- transurethral resection (TUR) with fulguration,
a bladder-sparing treatment in which the urolo-
gist removes the tumor via cystoscopy and uses
electrocautery to burn an area of surrounding
tissue to kill any stray cancer cells - intravesical BCC, in which the urologist instills
a solution of bacillus Calmette-Guérin (BCC) to
stimulate anIMMUNE RESPONSEthat targets any
residual cancer cells or isolated cancer cells
elsewhere in the urothelium - intravesical CHEMOTHERAPY, in which the urolo-
gist instills chemotherapy drugs into the blad-
der to target residual cancer cells topically - photodynamic therapy, in which the person
takes a chemical the cancer cells absorb that
makes them extraordinarily sensitive to certain
frequencies of light
Cancer that spreads into the urothelium or
beyond requires more aggressive treatment, typi-
cally surgery to remove the tumor and surround-
ing tissue in combination with chemotherapy,
RADIATION THERAPY, or both, and sometimes other
therapies such as photodynamic therapy and
intravesical BCC. In a segmental cystectomy the
urologist removes part of the bladder; in a radical
cystectomy the urologist removes all the bladder
along with adjacent structures and organs,
depending on the extent of the cancer. Segmental
cystectomy usually preserves enough of the blad-
der to retain function and urinary continence.
Radical cystectomy requires further surgery to
construct URINARY DIVERSIONsuch as a urostomy,
which drains urine continuously into a bag worn
attached to the outside of the body, or an internal
pouch structured from a loop of intestine that col-
lects urine. With the pouch method, the urologist
may be able to fashion a reservoir that collects the
urine from the kidneys, and attach it to the ure-
thra for normal continence and urination. When
this is not possible or practical, the urologist may
be able to construct an opening (stoma) into
which the person inserts a catheter to regularly
drain urine that collects in the reservoir.
Many of the treatment options for bladder can-
cer entail significant lifestyle changes. Radical cys-
tectomy and radiation therapy often result in
ERECTILE DYSFUNCTION in men, inability to have
vaginal intercourse in women, and sterility in men
and women. It is important to fully understand
the potential side effects, complications, and QUAL-
ITY OF LIFEimplications of the various treatment
options when making treatment decisions and to
obtain a second opinion consultation. Research is
ongoing for new therapies, and some people may
benefit from participating in clinical trials.Risk Factors and Preventive Measures
Bladder cancer is very rare in people under age- Cigarette smoking and occupational exposure
to aromatic amines are the leading causes of blad-
der cancer, and health experts believe both to be
preventable. It appears the highest risk of bladder
cancer associated with cigarette smoking is for
people who have smoked for several decades. The
risk for bladder cancer appears to remain elevated
even after stopping smoking. Some health experts
believe current and former smokers should have
annual urinalysis and urine cytology tests such as
NMP22 BladderChek beginning at age 60.
Though exposure-related bladder cancer takes
years to decades to develop, researchers believe
even brief, limited exposure to aromatic amines
may be sufficient to cause damage to the cells of
the bladder that later results in bladder cancer.
Most people who develop exposure-related blad-
der cancer have had long-term exposure to aro-
matic amines, however. Exposure-related bladder
cancer generally develops over 15 to 20 years
from the time of exposure, though can emerge up
to 40 or 50 years later. Strict federal regulations
limiting occupational exposure to known carcino-
gens such as aromatic amines have reduced risk
somewhat over the past several decades, though
the use of these chemicals remains so pervasive
across numerous industries that exposure remains
second only to cigarette smoking as a risk factor
for bladder cancer.
OCCUPATIONS WITH HIGH
AROMATIC AMINES EXPOSURE
chemical manufacturing hairdresser
leatherworker machinist
metalworker painter
printer rubber manufacturing
textile workerbladder cancer 181