|
BLADDER CANCER
- Bladder cancer is generally
considered a disease of aging since the average
age at diagnosis is about 68.
- More than 62,000 cases are
diagnosed each year in the United States.
- Because the major risk factors
for bladder cancer are environmental, rather
than hereditary, the prospects for preventing
this cancer from occurring are promising.
Bladder cancer occurs when healthy
cells in the bladder start to grow at an unusually
fast rate. This usually happens because the cells
develop the ability to divide sooner than they
are normally supposed to. The increased tissue
growth produces masses called tumors, or cancers.
There are three main types of
bladder cancer. The most common, transitional
cell carcinoma (TCC)—arises from the cells
that line the bladder—and accounts for almost
90 percent of all bladder cancers in the U.S.
Squamous cell carcinomas also come from the lining
cells, but grow differently than TCCs. They represent
five to seven percent of all bladder cancers in
the US. Adenocarcinomas come from glandular cells
in the bladder wall. They are rare, perhaps one
to two percent of all bladder cancers in the U.S.
The American Cancer Society
estimated that more that 62,000 new cases will
occur in the U.S. in 2006, and that more than
13,000 people will die of the disease. Most cases
of transitional cell carcinoma occur later in
life. Caucasian males between 67 and 68 years
of age have the highest risk of developing bladder
cancer.
The cause of transitional cell
carcinoma is unknown, but those who smoke or work
in the textile, rubber, and dye industries have
the greatest risk of acquiring the disease. For
those who both smoke and experience chemical exposure
in the workplace, the risk is greatly increased.
Generally there are two types of transitional
cell carcinoma—superficial and invasive—the
difference depending on whether the tumor has
grown into, or invaded, the layers underneath
the bladder lining.
As with many cancers, the cause of bladder
cancer is unknown. Men are three to four times
more likely to acquire bladder cancer than women
are, and Caucasian/European-American males are
nearly twice as susceptible as African-American
males. At the same time, women and black men have
reduced chances for recovery. Bladder cancer is
generally considered a disease of aging since
the average age at diagnosis is between 68 and
69. It is rare for a person under 40 to get the
disease.
Some risk factors offer important opportunities
for prevention. Bear in mind that a risk factor
is not the same as a cause.
The primary risk factor for
bladder cancer (up to 50 percent of cases) is
cigarette smoking, with smokers having a minimum
of twice the chance of acquiring bladder cancer
as non-smokers. At present, people exposed to
second-hand smoke are not thought to be at increased
risk for bladder cancer. But increasingly, research
is raising health concerns about secondary smoke
inhalation. The level of risk for smokers is related
to the number of packs smoked daily. It is thought
that some cancer-causing chemicals found in smoke
enter the bloodstream after being absorbed by
the lungs, are filtered through the kidneys, finally
settling in the urine where they can then damage
the cellular lining of the bladder.
There is a strong link between
occupational exposure to certain chemicals called
arylamines, or aromatic amines—commonly
used in the textile, rubber, and dye industries—and
the development of bladder cancer. Other industries
that use potentially bladder cancer-causing chemicals
include the makers of paint products, printers,
and leather. Practices that protect workers from
exposure to known cancer-causing chemicals are
crucial for those employed in these industries.
Those with a previous history of bladder cancer
are at increased risk of getting the disease again
in the bladder, the lining of the kidney, and
possibly other nearby organs.
Bladder Cancer Treatment:
Improvements in Radical Cystectomy and Continent
Urinary Tract Reconstruction
Surgical removal of the bladder (radical cystectomy)
is the most effective treatment for bladder cancer
that has invaded the muscle wall of the bladder.
Until recently, however, this surgery was associated
with major complications including complete loss
of urinary and sexual function.
Only a decade ago, patients undergoing bladder
removal had to wear an appliance on their abdomen
to collect urine. Our technique for reconstructing
a new urinary bladder from intestine that, in
most cases, can be joined to the urethra allowing
for normal urination is being performed by Dr.
Gary Steinberg.
We have
performed this operation in over 400 patients
for the past 12 years in men, and women. This
technique uses about 20 inches of small intestine
that is configured into a sphere. This provides
a high capacity, low-pressure urinary reservoir
that allows for normal urination and preservation
of kidney function. Furthermore, removing only
this small amount of small intestine has no adverse
effects on bowel function. The entire operation,
including removal of the bladder and construction
of a new intestinal bladder takes about 4 hours.
Patients are hospitalized for only about one week,
and have experienced very few complications with
this technique. With this new bladder, about 90
percent of patients have excellent urinary control,
and the other 10 percent usually experience only
mild urinary incontinence.
It is
now possible for many men and women to maintain
their sexual function following bladder removal.
In men, preservation of the nerves to the penis
that are adjacent to the bladder and prostate
allows about 50 to 70 percent of men to regain
their erections. In women, it is now possible
to preserve the entire vagina and external genitalia
allowing for normal sexual activity. These ongoing
advances in the surgical treatment of bladder
cancer allow patients the best chance of being
cured of their disease and yet able to enjoy an
excellent quality of life following surgery.
Robot
assisted laparascopic
radical cystectomy is also offered here at
The University of Chicago. In addition, a large
number of clinical trials for the early detection,
prevention and treatment of early or advanced
bladder cancer are presently available.
|
