Bladder Cancer Treatment Guidelines for Patients – Version II, June 2005

Introduction

With this study, patients have information on the way bladder cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been written for the general public by the American Cancer Society (ACS). To obtain another copy of these guidelines, call the ACS at 1-800-ACS-2345, or the NCCN at 1-888-909-NCCN, or visit these organizations’ Web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

These patient guidelines will help you better understand your cancer treatment options. We urge you to discuss them with your doctor and ask the following questions:

• Where is my cancer located?
• How far has my cancer spread? What is the stage of my cancer? How does this stage influence my outlook for cure and survival and my treatment options?
• What treatment options do I have?
• What are the risks or side effects
  associated with each of my treatment options and how are they likely to affect my quality of life?
• What should I do to be ready for treatment, reduce side effects of treatment, and hasten my recovery?
• What support services are available to me and my family?

In addition to these questions, be sure to write down some of your own. For instance, you might want more information about how long it will take you to recover from surgery so you can plan your work schedule. Or you may want to ask about clinical trials.

Making Decisions About Bladder Cancer Treatment

Bladder cancer is the fourth most common cancer in American men. The ACS estimates that about 63,000 new cases of bladder cancer will be diagnosed in the United States each year. Of these, around 47,000 will be in men and about 9000 men will die of this disease each year. In women, 16,000 cases will be diagnosed and around 4,000 will die each year.

Although bladder cancer is a very serious disease, it can be treated by a team of health care professionals experienced in treating bladder cancer. This team may include a urologist, a radiation oncologist, a medical oncologist, an oncology nurse, and a social worker, among others.

Not everyone with bladder cancer should receive the same treatment. Doctors must take into account each patient’s specific medical situation. This booklet is written to help you understand the treatment options available to people with bladder cancer so that you and your doctors can work together to identify which treatment best meets your needs.

In these pages you’ll find flow charts that doctors call “decision trees.” Each one shows how you and your doctor can arrive at the choices you need to make about your treatment, depending on the type, location, and extent of your bladder cancer.

You’ll also find information on what is bladder cancer, explanations of bladder cancer stages, work-up (evaluation), and treatments as well as a glossary of medical terms. Terms defined in the glossary are presented in blue italics. You can click on them to see their definitions in a pop-up window.

About the Bladder

Knowing a little about the normal function and anatomy of the kidneys and bladder can help patients understand the several types of bladder cancers, why they are treated differently, and how they can spread to other parts of the body.

Your bladder is a hollow organ with flexible, muscular walls that stores urine. It is located in the lower part of the abdomen, called the pelvis. It sits behind and above the bone in the pelvis.

The average adult bladder holds about 2 cups of urine. Urine is made by the 2 kidneys and is carried to the bladder by two tubes called ureters. The bladder empties the urine through another tube called the urethra. In women, the urethra is a very short tube that ends just in front of the vagina. In men, the urethra is longer. It passes through the prostate gland and the penis and ends at the tip of the penis.

The wall of the bladder has several layers. A layer of cells lines the inside wall of the kidney, ureter, bladder, and urethra. These cells are called transitional cells, and the layer they form is called the urothelium or transitional epithelium. Beneath the urothelium, there is another layer of tissue. This thin layer of connective tissue is called the lamina propria. Outside the lamina propria is the third layer of tissue, or muscle, which is called the muscularis propria. Finally, beyond the muscle is another layer of fatty connective tissue that separates the bladder from other nearby organs.

Blood from arteries enters and nourishes the tissues of the wall of the bladder. After flowing through these tissues, the blood flows into veins. Blood from the bladder returns to the heart and lungs and then travels back out to the rest of the body. This pattern of blood flow is important because cells may break off of a bladder cancer, enter veins leaving this organ, and travel elsewhere in the body where they can also form tumors.

Lymph is a clear fluid that contains tissue waste products and immune system cells. Lymphatic vessels carry this fluid to lymph nodes (small, bean-shaped collections of immune system cells important in fighting infections). Cancer cells may enter lymphatic vessels and spread out along these vessels to reach lymph nodes, where they can continue to grow. Most lymphatic vessels of the bladder lead to regional (nearby) pelvic lymph nodes. If cancer cells have multiplied in these lymph nodes, they are more likely to spread to other organs of the body as well. When a cancer spreads to other organs, it is called metastasis.

The entire report is also available as a PDF file:

NCCN Bladder Guidelines.pdf 732 k

You will need Adobe Acrobat to read this file.  Click here to download a current version.

TYPES OF BLADDER CANCER

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN's Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient's situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

NCCN Clinical Practice Guidelines were developed by a diverse panel of experts. The guidelines are a statement of consensus of its authors regarding the scientific evidence and their views of currently accepted approaches to treatment. The NCCN guidelines are updated as new significant data become available. The Patient Information version will be updated accordingly and will be available on-line through the NCCN and the American Cancer Society web sites. To ensure you have the most recent version, you may contact the American Cancer Society or the NCCN.

© 2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.