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Bladder Cancer: Overview

Bladder cancer is also known as urothelial carcinoma. Urothelial cells line the urinary tract, including the urethra, bladder, and ureters and renal pelvis in the kidneys. These urothelial or transitional cells are in contact with urine. Bladder cancer happens when those cells in the bladder start to grow out of control.

Smoking and being exposed to secondhand smoke increases the risk of developing bladder cancer. In addition, people exposed to occupational or environmental chemicals may have a higher risk of developing bladder cancer. White people are twice as likely to develop bladder cancer as are Black people or Hispanic people, and older age is another risk factor. Health history also matters, with chronic bladder inflammation, such as urinary tract infections or kidney stones, as well as a personal or family history of bladder cancer, associated with risk of the disease.

Many people are unaware of the common signs of bladder cancer, such as blood in the urine, known as hematuria. If blood in the urine can be seen, this is called gross hematuria. When a physician runs a urinalysis test as part of a routine checkup, tiny amounts of blood may be detected. This is microscopic hematuria. Any blood seen in the urine should be checked by a physician. Irritation when urinating, urgency and frequency are other warning signs. These signs may also be from other causes, such as a urinary tract infection, kidney stones or aging.

Bladder Cancer: Living with Cancer

Bladder cancer has a high rate of recurrence, which implies the need for regular surveillance with cystoscopy over the course of a patient’s lifetime. For some patients, the new normal after bladder removal surgery is adjusting to life with a urinary diversion. A patient should always feel comfortable talking with their health care team about any issues or questions. If the team can’t help, they can usually find someone who can.

Bladder Cancer: Types of Disease

Doctors usually describe and treat bladder cancer by how far it has grown into the bladder wall.

NMIBC (non-muscle invasive bladder cancer) is cancer that remains in the urothelial cells that line the bladder.

MIBC (muscle-invasive bladder cancer) is cancer that has grown into the deeper layers of bladder muscle.

If bladder cancer has spread to other parts of the body outside the urinary tract, it is advanced disease, or metastatic.

Types of bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma.

Urothelial carcinoma, the most common type of bladder cancer, is also known as transitional cell carcinoma. Transitional cell carcinoma begins in the part of the kidney, called the renal pelvis, where urine collects before moving to the bladder.

Squamous cell carcinoma comprises 1% to 2% of bladder cancers, according to the American Cancer Society. Most squamous cell carcinomas of the bladder are invasive.

Adenocarcinoma, which are also mostly invasive, occur in only 1% of bladder cancers.

Small cell carcinoma, which occurs in less than 1% of bladder cancers, start in the neuroendocrine cells. This subtype of the disease can grow quickly.

Sarcoma of the bladder is rare, and start in the muscle cells of the organ.

Bladder Cancer: Diagnosis

A urologist will make a bladder cancer diagnosis. Urologists use a cystoscope to examine the lining of the bladder and the tube that carries urine out of the body (urethra).

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall or spread beyond that, and, if so, to what parts of the body. Grade refers to how abnormal the cancer cells look and how many cells are multiplying. A higher grade means the cells are more uneven and are multiplying more. Knowing the grade can help your doctor predict how quickly the cancer will grow and spread.

Bladder Cancer: Treatment

When bladder cancer is classified as NMIBC, surgery to remove the tumor is often the first step. A transurethral resection of the bladder tumor uses a special instrument inserted through the urethra to remove the tumor. If the tumor is low risk/grade and has not invaded the muscle wall of the bladder, it may not require more treatment. Unfortunately, bladder cancer has a high rate of recurrence so most of those who receive diagnoses must return to their urologist at regular intervals for surveillance using cystoscopy to see if the tumors return.

If the tumor cells appear aggressive under the microscope and the pathologist determines that the cancer is high risk/grade, it is more likely to return or worsen. In these cases, further treatment to keep the cancer from returning or worsening is required. Most often, patients with high-grade NMIBC receive intravesical (inside the bladder) treatments. Bacillus Calmette-Guérin (BCG) is an early form of immunotherapy that uses a weakened form of bacteria. When these bacteria are put into the bladder, the immune system goes on alert. It responds by killing cancer cells on the bladder lining. Though BCG is very effective, it doesn’t work for all tumors. If BCG doesn’t work, there are other options such as mitomycin C, an antibiotic that helps fight tumors.

When bladder cancer grows into the deeper layers of the bladder (MIBC), it is more difficult to treat. In many cases, a urologist may suggest radial cystectomy, which is surgery to remove your bladder. Removing the bladder also involves removing lymph nodes around the organ. As part of the surgery, it will be necessary to create a urinary diversion, a new way for urine to leave your body.

