treatable.
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Tests
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What happens first
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Most people begin by seeing their family doctor if they have any symptoms of
illness. You may have to give a urine sample that can be sent away for testing.
This will rule out a urine infection. And it may also show up some cancer cells
which have been passed out of the bladder in the urine. Your doctor may want to
examine you internally, because the bladder is so near the bowel, the prostate
(in men) and the womb (in women). Your doctor will put a gloved finger into your
rectum (back passage) or vagina to see if everything feels normal.
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At the hospital
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The specialist you see will begin by asking you about your medical history and
symptoms. He or she will then examine you by feeling around your abdomen and
bladder. You may also be asked to have another internal examination and to give
another urine sample. Your doctor will then arrange for you to have a
cystoscopy.
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Cystoscopy
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This is the most important test for diagnosing cancer of the bladder. It means
putting a thin tube with a light inside your bladder. The tube has optic fibres
inside it. These allow your doctor to see inside your bladder. You can have this
test done under local or general anaesthetic. During cystoscopy under local
anaesthetic, your doctor will just examine the bladder. If you need tissue
samples taken, you will need a cystoscopy under general anaesthetic.
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Cystoscopy under local anaesthetic
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You can go home straight after this test. You may feel some discomfort or mild
pain when you pass urine for the first time afterwards. But apart from that,
there are usually no after effects.
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Cystoscopy under general anaesthetic
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For this test, you will have to come into hospital. You will probably not have
to come in until the day of the test. You shouldn’t eat or drink anything for at
least 6 hours before a general anaesthetic. Your specialist will give you exact
instructions. You can usually go home the same day if the procedure has been
minor. This will depend on
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How many biopsies your doctor took
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How you react to the anaesthetic
The time of day you have the anaesthetic - if it is very late in the day, it may
be better for you to stay overnight If there are large tumours which require
treatment you will need to stay longer and you may need a catheter (a tube in
the bladder) for a few days after the operation
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Further Tests
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If your tests show you have bladder cancer, your specialist will ask you to have
further tests at the hospital. If you have early bladder cancer, you may not
have any more tests. Or you may have an IVU to make sure any blood in your urine
is definitely not coming from anywhere else in your urinary tract. If you have
invasive bladder cancer, your specialist will want you to have tests to make
sure your cancer hasn’t spread. Your specialist will need to know this before it
is possible to decide on the best treatment for you.
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Intravenous Urogram
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This is sometimes called an IVU or IVP. It is a general X-ray examination to
look at the whole of your urinary system. This is to make sure the rest of your
urinary tract is healthy.
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Tests if you have invasive bladder cancer
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Your specialist may ask you to have any or all of these tests
1. CT scan
2. MRI scan
3. Bone scan
4. Liver ultrasound scan
CT scan
You may have a CT scan to check for cancer spread to other parts of the body.
MRI scan
This is a scan using magnetism to build up a picture of the inside of the body.
It may be done to look for cancer spread. MRI scans are particularly good for
looking at the soft tissues of the body.
Bone scan
Your specialist may ask for a bone scan to check for cancer spread to the bones
Liver scan
This is an ultrasound scan, using a microphone to bounce sound waves off the
liver and build up a picture. Liver ultrasound scans are used to check for
cancer spread to the liver.
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After the tests
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You will be asked to come back to the hospital when your test results have come
through. This is bound to take a little time, even if only a day or two. You may
feel very anxious during this time.
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Suggestion
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While you are waiting for results it may help to talk to a close friend or
relative about how you are feeling. Or you may want to contact a cancer support
group to talk to someone who has been through a similar experience.
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What are the types of bladder cancer?
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1. Transitional cell cancer:
About 9 out of 10 bladder cancers are this type. It is a cancer of the cells of
the bladder lining. Because they line the bladder, these cells come into contact
with waste products in the urine that may cause cancer, for example chemicals in
cigarette smoke. There are two main types of transitional cell cancer. These two
types behave in quite different ways. The two types are
1. Superficial or papillary bladder cancer
2. Invasive bladder cancer
The treatment of each is quite different. So you need to know which one you are
dealing with in order to get the right information.
