Friday, May 16, 2014

Bladder Cancer (May is Bladder Cancer Awareness Month)

By: Dr. Eric Brewer with Urology Centers of Alabama

Bladder cancer is a cancer that starts in the bladder, the body part that holds and releases urine. The exact cause of bladder cancer is uncertain. However, several things may make you more likely to develop it, including cigarette smoking, chemical exposure at work, chemotherapy, radiation treatment, and long-term bladder infection.

• Blood in the urine
• Painful urination
• Urinary frequency and urgency
• Weight loss
• Pain in the lower back and/or around the kidneys
• A growth in the pelvis

One of the physicians at Urology Centers of Alabama will perform a detailed history and physical examination, including a rectal and pelvic exam. Tests that may be done to look for bladder cancer include:

• CT scan: x-ray imaging that show detailed views of the abdominal and pelvic organs
• Urinalysis: office test used for finding blood in the urine
• Urine cytology: detailed microscopic evaluation of the urine looking for cancer cells floating in the urine
• Cystoscopy: visualization of the inside of the bladder with an endoscope
• Bladder biopsy: usually done in the operating suite, where suspicious areas are sampled to determine if cancer is present

Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.

Superficial Bladder Cancer Superficial Bladder Cancer is in the lining of the bladder. Treatment usually involves removing the tumor through an endoscope. Subsequent treatment may include chemotherapy and/or immunotherapy treatments, which is medicine instilled into the bladder over a series of weeks. This helps to reduce the chance that the cancer may return. Routine follow up is needed to ensure that the cancer hasn’t returned. This usually involves repeat Cystoscopy in the office every 3-6 months for several years.

Muscle-Invasive Bladder Cancer
Muscle-Invasive Bladder Cancer is cancer that has grown into the wall of the bladder. If the bladder cancer has progressed, and has grown into the wall of the bladder, much more aggressive treatment is warranted.

Radical Cystectomy
Radical Cystectomy is complete removal of the bladder and is major surgery, usually involving a hospital-stay of up to a week. The lymph nodes around the bladder are also removed to determine if the cancer has begun to spread. If you are male, the prostate is removed along with the bladder or if you are female, the uterus and ovaries are removed, if not already done so.

Once the bladder is removed, there are two options for patients to choice:

Ileal Conduit is a small section of your small bowel is used to create an ostomy on your abdomen for urine to drain into a bag. This is the most common type of diversion and offers the lowest risk.

Neobladder is when a larger section of your small bowel is used to create a reservoir in which to hold your urine inside your body. It is attached to the urethra, and the patient continues to urinate much in the same way as you do now. While a more attractive option for some patients, it is not for everyone and comes with it’s own set of drawbacks. Ask your urological surgeon if this option is right for you.

Robotic Surgery for Bladder Cancer
At Urology Centers of Alabama the physicians continue to lead the forefront in Robotic Surgery for various urological diseases. They have expanded their robotics program to include the treatment of bladder cancer with Robotic Radical Cystectomy. The specially trained robotic surgeons are among the nations’ most experienced, with numbers that would rival most centers around the world. Robotic surgery offers many advantages including:

• Much less blood loss, resulting in very seldom need for blood transfusions
• Less pain
• Shorter hospital stay
• Better cosmetic result

If surgery is not an option, radiation & chemotherapy may be recommend by your doctor to kill the cancer. As with all treatments, side effects are possible. Be sure to ask your doctor the pros and cons to each option, to decide which is right for you.

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