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An outer layer of muscle surrounds the inner lining of the bladder. When the bladder is full, the muscles in the bladder wall can tighten to allow urination. Urine leaves the bladder through another tube, the urethra. The wall of the bladder is lined with cells called transitional cells. It is in these cells that bladder cancer begins.
Cancer that is only in the cells in the lining of the bladder is called superficial bladder cancer. The doctor might call it carcinoma in situ. This type of bladder cancer often comes back after treatment. This is why your doctor will recommend frequent surveillance cystoscopy. If this happens, the disease most often recurs as another superficial cancer in the bladder.
Although it is uncommon, cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina (in women) or the prostate gland (in men). When bladder cancer spreads outside the bladder, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, cancer cells may also spread to other organs, such as the lungs, liver, or bones.
When cancer spreads (metastasizes) from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if bladder cancer spreads to the lungs, the cancer cells in the lungs are actually bladder cancer cells. The disease is called metastatic bladder cancer and is treated as bladder cancer.
If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The doctor may recommend one or more of the following procedures:
A patient who needs a biopsy may want to ask the doctor some of the following questions:
People with bladder cancer have many treatment options. They may have surgery, radiation therapy, chemotherapy, or biological therapy. Some patients get a combination of therapies.
Dr. Herman or Dr. Kester will describe your treatment choices and discuss the expected results of treatment.
Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. Dr. Herman or Dr. Kester can explain each type of surgery and discuss which is most suitable for you. The most common surgical procedure is in-office laser. This is performed through a cystoscope and is virtually painless. There is no cutting and it is quick and very effective.
These are some questions a patient may want to ask the doctor about surgery:
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.
These are some questions a patient may want to ask the doctor about radiation therapy:
Chemotherapy uses drugs to kill cancer cells. The doctor may use one drug or a combination of drugs.
Intravesical Chemotherapy – For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy. The medical assistant usually inserts a tube (catheter) through the urethra and into the bladder. Then a liquid chemotherapy agent is put through the catheter into the bladder where it remains for at least 30 minutes. The effects of this form of chemotherapy is limited to the bladder and is virtually painless. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once a month for up to a year or longer.
The doctor develops a treatment plan to fit each patient’s needs. Treatment depends on the type of bladder cancer, the stage of the disease, and the grade of the tumor. The grade of the cancer cells is a descriptive term, that explains just how closely the cancer cells resemble normal cells. The grade also suggests how fast the cancer is likely to grow. Low-grade cancers usually grow and spread more slowly than high-grade cancers. The doctor also considers other factors, including the patient’s age and general health.
These are some questions a patient may want to ask the doctor before treatment begins:
People do not need to ask all of their questions or understand all of the answers at once. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.