Superficial bladder cancer:
Superficial or papillary bladder cancers is early transitional cell bladder
cancer. The cancer is only in the lining of the bladder and hasn’t grown any
further. It usually appears as growths, like little mushrooms, growing out of
the bladder lining. Your surgeon can remove these quite simply. And they may
never come back.But some types of superficial bladder cancer are more likely to
come back. Your doctor may call these ‘high risk’. They are ‘carcinoma in situ’
(CIS) and T1 tumours. T1 tumours are superficial cancers that have grown a bit
further into the bladder tissues. The cancer has grown through the skin-like
lining of the bladder into a layer underneath. About 30 - 40 out of every 100
(30 - 40%) T1 bladder cancers come back.CIS is high grade, which means the
cancer cells look very abnormal and are likely to grow quickly. So it is also
more likely to come back. If you have CIS or T1 superficial bladder cancer, your
doctor may suggest more treatment than for a lower risk bladder cancer. And the
specialist will keep a close eye on you to make sure the cancer is picked up as
early as possible if it does come back. CIS and T1 are part of the staging of
bladder cancer.
* Invasive bladder cancer:
Transitional cell bladder cancer can become invasive. This means it has grown
into the muscle layer of the bladder, or even further. Some people have invasive
bladder cancer when they are first diagnosed. Invasive bladder cancer needs more
intensive treatment. This is because there is a danger that it could spread to
other parts of the body. Your doctor may say you have a T2, T3 or T4 bladder
cancer. This is part of the staging of bladder cancer.
2. Squamous cell cancer
Only about 2 out of a hundred bladder cancers are squamous cell cancers. It is
more common in developing countries where a worm infection called bilharzia or
schistosomiasis is widespread
3. Adenocarcinoma:
This is a very rare type of bladder cancer. Between 1 and 2 out of every 100
people diagnosed with bladder cancer will have this type. It is a cancer of the
cells in the lining of the bladder that produce mucus.
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What are the stages and grades of bladder cancer?
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What is staging?
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The stage of a cancer tells the doctor how far it has spread. It is important
because treatment is often decided according to the stage of a cancer. There are
different ways of staging cancers. The most common amongst doctors is the TNM
system. This is common to all cancers. TNM stands for ‘tumour, node,
metastasis’. So this staging system takes into account the size of the bladder
tumour, whether there is cancer in the lymph nodes and whether the cancer has
spread to any other part of the body. Doctors call cancer spread ‘metastasis’.
Another way of staging cancers is number staging. This is used for other
cancers, but not so much for bladder cancer. There are usually 4 main stages.
Stage 1 is the earliest cancer and stage 4 the most advanced. With bladder
cancer, it is more usual to refer to early (or superficial) bladder cancer,
invasive bladder cancer and advanced bladder cancer.
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What is ‘grade’?
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You may hear your doctor talk about the ‘grade’ of your cancer. This means how
well developed the cell looks like under the microscope. The more the cancer
cell looks like a normal cell, the more it will behave like one and less are the
chances of progression of disease. A low grade cancer is likely to be less
aggressive in its behaviour than a high grade one. Doctors cannot be certain how
the cells will behave. But grade is a useful indicator. If you have early
bladder cancer, grade is one thing that your doctor may take into account when
deciding your treatment. If the cells are high grade, you are more likely to
need further treatment to stop the cancer coming back after your specialist has
removed it.
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The ‘T’ stages of Bladder Cancer
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The ‘T’ of TNM tells you how far into the bladder the cancer cells have grown:
T1 - the cancer has started to grow into the tissue beneath the bladder lining.
T2 - the cancer has started to grow into the muscle under the tissue layer.
T3a - the cancer has grown almost all the way through the muscle layer.
