Introduction

Bladder cancer is a common type of cancer. Of every 10,000 people, about 2 to 3 persons will develop bladder cancer.

More than 9 out of 10 people with bladder cancer have a type called transitional cell cancer, also known as TCC.

This program focuses on TCC of the bladder. Transitional cells line the inside of the bladder and help it stretch when the bladder is full and shrink when emptied.

Bladder cancer is highly curable if found and treated early.

This reference summary will help you better understand what bladder cancer is and what treatment options are available.

Bladder Cancer

The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor.

If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are usually not life threatening.

If the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer. Cancerous cells spread to different parts of the body through blood vessels and lymph channels.

Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes.

Cancer that spreads from one organ to other body parts is known as metastatic cancer. For instance, a cancerous tumor in the bladder may grow through the bladder’s outer layer and nearby tissues over time.

Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the bladder will always be called bladder cancer, even if it has spread to other places in the body.

Causes and Risk Factors

bladder1 It is usually impossible to specify the cause of cancer in an individual patient. However, we do know what causes cancer in general. Doctors talk of factors that can increase the chances of getting cancer.

These are known as “risk factors”.

Smoking tobacco is the most important risk factor for bladder cancer. People who smoke for many years have a higher risk than nonsmokers or those who smoke for a short time.

For people with bladder cancer, quitting smoking may reduce the chance of getting other types of cancer, lung disease, or heart disease. Quitting smoking can also help cancer treatments work better.

People with a family history of bladder cancer have a slightly increased risk of the disease.

bladder2 Some people have a higher risk of bladder cancer because of cancer-causing chemicals in their workplace. Workers in the dye, rubber, chemical, metal, textile, and leather industries may be at risk of bladder cancer. Also at risk are hairdressers, machinists, printers, painters, and truck drivers.

People who have had bladder cancer have an increased risk of getting the disease again. People with other types of cancer who have been treated with certain drugs may be at increased risk of bladder cancer. Also, people with other types of cancer who have had radiation therapy to the abdomen or pelvis may be at increased risk.

Arsenic is a poison that increases the risk of bladder cancer. High levels of arsenic may be found in drinking water in some areas of the world.

Not everybody who has risk factors for bladder cancer develops bladder cancer. Some people who have no risk factors for bladder cancer can still develop the cancer.

Symptoms

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Common symptoms of bladder cancer are:

• Finding blood in your urine, which may make the urine look rusty or darker red

• Feeling an urgent need to empty your bladder

• Having to empty your bladder more often than you used to

Symptoms of bladder cancer also include:

• Feeling the need to empty your bladder without results

• Needing to strain or bear down when you empty your bladder

• Feeling pain when you empty your bladder

These symptoms may not be caused by bladder cancer. Make sure to see a doctor to find out what is causing your symptoms.

Diagnosis

If you have symptoms of bladder cancer, your doctor will try to find out if bladder cancer is the cause of your symptoms or if there is another cause. You may have a physical exam and additional tests. Your urine may be tested by the lab.

The lab checks your urine for blood, cancer cells, and other signs of disease.

A cystoscopy is another possible test your doctor may use in diagnosing bladder symptoms. During a cystoscopy, your doctor uses a thin, lighted tube called a cystoscope to look directly into your bladder. Your doctor can remove samples of tissue with the cystoscope. This is called a biopsy.

A pathologist examines the tissue under a microscope to see if it is cancerous or not. In most cases, a biopsy is the only sure way to tell if cancer is present.

If cancer cells are found, the pathologist will examine them and decide what grade they are. The grade of the tumor describes how abnormal the cells look as well as how fast the tumor is likely to grow and spread. The grade describes how advanced the cancerous tumor is.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Staging

If you have bladder cancer, your doctor will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body.

Stages are usually described using the numbers 1 - 4; a lower number indicates an earlier stage. Staging is helpful in deciding the best course of treatment.

When staging bladder cancer, doctors want to find out:

• Whether the tumor has invaded the muscle layer of the bladder

• Whether the tumor has invaded nearby tissues

• Whether the cancer has spread, and if so, to what parts of the body

Blood tests may be one way that doctors determine the stage of bladder cancer. Blood tests can show how well the liver and kidneys are working.

A chest x-ray may also be used to determine the stage of bladder cancer. An x-ray is a type of high-energy radiation that can go through the body and onto film, making a picture. An x-ray of the chest can show a tumor in the lung.

IVP stands for intravenous pyelography. During this procedure, a dye that shows up on bladder4 x-rays is injected into your blood vessel. The dye collects in your urine, which makes the bladder and the rest of the urinary tract show up on x-rays.

Tumors can show up on a CT scan. A CT scan is an x-ray machine linked to a computer. A CT scan takes detailed pictures of your organs.

An injection of dye may be given to make abnormal areas easier to see. An MRI is also used to make detailed pictures of areas inside your body. It uses strong magnets to create images of the inside of the body. You may receive contrast material by injection to make abnormal areas easier to see.

Another test that may be done to determine the stage of bladder cancer is an ultrasound. Sound waves are used to create pictures that show the organs and tissues in the body, including your bladder. The picture can show a tumor or blockage in the urinary tract.

 

Proton Therapy for Bladder Cancer Treatment

 When treating bladder cancer with radiation, the primary goal is to apply the maximum dose to the tumor, while minimizing exposure to surrounding tissue. Proton therapy can help accomplish this goal. Protons can be programmed to deposit their highest energy directly in the diseased tissue. As a result, less radiation reaches healthy structures near the cancer.

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Bladder cancers treated with proton therapy

    • Transitional cell carcinoma
    • Adenocarcinoma
    • Squamous cell carcinoma of the bladder

What to expect

Each patient’s therapy is precisely tailored to their needs. Patients and clinicians collaborate closely to create a personalized treatment plan. The number and length of treatments will vary, based on the cancer. How patients respond depends on many factors, including the types of bladder treatments they are receiving. Many people tolerate proton therapy well and continue to perform normal activities; however, individual responses vary.

Advantages of Proton Therapy for Bladder Cancer

Although proton radiation treatment is relatively new, clinical trials for bladder cancer have already shown excellent signs of disease control and minimal side effects compared with traditional forms of treatment. Proton therapy also offers a number of other compelling benefits:

    • Treatment is noninvasive and painless
    • Proton therapy is effective for treating early stage bladder cancer
    • Treatment offers quicker recovery times with minimal side effects
    • It is more accurate and precise than other kinds of radiation
    • Treatment is provided in an outpatient setting
    • Proton radiation has little to no impact on patient energy level