Tumors of the bladder arise from the epithelial cell membrane lining the bladder interior. These neoplasms are almost always malignant, and they metastasize readily. Bladder tumors are staged according to their depth of penetration. Transitional cell carcinoma is the most common type of bladder cancer in the United States.
The cause of bladder tumors is unknown; however, cigarette smoking is thought to be the predominant cause. Predisposing factors may include exposure to certain types of industrial chemicals. Individuals with chronic cystitis also seem prone to develop bladder tumors. The disease affects men three times more frequently than women and generally occurs between ages 50 and 70. Bladder cancer is the fourth most common cancer in men.
Signs and Symptoms
Many persons are asymptomatic until advanced stages of the disease. For those presenting with symptoms, however, painless, gross hematuria is the most common indicator. Less frequently, the individual may complain of dysuria, urinary frequency and urgency, or nocturia. A UTI is a common complication.
The history may reveal occupational exposure to certain industrial chemicals. A complete physical examination and a urinalysis to detect hematuria are performed. Microscopic urinalysis may reveal cancer cells. Cystoscopy and biopsy of the suspected lesions are usually required to reach a definite diagnosis. A bone scan, CT scan, and MRI will help determine possible metastases.
The choice of treatment is based on the extent of the disease. If the disease is superficial, an endoscopic resection may be all that is necessary. If it is invasive, further surgery is required. The tumor may be surgically removed through fulguration (electrical destruction) or transurethral resection, a surgical procedure in which cancerous tissue is removed from the bladder using an instrument passed through the urethra. For advanced cases, removal of the urinary bladder, or radical cystectomy, may be required, followed by radiation, immunotherapy, or chemotherapy treatment.
Some therapies to help clients live more comfortably with both symptoms of the disease and side effects of treatment include meditation, whole-foods nutrition, yoga, tai chi, acupuncture, and guided imagery.
Inform clients of all options for treatment, possible surgical techniques, follow-up care, and the possibility of recurrence. Because of the risk of recurrence, bladder cancer survivors often undergo follow-up screening tests for years after treatment.
The prognosis varies depending on the depth of penetration of the tumor. Although the immediate prognosis for an individual with a superficial bladder tumor may be good, there is still a great likelihood of recurrence within 3 years. When the tumor penetrates the bladder more deeply or has metastasized, the prognosis is poor, with a low 5-year survival rate.
The best prevention is to minimize risk factors by suggesting clients protect themselves from exposure to industrial chemicals, that they not smoke, and that they seek treatment for all UTIs.