T3b - the cancer has grown all the way through the muscle layer into the fat
layer underneath.
T4 - the cancer has spread outside the bladder to the prostate, vagina or other
organs in the pelvis.
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The ‘N’ stages of bladder cancer
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There are four lymph node stages in bladder cancer. These relate to lymph nodes
in the pelvis (the lower part of your tummy, inside your hip bones, or pelvic
girdle). The stages are:
N0 - no cancer in any lymph nodes.
N1 - one affected lymph node smaller than 2cm across.
N2 - one affected lymph node larger than 2cm, but smaller than 5cm. Or more than
one node affected, but all of them smaller than 5cm across.
N3 - at least one affected lymph node larger than 5cm across.
The size of the lymph nodes is used because the more cancer there is growing in
a lymph node, the larger it will be.
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The ‘M’ stages of bladder cancer
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As with most cancers, there are two stages for cancer spread or metastases.
Either the cancer has spread to another body organ (M1) or it hasn’t (M0). If
bladder cancer does spread to another part of the body, it is most likely to go
to the bones, lungs or liver. If your cancer has spread, then you have advanced
bladder cancer.
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Early bladder cancer and carcinoma in situ
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Early bladder cancer is also called ‘superficial bladder cancer’. This includes
Ta tumours, T1 tumours and carcinoma in situ (CIS)(please see TNM staging). CIS
is called Tis in the bladder cancer TNM staging. All these are cancers that
have been picked up early in their development. The cancer cells are only in the
topmost layer of the bladder - in the lining. Often, these early bladder tumours
look like mushrooms growing out of the bladder wall. In many cases, these cause
no more trouble after your specialist has removed them. There is a group of
early bladder cancers that doctors call ‘high risk’. They are more likely to
come back and more likely to go on to develop into a more dangerous invasive
bladder cancer. This group includes carcinoma in situ and T1 tumours. T1 tumours
have just started to grow further into the bladder wall than the lining. High
grade cancer cells are more likely to grow quickly and to spread than low grade
ones. If you have ‘high risk’ early bladder cancer, your specialist will want
you to have more treatment after removing the cancer. This will be treatment to
the inside of your bladder called intravesical therapy.
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Invasive bladder cancer
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If you have stage T2 or T3 bladder cancer, then this is called invasive bladder
cancer. In T2, the cancer has started to grow into (or invade) the muscle layer
of the bladder. In T3, the cancer has grown nearly through, or completely
through the muscle layer. There is more risk that the cancer could spread than
with early bladder cancer. Advanced bladder cancer includes T4 bladder cancer,
cancer in the lymph nodes or cancer that has spread to another part of the body,
but if the cancer spread is only local (in the area around the bladder, or to
local lymph nodes), your specialist may treat you as if you had T2 or T3
invasive bladder cancer.
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Statistics and prognosis
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Prognosis is the likely outcome of your disease and treatment. In other words,
how likely you are to get better and how long you are likely to live. But not
everyone who is diagnosed with a cancer wishes to read this type of information.
If you are not sure, whether you want to know at the moment or not, then perhaps
you might like to skip this page for now. You can always come back to it. Please
note: There are no national statistics available for different stages of cancer
or treatments that people may have received. The statistics - we present here
are pulled together from a variety of different sources, including the opinions
and experience of the experts. We provide statistics because people ask us for
them, but they are only intended as a general guide and cannot be regarded as
any more than that.
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Cancer statistics generally
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‘5 year survival’ is a term doctors use. It does not mean you will only live 5
years! It relates to the proportion of people in research studies who were still
alive 5 years after diagnosis.
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Prognosis by stage and grade
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As with many other types of cancer, the outcome of bladder cancer depends on how
advanced it is, when it is diagnosed.
Most bladder cancers are diagnosed while they are still only in the bladder
lining. About 3 out of 4 (75%) bladder cancers are of these early type when they
are diagnosed. You may hear this early cancer called Ta or T1 bladder cancer.
