Bladder cancer

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Urinary bladder cancer is one of the most common cancers. Treatment can vary widely between people, depending on how the disease develops. Sometimes a larger operation is needed that affects you more. Then, among other things, the bladder is removed. However, most people can continue to live about as usual.

Urinary bladder cancer can occur at any age but is unusual before age 50.

Symptoms of bladder cancer

You may have one or more of the following symptoms:

  • You have blood in the urine.
  • It stings when you pee.
  • You feel pissed even though you’ve just pissed.
  • You get recurrent urinary tract infections .

Blood in the urine can cause the urine to stain red or brown or contain lumps. In bladder cancer, it is common to have blood in the urine once and then it will be delayed before you get it again.

Blood in the urine and trouble peeing may also have other causes, such as urinary tract infection or kidney stones . It is nevertheless important that you seek care and be examined if you have any of the symptoms.

When and where should I seek care?

Contact a health care provider  if you suspect you have bladder cancer. In some places, you can seek treatment directly at a urology clinic, without referral. You can contact many receptions by logging in .

Investigations and investigations

You are offered an examination according to a standardized course of care if the doctor suspects you have bladder cancer. Standardized care   is a way of organizing the investigation so that it goes as quickly as possible.

Among other things, there are times set for the surveys you may need to do. The doctor writes a referral and tells you why you should be investigated, what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you, so that you do not miss any time.

Studies that can show if you have cancer

Your doctor may need to examine you in different ways to find out how you are feeling and why you have symptoms. A body examination is common .

Here are some common studies to find out if you have bladder cancer.

Urine sample

You may pass a urine test to show if you have an infection and if there are cancer cells in the urine.

cystoscopy

A cystoscopy is an examination that involves the doctor inserting a narrow instrument into the urethra and further into the bladder to see how it looks there. It may feel a bit uncomfortable but doesn’t hurt. You get stunned. The survey takes a few minutes.

CT urography

CT urography means that the urinary tract is imaged with computed tomography, also called X-ray. Before the examination, you need to drink plenty of water. First, the X-ray nurse takes some pictures. Then you get contrast fluid in the blood through a small, thin plastic tube inserted with a needle in the arm fold or hand. The survey takes about 20-40 minutes. Here you can read more about computed tomography and contrast media .

Investigations if you have cancer

You may need to be examined to see if the cancer has spread outside the bladder. The chest and abdomen can be examined with computed tomography  or PET camera .

What is bladder cancer?

Urinary bladder cancer usually begins in the mucosa covering the inside of the bladder. How the disease develops largely depends on the type of cells the cancer tumor consists of and how much it has grown into the wall of the bladder.

Non-muscle invasive bladder cancer – the cancer does not grow into the bladder muscle

The most common is that bladder cancer is found only in the mucous membrane of the bladder or in the connective tissue around the bladder. However, the muscle around the bladder is unaffected. The cancer can come back after treatment but then it can be treated again.

Muscle invasive bladder cancer – the cancer grows into the bladder muscle

Sometimes the cancer grows through the mucosa, connective tissue and into the muscle around the bladder. Then there is a risk of the cancer spreading in the body. There are various treatments that can be combined to be as effective as possible. About half of all people with muscle invasive bladder cancer get rid of the disease after treatment.

Scattered bladder cancer

It is quite uncommon for bladder cancer to be detected so late that it has already spread. Urinary bladder cancer can spread through the lymphatic system  to lymph nodes near the bladder. The cancer can also spread through the blood and form metastases in other parts of the body, such as the liver, lungs or skeleton. Metastases are the same as daughter tumors.

It is more difficult to get rid of the disease if it has spread. Instead, it is usually possible to curb the disease and alleviate problems with the help of various treatments.

Treatment begins with a TUR-B operation

Everyone who gets bladder cancer needs to be operated on with a method called TUR-B. The surgery may be sufficient if you have non-muscle invasive bladder cancer. The surgery begins treatment if you have muscle invasive cancer. Then TUR-B is made to allow the surgeon to take a cell sample and see how much the cancer tumor has grown.