Systemic chemotherapy is medicine that treats cancer throughout the whole body. Neoadjuvant chemotherapy is chemotherapy patients get before bladder removal surgery. Clinical trials have shown that cisplatin chemotherapy before bladder removal improves survival for patients with MIBC because it helps kill bladder cancer cells that may be outside the bladder. Adjuvant chemotherapy is the chemotherapy patients get after surgery.

Recently approved targeted therapies can block the growth and spread of cancer. They focus on stopping the cancer-driving activity caused by specific genetic mutations that are found in some bladder cancers.

Some patients may benefit from combined modality therapy, which uses surgery to remove the tumor, plus chemotherapy and radiation to help kill the cancer while keeping the bladder intact. This option can be used for some patients who are ineligible for bladder removal surgery. Those with advanced or metastatic disease may benefit from chemotherapy and a variety of immunotherapies that can help the body fight off the cancer.

There are many talented researchers and clinicians working to improve the diagnosis and treatment of the disease. Clinical trials are an essential part of bladder cancer research. They may provide treatment alternatives to patients who have not had success with standard and approved therapies.

Gastrointestinal Cancer: Types of Disease

Gastrointestinal cancers can develop in a variety of organs, and include:

The most common types of gastrointestinal cancer are esophageal, stomach, colorectal, pancreatic and liver.

Gastrointestinal Cancer: Living with Cancer

Similar to other cancer types, a gastrointestinal cancer diagnosis, treatment and survivorship can come with a variety of emotions. Staying diligent with one’s care and follow-up appointments is key.

Moreover, to lower one’s risk for cancer recurrence or to negate any long-term effects, exercising, eating a certain type of diet or taking nutritional supplements may help.

Lastly, the GI Cancers Alliance, or GICA, have a number of advocacy groups to aid in living with a gastrointestinal cancer diagnosis.

Gastrointestinal Cancer: Treatment

Among the most common gastrointestinal cancers, treatment options vary. However, what is consistent across the different cancer types is the utilization of a multidisciplinary approach to care, which can include a medical oncologist, surgeon, gastroenterologists, radiation oncologists, and more.

Treatment options for colorectal cancer include surgery – including laparoscopic surgery, colostomy, radiofrequency ablation or cryoablation – as well as radiation, chemotherapy, immunotherapy and targeted therapies.

Similarly, esophageal cancer can be treated with surgery, radiation, chemotherapy, immunotherapy and targeted therapy, as well as endoscopic treatments like endoscopic mucosal resection, photodynamic therapy, radiofrequency ablation, laser ablation, argon plasma coagulation, electrocoagulation and esophageal stent.

For pancreatic cancer, the best option may include more than one type of treatment, comprised of surgery, ablation or embolization, radiation, chemotherapy, targeted therapy and immunotherapy.

Treatment for stomach cancer is dependent on stage, age, overall health and personal preferences. Typically two or more treatment options – including surgery, chemotherapy, targeted therapy, immunotherapy and radiation – will be used.

Gastrointestinal Cancer: Overview

A tumor can form in the gastrointestinal tract, a 25-foot pathway starting from the mouth to the anus, after a change in DNA causes abnormal cells to grow.

According to Yale Medicine, gastrointestinal cancers are more likely to develop in men, and risk for the diseases increases with age. Other risk factors include smoking, alcohol consumption and an unhealthy diet, as well as underlying conditions like gastroesophageal reflux disease in the esophagus, Helicobacter pylori infection in the stomach, diabetes in the pancreas, inflammatory bowel disease in the large intestine, and hepatitis B or C virus infection or cirrhosis in the liver. Meanwhile, a small percentage of these cancers can be associated with family history or genetics.

Symptoms of gastrointestinal cancers depend on the type of cancer, and often may not occur until the disease has become more advanced.

Gastrointestinal Cancer: Diagnosis

If gastrointestinal cancers are suspected, the following may be conducted:

Endoscopy or esophagogastroduodenoscopy: evaluates the lining of the esophagus, stomach and small intestine for tumors.

Colonoscopy: checks the colon and rectum for polyps.

Lab tests: searches for changes I the blood.

Imaging: including MRI, X-Ray, ultrasound, CT or PET scans, looks for abnormal tissue in the digestive system.

Biopsy: evaluates sample obtained for cancer cells.

Head & Neck: Living with Cancer

While treatment for cancer can often come with long-term side effects, there is also concern of preserving the function of affected areas by the head and neck cancer. Therefore, rehabilitation has been a larger effort over the years to ensure patients can return to normal activities, such as speaking, eating and more.

Rehabilitation can include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma – an opening into the windpipe after a laryngectomy, through which a patient breathes.

Moreover, these types of cancers may result in reconstructive and plastic surgery, or if those are not options, use of a prosthesis.

However, resources are available to help patients return to their new normal, and to deal with the psychosocial effects related to head and neck cancer.