These early bladder cancers can all be cured or controlled with surgery or
immunotherapy or chemotherapy into the bladder. The low grade or grade 1 early
bladder tumours are more likely to be cured. Moderate or high grade (grades 2 or
3) early bladder tumours are more likely to come back and need further
treatment. Taking all superficial bladder tumours together, about 65 out of
every 100 (65%) will come back. But most of these will recur as early
non-invasive bladder cancer. About 30 out of every 100 early bladder cancers
(30%) will come back as more serious disease. Most Ta tumours are low grade.
About 7 out of 10 stage Ta early bladder cancers (70%) will come back, but most
of these will come back again as superficial tumours that can be nipped out
again. Fewer than 1 in 10 (10%) will come back as an invasive cancer and need
more serious treatment. Most T1 early bladder cancers are higher grade. These
are more likely to go on to develop into an invasive cancer. As many as half
(50%) will develop into invasive cancer if they aren’t treated. For this reason,
you are more likely to have further treatment into your bladder after having
bladder cancer tumours removed.
About 1 in 5 bladder cancers (20%) have grown into the muscle layer of the
bladder when they are diagnosed. These are called invasive bladder cancers.
About 1 in 2 of those diagnosed with T2 invasive bladder cancer (50%) are alive
and well 3 years after their diagnosis. Unfortunately, treatment is less
successful for tumours that have grown further into the bladder. About 1 in 4 of
those with a T3 tumour (25%) will be alive and well 3 years after diagnosis and
treatment. In the UK specialists use either surgery to remove the bladder or
radiotherapy. The treatments are about equally effective. The choice often
depends on your preference and what your specialist recommends. Surgery or
radiotherapy will cure many of these cancers., but the rest will come back and
need more treatment. Doctors cannot usually tell which cancers are likely to
come back and which are likely to be cured. One of the most important factors is
how far the cancer has grown into the wall of the bladder. For instance, a stage
T3 or T4 cancer is more likely to come back than a stage T2 cancer. To try to
reduce the number of cancers that come back, you may have chemotherapy as well
as surgery or radiotherapy. In several large clinical trials, chemotherapy
before surgery did lower the risk of recurrence for high risk invasive bladder
cancers.
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Advanced (metastatic) bladder cancer
This is bladder cancer that has spread to another part of the body. About 1 in
20 bladder cancers (5%) has already spread by the time it is diagnosed. Like
most cancers, the outlook once a cancer has spread is not so good. Only about 1
in 10 people with bladder cancer that has spread to the lymph nodes will live
for more than 5 years after their diagnosis. Unfortunately, if your cancer has
spread to another body organ, your cancer is not going to be curable, but you
can still have treatment to try to keep it under control for a while and to help
control any symptoms you may be having. Once a cancer has spread in this way,
the average life expectancy is between a year and 18 months. Remember, this is
an average and some people will live longer than that.
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How reliable are these statistics?
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No statistics can tell you what will happen to you. Your cancer is unique. The
same type of cancer can grow at different rates in different people for example.
The statistics are not detailed enough to tell you about the different
treatments people may have had and how that treatment may have affected their
prognosis. Chemotherapy may help people to live longer as well as relieving
symptoms. There are many individual factors that will determine your treatment
and prognosis. If you are fit enough to have treatment, you are likely to do
better than average, particular if your cancer is more advanced.
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What are the treatments for bladder cancer?
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What is early bladder cancer?
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Early bladder cancer is also called superficial bladder cancer. This means a
bladder cancer that is confined to the innermost lining of the bladder. There
are 3 stages of early bladder cancer:-
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Stage Tis or carcinoma in situ
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Stage Ta
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Stage T1
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Removing early bladder cancer tumours
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If you have Ta or T1 early stage bladder cancer, you will need to have the
tumours in your bladder removed. Your specialist will do this during your
cystoscopy, while you are under a general anaesthetic. If you have stage Ta
bladder cancer, this may be all the treatment you need. The tumours may come
back, but they can often just be removed again. If you have stage T1 bladder
cancer, you may need to have some treatment into the bladder to help stop the
tumours from coming back. Your specialist will decide this by checking the grade
of your cancer cells. If the cells are ‘high grade’ you have a higher risk of
developing invasive bladder cancer in the future. So your specialist will
suggest further treatment to try to reduce this risk.