This is how the operation is done

A TUR-B operation means that the cancer tumor is removed with an operating cystoscope that the doctor enters the bladder through the urethra. You get anesthetized or you get back anesthesia .

The operation takes about 30-60 minutes and usually ends with a catheterinsertion. The catheter is a thin tube that allows blood and urine to easily flow out of the bladder. It may remain until the morning after the operation.

How long you need to stay in the hospital depends on how you feel and the procedures that apply where you have been treated. In some hospitals you are allowed to go home the same day as the surgery, in other hospitals you are allowed to stay until the catheter has been removed and you can pee yourself again.

After the surgery

Often, blood needs to be flushed away from the catheter for a few hours after surgery. The flushing can burn and make you feel pissed. It may feel uncomfortable but goes over when the flushing is complete. You can get treatment that removes the symptoms if you need to.

It may sting in the urethra when the catheter is removed and you may leak some urine if you become very pissed off. The problems usually disappear after one to two weeks.

It can be difficult to reach the toilet when you need to kiss. It usually goes on after the first few days.

The urine may get a little blood stained every now and then in the first few weeks after surgery. This is because it seeps blood from the operating wound inside the bladder. Then it is good to drink properly until the urine clears again. Drink about two liters a day.

You need to take it a little cautiously two to three weeks after the surgery. Otherwise, the wound in the bladder may begin to bleed. To reduce the risk of bleeding:

  • Avoid running, cycling or any other heavy body effort.
  • Avoid sharp wheezing when pooping.
  • Avoid intercourse.

You may need to be on sick leave or have easier work until the wound in the bladder has healed, if you have a job that is physically heavy. The wound has healed quite well after about four weeks.

Post-operative complications

You may get a urinary tract infection after surgery. If you have one or more of the following problems, call the department where you have been operated:

  • You bleed more even though you drink a lot.
  • There will be clots of blood when you kiss.
  • You have a hard time peeing.

Treatment for non-muscle invasive cancer

The cancer tumor is removed during a TUR-B operation. You can read more about it in a previous chapter. Sometimes more treatment is needed.

Rinsing the bladder with cytostatic drugs or BCG

The bladder can be rinsed with drugs, for example if the cancer recurs several times or if it grows a little deeper in the connective tissue without reaching the bladder muscle. The drugs are either cytostatics or BCG, which is a vaccine. The drug is injected into the urethra through a thin catheter which is removed immediately afterwards. The rinses are called instillations.

The bladder is rinsed with cytostatics

It is most common to be treated with cytostatics in hospitals once a week for six to eight weeks. You can usually leave the hospital immediately after the drug is injected. You pour out the solution after one to two hours.

It is common for it to burn when you are kissing and that you become pissed off by the treatment. It usually goes away by itself after you finish the entire treatment. You can get medicines that relieve if you have a lot of trouble.

You get no other side effects from the cytostatic.

The bladder is rinsed with BCG

BCG is an acronym for Bacillus Calmette Guerin. It is also called calmette vaccine. It is initially a vaccine for tuberculosis.

BCG in the bladder causes the immune system to react in the bladder’s mucosa in a manner that is effective against certain types of cancer cells.

It is most common to be treated with BCG at the hospital once a week for six weeks. You can usually leave the hospital immediately after the drug is injected.

Avoid drinking four hours before treatment. It is important that the bladder is empty when the agent is injected. It is good if you sit up or walk around so that the entire bladder is rinsed with the drug. The vaccine is supposed to remain in the bladder for two hours but pee it out before you become very pissed. Shake a lot when you urinate so that the entire bladder becomes empty.

The treatment with BCG may make you need to urinate more often and it will burn when you urinate. You may also have fever, pain in the body and feel nausea during treatment. For the most part, the hassles go over fairly quickly. If you are still having trouble after three to four days, contact the department where you will be treated. You can get medicines that relieve if you have a lot of trouble. It may also be possible to interrupt treatment.