Head & Neck: Types of Disease

Head and neck cancers have different names and vary by its site of origin. Head and neck cancer types include:

Laryngeal cancer: starts in the larynix, or the voice box.

Hypopharyngeal cancer: starts in the hypopharynx, or the lower part of the throat behind the voice box.

Oral cavity cancer: starts in the oral cavity, or the mouth.

Oropharyngeal cancer: starts in the oropharynx, or the middle part of the throat behind the mouth.

Nasopharyngeal cancer: starts in the nasopharynx, or the upper part of the throat behind the nose.

Nasal cavity cancer: starts in the nasal cavity, or the opening behind the nose.

Paranasal sinus cancer: starts in the sinuses, or the air-filled spaces in the bones around the nose.

Salivary gland cancer: starts in the glands that make saliva, and can include parotid gland cancer or submandibular gland cancer.

Head & Neck: Diagnosis

Most often, head and neck cancers are discovered after a patient has sought treatment for symptoms that may have become problematic. However, they may be found during routine exams by a doctor or dentist.

If further evaluation is required, patients will be referred to an ear, nose and throat specialist or a head and neck surgeon.

Additional tests by an ear, nose and throat specialist could include a panendoscopy, biopsy, HPV testing or imaging.

Staging of head and neck cancer includes the location of the primary tumor, the size or extent of the tumor, whether the cancer has spread to the lymph nodes and whether the cancer has spread to other parts of the body, also known as TNM staging. TNM classifications are then combined to determine the stage, ranging from stage 1 through 4, with stage 4 being the most advanced.

Head & Neck: Overview

Head and neck cancer is a number of cancers that develop in or around the throat, larynx, nose, sinuses and mouth.

According to the Head and Neck Cancer Alliance, head and neck cancers occur twice as often in men than women, and are more often diagnosed in people over the age of 50.

Common symptoms may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing or a change or hoarseness in the voice.

Risk factors for head and neck cancers include alcohol and tobacco use, including smokeless tobacco; human papillomavirus (HPV) infections; paan, or betel quid, use among immigrants of Southeast Asia; mate consumption, a tea-like beverage in South America; preserved or salted food consumption; poor oral health; occupational exposure; radiation exposure; Epstein-Barr virus infection; and Asian ancestry.

Head & Neck: Treatment

Treatment for head and neck cancers can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments. However, treatment options will depend on the exact location of the tumor, the stage of the cancer and the person’s age and general health. Moreover, those with HPV-related cancers may also be treated differently than those who test negative for the infection.

Kidney Cancer: Treatment

Various factors, like disease subtype, genetics and stage can all play into the treatment of kidney cancer. Types of treatment for kidney cancer consist of surgery, ablation and other local therapy, active surveillance, radiation, targeted therapy, immunotherapy, and chemotherapy. As a result, it is important to be treated by a multidisciplinary team, including a urologist, urologic oncologist, medical oncologist, radiation oncologist and surgeon.

Active surveillance consists of close monitoring with regular diagnostic tests and appointments with an individual’s care team. This approach may be used for older adults, those who have a small renal tumor and a comorbidity, and those who are otherwise well and have few or no symptoms.

In those undergoing active surveillance, if symptoms suggest that action is needed, then a new treatment plan would be considered.

Part or all of the kidney tumor as well as some surrounding tissue and lymph nodes can be removed during surgery, in particular, for cancer that has not spread beyond the kidneys.

Types of surgery include radical nephrectomy (surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy), partial nephrectomy (surgical removal of the tumor) and minimally invasive surgery, such as laparoscopic and robotic surgery.

Non-surgical procedures may be utilized if surgery is not recommended because of characteristics of the tumor or the patient’s overall health. Non-surgical procedures include radiofrequency ablation (the use of a needle inserted into the tumor to destroy the cancer with an electrical current) or cryoablation (freezing of cancer cells with a metal probe inserted through a small incision).

Targeted therapies aim to treat specific genes, proteins or tissue environment that blocks the growth and spread of kidney cancer cells and limits damage to healthy cells. Targeted therapies for kidney cancer include anti-angiogenesis therapies, which stops the process of making new blood vessels; mTOR inhibitors, that target mTOR to slow kidney cancer growth; and HIF2a inhibitors, which target hypoxia-inducible factor-2 alpha.

More recently, the combination use of two targeted treatments and/or immunotherapies to treat various lines of relapsed/refractory kidney cancer.

Immunotherapy boosts the body’s immune system to treat cancer. Immunotherapies for kidney cancer treatment include interleukin-2, or IL-2, a cytokine (a protein produced by white blood cells) to destroy tumor cells; alpha-interferon, which changes the proteins on the surface of cancer cells and slows their growth; and immune checkpoint inhibitors.

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