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Treatment into the bladder
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Your specialist is very likely to recommend treatment into the bladder, if you
have had T1 bladder cancers removed that have turned out to be high grade.
Doctors call this type of treatment ‘intravesical therapy’. This just means
treatment into the bladder. To have this, you first have a tube put into your
bladder, called a catheter. The doctor puts the treatment solution into your
bladder through the catheter. You have to try not to pass urine for about 2
hours. This will give the solution time to work. You can have chemotherapy
treatment this way, but it is more common to have BCG into the bladder for early
bladder cancer.
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Keeping an eye on you
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After any treatment for early bladder cancer, your specialist will want to keep
a close eye on you to make sure that the cancer doesn’t come back. You will have
regular check ups for some years to come.
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PROSTATE CANCER |
FREQUENLTY ASKED QUSETIONS |
What is Prostate
Cancer?
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Prostate cancer occurs when cells within the
prostate grow uncontrollably, creating small tumors. The term “cancer” refers
to a condition in which the regulation of cell growth is lost and cells grow
uncontrollably. Most cells in the body are constantly dividing, maturing and
then dying in a tightly controlled process. Unlike normal cells, the growth of
cancer cells is no longer well-regulated. Instead of dying as they should,
cancer cells outlive normal cells and continue to form new, abnormal cells.
Abnormal cell growths are called tumors. The term “primary tumor” refers to the
original tumor; secondary tumors are caused when the original cancer spreads to
other locations in the body. Prostate cancer typically is comprised of multiple
very small, primary tumors within the prostate. At this stage, the disease is
often curable (rates of 90% or better) with standard interventions such as
surgery or radiation that aim to remove or kill all cancerous cells in the
prostate. Unfortunately, at this stage the cancer produces few or no symptoms
and can be difficult to detect. |
What is Metastatic
Prostate Cancer?
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If untreated and allowed to grow, the cells
from these tumors can spread in a process called metastasis. In this process,
prostate cancer cells are transported through the lymphatic system and the
bloodstream to other parts of the body, where they lodge and grow secondary
tumors. Once the cancer has spread beyond the prostate, cure rates drop
dramatically.
In most cases, prostate cancer is a relatively slow-growing cancer, which means
that it typically takes a number of years for the disease to become large enough
to be detectable, and even longer to spread beyond the prostate. This is good
news. However, a small percentage of patients experience more rapidly growing,
aggressive forms of prostate cancer. Unfortunately, it is difficult to know for
sure which prostate cancers will grow slowly and which will grow aggressively –
complicating treatment decisions.
The spread of cancer outside the prostate can be detected by the presence of
prostate cancer cells in areas surrounding the prostate such as the seminal
vesicle, lymph nodes in the groin area, the rectum and bones. When prostate
cancer spreads to another site, such as bone, the new tumor is still considered
to be prostate cancer, not bone cancer. |
How Common is Prostate
Cancer?
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It is the most common non-skin cancer in
America, affecting 1 in 6 men. A non-smoking man is more likely to develop
prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and
kidney cancers combined. In fact, a man is 35% more likely to be diagnosed with
prostate cancer than a woman is to be diagnosed with breast cancer.
In 2009, more than 192,000 men will be diagnosed with prostate cancer, and more
than 27,000 men will die from the disease. One new case occurs every 2.7 minutes
and a man dies from prostate cancer every 19 minutes. |
How curable is prostate
cancer?
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As with all cancers, "cure" rates for
prostate cancer describe the percentage of patients likely remaining
disease-free for a specific time. In general, the earlier the cancer is caught,
the more likely it is for the patient to remain disease-free.
