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Friday, 17 March, 2000, 17:08 GMT
The bladder is the sac which gathers urine produced by the kidneys. It can be found in the lower abdomen.
Dr Nick James, a consultant oncologist at Birmingham City Hospital, some of whose work is funded by the Cancer Research Campaign, said that patients finding any blood in their urine need to be referred to a hospital clinic.
He said: "If the cancer is superficial, then long term survival is exceptional, but, considering how early it is normally found, if it is an invasive cancer, survival is surprisingly poor."
Certainly if radical surgery has to be carried out, it can have highly inconvenient and lasting effects on the patient, and doctors will try to avoid this wherever possible.
Dr James stresses the importance of discussing other options, such as radiotherapy, before agreeing to an operation.
"I think it's important that patients get the opportunity to discuss alternatives to surgery with an oncologist," he said.
However, bladder cancer is overall considered one of the more surviveable cancers, with more than half of both men and women alive five years after diagnosis.
to listen to Dr Nick James talk about bladder cancer
Some are not detected until they spread through this lining into the muscle beyond which helps the bladder contract and push out urine.
Some common symptoms of bladder cancer include:
These are not definite signs that bladder cancer is present, and many symptoms like these can be explained by a simple infection, treatable with antibiotics.
Even if there is a tumour there which is causing pain, it could be benign rather than a malignant cancer.
To confirm or rule out cancer, the doctor will carry out a full physical examination, and probably a rectal exam using a gloved finger to check for unusual masses which might be a tumour.
Another method used by doctors is cytoscopy.
This involves inserting a very thin probe up the urethra - the tube through which urine is passed. This is an uncomfortable procedure but not usually painful.
The probe allows the doctor to look around for signs of disease, or another cause for the symptoms such as bladder stones.
The probe can also remove a tissue sample which can be removed and examined under a microscope for cancer cells.
If this confirms cancer, then further tests, such as CT scans, MRI, or other x-rays may be carried out to check the spread of the disease.
In addition, scientists have found links with certain occupations and perhaps the chemicals used there.
Increased risk appears to affect the rubber, chemical and leather industries.
However, despite these discoveries, researchers do not know exactly why and how the disease first develops.
If it is confined to the lining of the bladder, then a simple procedure called transurethral resection (TUR) can be carried out.
This is similar to cytoscopy, except the probe is used to burn away cancer cells with an electric current. This is normally carried out under anaesthetic.
The patient may have pain when passing water for a short time afterwards, and some blood in the urine.
However, if the cancer has spread into the bladder muscle, then a bigger operation may be needed.
If the cancer is not particularly fast-spreading and aggressive, and is confined to only one part of the bladder wall, then a partial or "segmental" cystectomy could be carried out.
This involves removing part of the bladder, and allows the patient to urinate normally once recovered.
However, if the cancer has spread more, "radical" cystectomy is carried out, and the entire bladder is taken out, along with any nearby organs that bladder cancer cells may have spread to.
In men, these can include the prostate - a gland near the testicles which makes a component of semen, and the seminal vesicles, the tubes which carry semen to the penis.
In women, the cancer may have spread to the womb, ovaries, and other parts of the reproductive system.
If the bladder has been removed, the patient no longer has anywhere to store the constant slow stream of urine coming from the kidneys.
The surgeon creates an opening in the patient's side, which is called a stoma. This allows a bag to be attached to collect the urine.
A piece of the patient's own small intestine can be used as the tube carrying the urine to the stoma.
Modern surgical techniques may allow a replacement bladder to be fashioned in some patients, giving back a degree of urinary control, and doctors are constantly improving these.
The doctor may also recommend radiotherapy either as the first treatment, or to try to kill any cancer cells which remain after surgery.
This is either targeted on the pelvic area, or the patient is given a radioactive implant which is placed directly into the bladder.
chemotherapy can also be directly targeted at the bladder in some cases, which helps prevent some of the unpleasant side-effects, with drugs being pumped up a tube into the bladder.
However, if the cancer is widely spread, then standard chemotherapy may be used to try to kill lingering cancer cells.
05 May 99 | Health
Drinking fluids cuts bladder cancer risk
11 Mar 99 | Health
Early detection test for bladder cancer
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