Regular checks after the TUR-B operation

Postoperative cystoscopy  is important .

The first cystoscopy is about three months after surgery. Then you have to go on checks at regular intervals.

The cancer can come back. Very small cancer tumors can be removed in conjunction with a cystoscopy. You will be operated on with the TUR-B method again if there is a larger cancer tumor coming back.

Treatment for muscle invasive cancer

A group of different specialists advise on all people who have been diagnosed with muscular invasive bladder cancer. Your doctor will tell you which treatment the specialists assess will be best for you based on the examinations that have been done.

The most common treatment is an operation called cystectomy if you have muscle invasive cancer. Then, among other things, the bladder is removed. You can get radiation treatment instead, if an operation is unsuitable for you.

You can get cytostatic drugs before surgery or at the same time as the radiation therapy.

Cytostatic treatment prior to surgery

Prior to surgery or radiotherapy, you will receive treatment with cytostatic drugs . There are many different cytostatic drugs that can be combined in different ways. What suits you best depends on the cancer tumor and what symptoms you have. The purpose of the treatment is to shrink the cancerous tumor in the bladder and remove cancerous cells that may have spread.

Cytostatics are given as a drop in the blood. The treatment is done at the hospital once a week. You are often treated with cytostatic drugs for a few months before surgery.

The treatment can make you feel unwell and feel tired. There are medicines that relieve.

You can lose hair but it will come back after the treatment. You may want to  try out a wig before treatment begins.

You also become more susceptible to infections.

Cystectomy – bladder operation is removed

Cystectomy means that the doctor will remove the bladder, lymph nodes near the bladder, the urethra, parts of the vagina, the entire uterus and one or both ovaries, if you have one. The prostate gland is removed if you have one.

During the operation, you will receive a new artificial urinary tract, so that the urine can be released in the future. The vagina is also recreated.

You are  anesthetized  before surgery.

It varies how long you need to stay in the hospital after the operation. Some may go home after ten days, others may need to stay longer. You can leave the hospital when you can manage the new urinary tract yourself and when you feel well enough.

Sometimes there may be  infection  in the operating wounds. Contact the clinic where you were operated on if the operating wounds become swollen, hot and maybe a little sticky.

You can also more easily get infections of the upper urinary tract after surgery. This may be because there has been scarring in the ureters so that they become narrower and the urine becomes more difficult to pass. Contact the ward where you were operated on if you get a fever or a sore as it may be a sign of an infection.

Follow-up after surgery

After a cystectomy, you need to go for controls to be examined in different ways. The checks need to take place more often at the beginning but then it can go longer between visits.

The checks mean that the doctor does a  body examination . You may also submit blood tests and be examined with a computer tomography  or  magnetic camera . The purpose is to see if the cancer has returned and that the new urinary tract is functioning properly.

It is very uncommon for the cancer to return after five years. You should still continue to check once a year throughout your life to have the urinary tract examined.

Radiation therapy instead of surgery

You can receive radiotherapy  instead of being operated on if, for example, you have other illnesses besides urinary bladder cancer. Most often you receive radiation treatment every day Monday to Friday for seven weeks.

It is common for radiation therapy to be given together with cytostatic drugs. It is called chemoradiotherapy.

Radiation treatment can make you feel tired. You may also need to go to the toilet more often and have spasm in the bladder. It can feel uncomfortable. It can also hurt when you are peeing and you may have diarrhea. Usually, the problems go away when the radiation treatment is finished, but not always. There are medicines that relieve you if you get a lot of trouble.

Follow-up after radiotherapy

You need to go on regular checks after the radiation treatment is completed. Then you are examined with cystoscopy . The first few years you need to go a few times a year. After that, fewer checks will suffice, but you need to keep going out on a regular basis. The risk of the cancer coming back remains for a long time.

Three methods to replace the bladder

The urine must come out of the body through an artificial duct if the bladder has been removed. The canal is usually made by a piece of your small intestine. There are three methods.