Because approximately 90% of all prostate cancers are detected in the local and
regional stages, the cure rate for prostate cancer is very high—nearly 100% of
men diagnosed and treated at this stage will be disease-free after five years.
By contrast, in the 1970s, only 67% of men diagnosed with local or regional
prostate cancer were disease-free after five years.
Yet being diagnosed with prostate cancer can be a life-altering experience. It
requires making some very difficult decisions about treatments that can affect
not only the life of the man diagnosed, but also the lives of his family members
in significant ways for many years to come.
Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6
men. The older you are, the more likely you are to be diagnosed with prostate
cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate
shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. In fact,
more than 65% of all prostate cancers are diagnosed in men over the age of 65.
But the roles of race and family history are important as well. African American
men are 61% more likely to develop prostate cancer compared with Caucasian men
and are nearly 2.5 times as likely to die from the disease. Men with a single
first-degree relative—father, brother or son—with a history of prostate cancer
are twice as likely to develop the disease, while those with two or more
relatives are nearly four times as likely to be diagnosed. The risk is even
higher if the affected family members were diagnosed at a young age, with the
highest risk seen in men whose family members were diagnosed before age 60.
(When weighing risk factors for prostate cancer, it’s also important to
recognize that there are non-risk factors, or factors that have not been linked
to an increase in risk.)
Although genetics might play a role in deciding why one man might be at higher
risk than another, social and environmental factors, particularly diet and
lifestyle, likely have an effect as well.
In fact, research in the past few years has shown that diet modification might
decrease the chances of developing prostate cancer, reduce the likelihood of
having a prostate cancer recurrence, or help slow the progression of the disease |
Understanding the
Links Between Nutrition, Exercise and Prostate Cancer
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Our modern society is characterized by a
lifestyle with low levels of exercise coupled with consumption of foods that are
high in calories, fat, sugar, and salt. But your body still responds in the only
way it knows — it stores excess food as fat to prepare for times of prolonged
starvation. Of course, because prolonged starvation typically does not happen in
modern society, this safety mechanism means that we just continue to gain weight
and store more fat.
This excess fat, especially the fat around the middle of your body, has been
associated with an increased risk of many diseases, including prostate cancer,
and particularly aggressive prostate cancer. But you don’t have to be 50 pounds
overweight to suffer the ill effects of excess body fat. Body fat is actually an
organ with functions. It secretes hormones and specialized proteins that can
increase inflammation and oxidation in the cells of your body — two natural
processes that are strong contributors to the development and progression of
prostate cancer. |
What are the
symptoms of prostate cancer?
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If the cancer is caught at its earliest
stages, most men will not experience any symptoms. Some men, however, will
experience symptoms such as frequent, hesitant, or burning urination, difficulty
in having an erection, or pain or stiffness in the lower back, hips or upper
thighs.
Because these symptoms can also indicate the presence of other diseases or
disorders, men who experience any of these symptoms will undergo a thorough
work-up to determine the underlying cause of the symptoms. |
Prostate Cancer Symptoms
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If the cancer is caught at its earliest
stages, most men will not experience any symptoms. Some men, however, will
experience symptoms that might indicate the presence of prostate cancer,
including:
- A need to urinate frequently, especially at
night;
- Difficulty starting urination or holding back
urine;
- Weak or interrupted flow of urine;
- Painful or burning urination;
- Difficulty in having an erection;
- Painful ejaculation;
- Blood in urine or semen; or
- Frequent pain or stiffness in the lower back,
hips, or upper thighs.
Because these symptoms can also indicate the
presence of other diseases or disorders, such as BPH or prostatitis, men who
experience any of these symptoms will undergo a thorough work-up to determine
the underlying cause of the symptoms.
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If there are no symptoms,
how is prostate cancer detected?
