American Medical Association Family Medical Guide - American Medical Association [539]
Bladder Tumors
Bladder tumors are usually malignant and tend to recur, but are not likely to spread. The tumors originate from cells that line the bladder and most of the urinary tract, and they tend to produce a growth or growths that project inward, into the space inside the bladder where urine is stored. The tumors may also invade the muscle of the bladder. Any tumor in the urethra or near where a ureter (the muscular tube that carries urine from the kidney to the bladder) enters the bladder can block the flow of urine. Urine can then build up in a kidney, causing it to expand (a condition called hydronephrosis). Bladder tumors occur more frequently in men than in women. Cigarette smoking increases the risk of bladder cancer.
Bladder tumor
Most bladder tumors project inward from the bladder’s inside wall. If the tumor develops near the openings to the ureters, it can block the flow of urine from the kidneys to the bladder. If it develops near the urethra, the tumor can block urine flow from the bladder out of the body.
Symptoms
The main symptom of a bladder tumor is a frequent, urgent need to urinate. Urination is usually not painful, but you may have pain after you finish urinating. You may also have a burning sensation and a tendency to urinate small amounts at frequent intervals. There may be blood in the urine. If hydronephrosis has developed, you may also have pain in your back or side.
Diagnosis
To help diagnose a bladder tumor, your doctor will order a urine test to check for blood in the urine. He or she may also order other diagnostic tests, including cystoscopy (see page 805), or an ultrasound scan (see page 111), CT scan (see page 112), or MRI (see page 113) of the bladder. If the doctor detects a tumor that has not penetrated the wall of the bladder, he or she will probably remove it using instruments inserted through a cystoscope (viewing tube). Cells from the tumor are then examined under a microscope to see if they are cancerous.
Treatment
Treatment of bladder tumors depends on their location. Tumors in the lining of the bladder are often removed with instruments passed through a cystoscope. At some stages of bladder cancer, a doctor may insert a catheter through the urethra into the bladder to deliver a solution containing anticancer medications or an immune system stimulator, such as tuberculosis vaccine. You will be asked to hold the solution in the bladder for 1 or 2 hours before urinating. The medication causes the bladder to shed its lining, which is then replaced by healthy cells. Although these treatments may effectively destroy the tumor and prevent its recurrence, the doctor will recommend regular checkups to monitor the condition.
If a tumor has affected a large area of the bladder, or if it has grown into nearby tissue, the doctor may recommend surgical removal of part, or all, of the bladder. After removing the bladder, the surgeon may connect the ureters to a portion of the intestine that he or she has formed into a pouch. The surgeon then attaches the pouch to the urethra, creating a new bladder, which allows you to urinate normally. Alternatively, the surgeon may attach the ureters to a disconnected section of the small intestine, the end of which is sewn to an opening in the skin; urine flows through the opening into a removable external pouch, which you must empty from time to time. After surgery, the doctor may prescribe chemotherapy to destroy any remaining abnormal cells.
Kidney Stones
A kidney stone usually begins as a tiny speck of solid material deposited in the renal pelvis, the tissues in the kidney where urine collects before flowing into the ureter (the tube that connects the kidney and the bladder). As additional material adheres to the first speck, it gradually increases in size. This process can occur in