Bag on the stomach – urostomy

The most common method of creating a new urinary tract is to do a urostomy. It is also called brickblower. At one end, a portion of the intestine is connected to the ureters, the other end is passed through the ostomy hole in the abdomen to the right below the navel.

The urine is collected in a bag that you carry on your stomach and that you need to empty regularly several times a day and change every two to three days. There is little risk of leaking urine or smelling urine. Here you can read more about getting a urostomy .

Reporting: Leif has a stoma

Intestinal bladder inside the stomach – continent urostomy

The doctor can use a piece of the intestine to make a container inside the stomach where the urine collects. You empty the container every fourth to every five hours with a thin tube that you insert through a hole in your stomach. Between the discharges, it is sufficient that the hole in the stomach is covered by a thin plastic compress or a patch.

Some suffer from urine leaks. It can sometimes be corrected with a simpler operation.

Intestinal bladder at the site of the old bladder – the urethra remains

The doctor can make a new bladder of a piece of the intestine and attach it between the ureters and the urethra, if the urethra was preserved during surgery. This method is also called bladder substitute and means that you can continue to pee almost as before.

It is important that you empty the bladder every three to four hours because you are no longer feeling pissed. You can pee in the usual way while you are crawling properly, or get a thin hose with which you empty the bladder.

You can leak some urine with this method, but usually it is enough with a drip guard to soak up the leak. It may leak more urine at night than during the day.

Which method is best for you?

You choose a method together with your doctor based on how the disease behaves in you, how you feel and what you want yourself. You may also discuss with an ostomy therapist. It is a nurse who specializes in ostomy care.

Sometimes it can be arranged so that you get to meet a person who already has a new urinary tract of the same type that you should get yourself.

You will learn to care for the urinary tract

The ostomy therapist teaches you to care for the urinary tract before being discharged from the hospital after the cystectomy operation. You get the items you need through a help card. It’s a kind of recipe for aids .

Treatment of disseminated cancer

Spread cancer usually means you can’t get rid of the disease. However, there are treatments that can alleviate the discomfort and make the disease progress more slowly, such as cytostatics or radiation therapy.

The treatment you receive depends on the symptoms you have. You will be treated for pain if you need to.

Treatments that slow down the disease and relieve symptoms are called  palliative care .

What can I do for myself?

Cancer treatment is often painful. You can cope better with the physical and mental stresses that the treatments can entail if you take care of yourself. You can do this in different ways:

  • Eat good food .
  • Be moderate with alcohol .
  • Avoid smoking .
  • Do any physical activity that you enjoy and cope with.

How is the life of urinary bladder cancer affected?

Most can go on with life much like it was before the cancer when the treatment is complete and the wounds have healed. But life can feel different. You always have the experience of what you have been with. It can be painful periodically, but usually it gets better – although it can take time. Some feel vulnerable or depressed long after treatment is over. Here you can read more about help with thoughts and feelings about cancer .

How big the changes will be depends on what treatment you have received, if you have other illnesses and how you feel otherwise. What you feel and how you feel can also vary.

Tell your contact nurse or other healthcare professional how you are feeling. The vast majority of inconveniences are helpful.

Here are some examples of how life can be affected and what help is available.

Usually to be tired

It is common to feel very tired. It can have different causes. Fatigue can cause you to become easily irritated and less able. Take several short rest breaks rather than a single longer rest break when you need rest. Physical activity can make you feel less tired. 

Tell the health care provider if you are very tired. Make sure you get to know about the fatigue and what it is due to. Often there is help to get. If you have close relatives, it is good that they also get information. It increases understanding from the surroundings.

Getting a new urinary tract is a big change

A cystectomy operation and getting a new urinary tract is a big change. It may take time to learn to live with the new situation. But it is common to be able to continue with life much like before. 

Sexuality and closeness

Cohabitation can be altered by a cancer message and after a cystectomy or radiation treatment. After an operation, you become sterile. Most often both the sexual ability and the emotion change. The illness and treatments can also make you think differently about yourself and your body. Some lose their desire for feeling anxious or depressed.