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Screening for prostate cancer can be
performed in a physician’s office using two tests: the PSA (prostate-specific
antigen) blood test and the digital rectal exam (DRE).
It is recommended that both the PSA and DRE should be offered annually,
beginning at age 50, to men who have at least a 10-year life expectancy. Men at
high risk, such as African American men and men with a strong family history of
one or more first-degree relatives diagnosed at an early age should begin
testing at age 45. Men at even higher risk, due to multiple first-degree
relatives affected at an early age, could begin testing at age 40.
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PSA & DRE Screening
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The purpose of screening for cancer is to
detect the cancer at its earliest stages, before any symptoms have
developed.Some men, however, will experience symptoms that might indicate the
presence of prostate cancer. Because these symptoms can also indicate the
presence of other diseases or disorders (such as BPH or prostatitis), these men
will undergo a more thorough work-up. Typically, men whose prostate cancer is
detected through screening are found to have very early-stage disease that can
be treated most effectively.Screening for prostate cancer can be performed
quickly and easily in a physician’s office using two tests: the PSA
(prostate-specific antigen) blood test, and the digital rectal exam (DRE). |
The PSA Blood Test
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PSA is a protein
produced by the prostate and released in very small amounts into the
bloodstream. When there’s a problem with the prostate, such as when prostate
cancer develops and grows, more and more PSA is released, until it reaches a
level where it can be easily detected in the blood.
During a PSA test, a small amount of blood is
drawn from the arm, and the level of PSA is measured. PSA levels under 4 ng/mL
are usually considered "normal," results over 10 ng/mL are usually considered
"high," and results between 4 and 10 ng/mL are usually considered
"intermediate."
However, PSA can also
be elevated if other prostate problems are present, such as BPH or prostatitis,
and some men with prostate cancer have "low" levels of PSA. This is why both the
PSA and DRE are used to detect the presence of disease.
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The Digital Rectal Exam
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During a DRE, the physician inserts a gloved,
lubricated finger into the rectum and examines the prostate for any
irregularities in size, shape, and texture. Often, the DRE can be used by
urologists to help distinguish between prostate cancer and non-cancerous
conditions such as BPH. |
Urine Tests
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A lab checks the urine for blood or
infection.
The doctor may order tests to learn more about the cause of the symptoms and
help determine whether conditions of the prostate are benign or malignan |
Transrectal
Ultrasonogrophy
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The sound waves that cannot
be heard by humans are sent out by probe interested into the rectum.The waves
bounce off the prostate, and a computer uses the echoes a picture called a
sonogram.
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Should I Be Screened?
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The American Cancer Society recommends that
both the PSA and DRE should be offered annually, beginning at age 50, to men who
have at least a 10-year life expectancy. Men at high risk, such as African
American men and men with a strong family history of one or more first-degree
relatives {Any relative who is one meiosis away from a particular individual in
a family (i.e., parent, sibling, offspring)}diagnosed at an early age, should
begin testing at age 45. However, all men over 40 should speak with their
doctors at the the time of their annual physicals and develop a proactive
prostate health plan that is right for them based on their lifestyles and family
history.
There is no unanimous opinion in the medical
community regarding the benefits of prostate cancer screening. Those who
advocate regular screening believe that finding and treating prostate cancer
early offers men more treatment options with potentially fewer side effects.
Those who recommend against regular screening note that because most prostate
cancers grow very slowly, the side effects of treatment would likely outweigh
any benefit that might be derived from detecting the cancer at a stage when it
is unlikely to cause problems.
Because a decision of whether to be screened
for prostate cancer is a personal decision, it's important that each man talk
with his doctor about whether prostate cancer screening is right for him. |
Diagnosis (Gleason Scores and
Staging the Disease)
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Although the DRE and
PSA tests cannot diagnose prostate cancer, they can signal the need for a biopsy
to examine the prostate cells and determine whether they are cancerous. In some
men, changes in urinary or sexual function lead to a full evaluation by the
doctor, and, if prostate cancer is suspected, a biopsy will be performed.
