Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Cancer of the urinary bladder develops in over 70,000 Americans each year, leading to over 14,000 deaths. According to the American Cancer Society, the chance of a man developing this cancer at any time during his life is about
one in 30; for a woman, the chance is one in 90. Since bladder cancer
that is detected in the early stages has a good chance of cure, awareness of the signs and symptoms of this malignancy are critical. Anyone experiencing the signs or symptoms of bladder cancer should be checked by a urologist, who can perform tests to diagnose
bladder cancer even in its early stages.
The cause of bladder cancer is not understood, but certain risk factors are
known to increase an individual's risk of getting bladder cancer. Men are about
three times more likely than women to develop bladder cancer, and older people
are more likely to be affected. Up to 90% of those affected are over 55 years of
age. Smokers are at an increased risk for development of bladder cancer. Exposure to certain chemicals used in manufacturing and industry (including paints and paint thinners, some hairdressing supplies, and certain dyes) are associated with a higher risk of bladder cancer, so people who work in certain occupations
(workers in the rubber, chemical, and leather industries; hairdressers; machinists; metal workers; printers; painters; textile workers; and truck drivers)
are at increased risk. Being infected with certain parasites that are common in tropical areas also increases the risk for bladder cancer.
The following are signs and symptoms of bladder cancer:
Blood in the urine: This is the most common symptom of bladder cancer and occurs in the vast majority of people with bladder cancer. Having blood in the urine does not necessarily mean a person has cancer, since other conditions (including infections) can lead to bloody urine, but blood in the urine is never normal and should always be evaluated by a doctor.
The urinary bladder, or the bladder, is a hollow organ present in the pelvis.
Most of it lies behind the pubic bone of the pelvis but when full it can extend
up into the lower part of the abdomen. Its primary function is to store urine
that drains into it from the kidney through tube-like structures called the
ureters. The ureters from both the kidneys open into the urinary bladder. The
bladder forms a low-pressure reservoir which gradually stretches out as urine
fills into it. In males, the prostate gland is located adjacent to the base of
the bladder where urethra joins the bladder. From time to time, the muscular
wall of the bladder contracts to expel urine through the urinary passage
(urethra) into the outside world.
What are the layers of the bladder?
The bladder consists of three layers of tissue. The innermost layer of the
bladder which comes into contact with the urine stored inside the bladder is
called the "mucosa" and consists of several layers of specialized cells called
"transitional cells," which are almost exclusively found in the urinary system of
the body. These same cells also form the inner lining of the ureters, kidneys,
and a part of the urethra. These cells form a waterproof lining within these
organs to prevent the urine from going into the deeper tissue layers.
The middle layer is a thin lining known as the "lamina propria" and forms the
boundary between the inner "mucosa" and the outer muscular layer. This layer has
a network of blood vessels and nerves and is an important landmark in terms of
the staging of bladder cancer (described in detail below in the bladder cancer
staging section).
The outer layer of the bladder comprises of the "detrusor" muscle and is
called the "muscularis." This is the thickest layer of the bladder wall. Its
main function is to relax slowly as the bladder fills up to provide low-pressure
urine storage and then to contract to compress the bladder and expel the urine
out during the act of passing urine. Outside these three layers is a variable
amount of fat which lines and protects the bladder like a soft cushion and
separates it from the surrounding organs such as the rectum and the muscles and
bones of the pelvis.
Picture of the urinary system: kidneys, ureters, and bladder
What is bladder cancer?
Bladder cancer is an uncontrolled abnormal growth and multiplication of cells
in the urinary bladder which have broken free from the normal control mechanisms
of the body. Bladder cancer (like
cancers of other organs) has the ability to
spread (metastasize) to other body parts including the lungs, bones, and liver.
Bladder cancer invariably starts from the innermost layer of the bladder (for
example,
the mucosa) and may invade into the deeper layers as it grows. Alternately, it
may remain confined to the mucosa for a prolonged period of time. Visually, it
may appear in various forms. Most common is a shrub-like appearance
(papillary) but it may also appear as a nodule, an irregular solid growth or a
flat, barely perceptible thickening of the inner bladder wall (details in
subsequent sections).
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Hydronephrosis is a condition in which the kidney swells, due to a backup of urine. Hydronephrosis generally occurs with another disease.Symptoms of hydronephrosis include nausea, vomiting, urinary tract infection, fever, painful urination, increased urinary frequency and urgency, flank pain, and swelling of the abdomen. Treatment of hydronephrosis depends on the cause.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Schistosomiasis (snail fever), a disease caused by parasites, causes a variety of symptoms and signs, such as cough, rash and bloody diarrhea. Praziquantel is used in the treatment of schistosomiasis.
Tumor grade is a system used to classify cancer cells in how likely the tumor is to grow, and how abnormal they look under a microscope. Tumor grade is not the same as tumor stage. A biopsy is taken to determine if the tumor is benign (non cancerous) or malignant (cancerous).
Urethral cancer is a rare form of cancer that primarily affects white females, people over 60 years of age, and those who have stds or who experience frequent urinary tract infections. Symptoms and signs of urethral cancer include blood in the urine, interrupted urine flow and discharge from the urethra. Treatment involves surgery, radiation therapy, and chemotherapy.
Smokeless tobacco can have negative health effects such as cancers, poor oral health (gum disease and tooth decay), infertility, pregnancy complications, and nicotine addiction.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Hematuria, or blood in the urine, can be either gross (visible) or
microscopic (as defined by more than three to five red blood cells per high power
field when viewed under magnification). Gross hematuria can vary widely in
appearance, from light pink to deep red with clots. Despite the quantity of
blood in the urine being different, the types of conditions that can cause
the problem are the same, and the workup or evaluation that is needed is
identical.
People with gross hematuria usually present to their doctor
with this as a primary complaint. Microscopic hematuria, on the other hand, is
most commonly detected as part of a periodic checkup by a primary-care
physician.
What are the causes of blood in urine?
The causes of gross and microscopic hematuria are similar and may result from bleeding anywhere along the urinary tract. One cannot readily...
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