It may be difficult to talk to a possible partner about the changed situation. You can get help, for example by a psychotherapist or a sexologist. You can get help whether you have a partner or not. You can read more in the article Cancer and Sexuality .

Help with obstruction in the vagina

A cystectomy can make the vagina shorter and narrower. You can get help trying out a dilator that you use regularly to widen the vagina. You may need to change to a dilator with a different size after a while.

The mucous membranes can become dry and brittle. A cream or ointment containing estrogen can help.

Help if you have trouble getting up and running

A cystectomy can make it difficult to get up and the ability to ejaculate is affected. You can still have orgasm. There are various medicines and aids that can improve the condition.

What is the cause of bladder cancer?

Probably it is the carcinogenic residual products in the urine that damage the mucous membrane of the bladder, so that the result can become cancer after many years. Both lifestyle and environment affect the risk of having bladder cancer. Urinary bladder cancer can sometimes be hereditary.

  • Smoking is the cause in about half of all people who have bladder cancer. The risk of bladder cancer and relapse decreases over time if you stop smoking. After ten to fifteen years, the risk is at the same level as for a person who has never smoked.
  • Work in, for example, the rubber industry or the paint industry can increase the risk of bladder cancer. The mucous membrane of the bladder is damaged by combustion gases of coal or the chemical substances used in these areas.
  • The risk of having bladder cancer can be higher if you have a parent or sibling who also has or has had bladder cancer.

Occasionally, heredity may be investigated at an oncogenetic site. Talk to your doctor if you want to know more.

How does cancer occur?

The body consists of many billions of cells. The cells divide to form new cells so that the body can function. Sometimes it gets wrong when a cell divides. Usually it does nothing or the cell can stop the error from spreading to more cells at the next cell division. But sometimes it doesn’t work. Then more and more altered cells can be formed for each cell division. Eventually, cancer cells can form and become a cancerous tumor. The cancer cells divide uncontrollably and do not die when they should. You can read more in the article What is Cancer?

Getting a cancer message

You can respond to a cancer message in many different ways. Often, you need plenty of time to talk to your doctor and other healthcare professionals about what the message means. If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

In many hospitals there are special nurses called contact nurses who  can provide support and also help with various practical things.

You can get help in several places

Talk to the contact nurse or the hospital’s curator if you feel anxious or have questions. You can also contact for example Cancer Counseling or Cancer Foundation. There is an association of interests for people with ostomy. The compound is called ILCO. There you can get in touch with people who have similar experiences to you. Here you will find contact information for advice and support in cancer. 

It is common to feel easier once treatment has begun and you know what is going to happen.

Children need to know

A minor child has the right to receive information and support based on his or her own needs if a relative is ill. You can get help with what you can say if you want to tell the child yourself. Often it is good to make children as involved as possible, no matter how old they are. That doesn’t mean you have to tell everything.

Be involved and influence your care

You have the right to be involved in your care as far as possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. This way you can help decide on your treatment.

Ask questions if you don’t understand. You can also ask for information printed so that you can read it peacefully.

You can get a new medical assessment

You may get a  new medical assessment  from another doctor if you have a life-threatening or particularly serious illness. Obtaining another doctor’s assessment can help you, for example, if you are unsure of which treatment or treatment is best for you. 

Make a care plan

You can make a care plan together with the contact nurse, the doctor and other staff. The care plan should contain information that is important to you, such as contact information and how to get the rehabilitation you need. Here you can read more about the contact nurse and the care plan .

Being related

It can feel difficult to be close to someone who is sick. It is common to want to support while you yourself have a strong concern and feel bad.

People in your vicinity can be a support. It often becomes easier for others to help you by telling them how it feels. You can also talk to the contact nurse  if you are close and need supportive calls.

You can get relief if you help take care of or support the sick person. You can also get support, for example in the form of calls or help with practical things.

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