- The Biopsy
- During a biopsy, needles are inserted into
the prostate to take small samples of tissue, often under the guidance of
ultrasound imaging. The biopsy procedure may cause some discomfort or pain, but
the procedure is short, and can usually be performed without an overnight
hospital stay.
- Gleason Grading and
Gleason Scores
- Under normal conditions, prostate cells, just
like all other cells in the body, are constantly reproducing and dying, and each
new prostate cell has the same shape and appearance as all of the other prostate
cells. But cancer cells look different, and the degree to which they look
different from normal cells is what determines the cancer grade. "Low-grade"
tumor cells tend to look very similar to normal cells, whereas "high-grade"
tumor cells have mutated so much that they often barely resemble the normal
cells.
- The Gleason grading system accounts for the
five distinct patterns that prostate tumor cells tend to go through as they
change from normal cells. The scale runs from 1 to 5, where 1 represents cells
that are very nearly normal, and 5 represents cells that don’t look much like
prostate cells at all.
- After examining the
cells under a microscope, the pathologist looking at the biopsy sample assigns
one Gleason grade to the most common pattern, and a second Gleason grade to the
next most common pattern. The two grades are added, and the Gleason score, or
sum, is determined.
- Generally speaking, the Gleason score tends
to predict the aggressiveness of the disease and how it will behave. The higher
the Gleason score, the less the cells behave like normal cells, and the more
aggressive the tumor tends to be.
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Staging the Disease
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Staging determines the extent of prostate
cancer. Localized prostate cancer means that the cancer is confined within the
prostate. Locally advanced prostate cancer means that most of the cancer is
confined within the prostate, but some has started to escape to the immediate
surrounding tissues. In metastatic disease, the prostate cancer is growing
outside the prostate and its immediate environs, possibly to more distant
organs.
A number of tests can be used to help determine the stage of disease. For
example, cancers growing outside of the prostate can often be detected through
traditional imaging studies, such as CT scans, MRIs, or x-rays, or through more
specialized imaging tests such as bone scans. Note that because these tests
cannot detect very small groups of cancer cells, results of these tests cannot
be used alone to determine the stage of the disease, to guide treatment options,
or to predict outcomes.
Metastatic disease can also be detected through imaging studies, and often can
be detected in the lymph nodes. Cancers that spread to more distant organs tend
to travel through the lymph system, a circulatory system similar to the blood
stream that carries cells important in fighting infection and disease. During a
biopsy, or, more often, during surgery, lymph nodes will be removed and examined
for the presence of cancer cells. |
How is prostate
cancer treated?
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There are a wide variety of treatment options
available for men with prostate cancer, including surgery, radiation therapy,
hormone therapy and chemotherapy, any or all of which might be used at different
times depending on the stage of disease and the need for treatment.
Consultation with all three types of prostate cancer specialists—a urologist, a
radiation oncologist and a medical oncologist—will offer the most comprehensive
assessment of the available treatments and expected outcomes |
Prostate Cancer Treatment
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There is no "one size fits all" treatment for
prostate cancer, so each man must learn as much as he can about various
treatment options and, in conjunction with his physicians, make his own decision
about what is best for him.
For most men, the decision will rest on a combination of clinical and
psychological factors. Men diagnosed with localized prostate cancer today will
likely live for many years, so any decision that is made now will likely
reverberate for a long time. Careful consideration of the different options is
an important first step in deciding on the best treatment course.
Consultation with all three types of prostate cancer specialists—a urologist, a
radiation oncologist and a medical oncologist—will offer the most comprehensive
assessment of the available treatments and expected outcomes.
- Active Surveillance
- Prostatectomy (Surgery)
- Other Surgical Procedures
- Radiation Therapy
- Radiation Therapy for Advanced or Recurrent
Prostate Cancer
- Hormone Therapy
- Chemotherapy
- Other Treatment Options
- Emerging Therapies
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