This approach may be able to cure the patient, however recurrences do occur. Researchers want to find out which patients may be more susceptible to a recurrence so that they can either monitor them more closely or treat them more aggressively to reduce the risk of recurrence.

An article was published in Lancet Oncology saying that markers may help predict the risk of cancer recurrences in patients who are treated with a radical cystectomy. Researchers from Texas and Canada conducted a clinical study to evaluate markers found in the the tissue samples taken after surgery. The markers tested included the expression of Bcl-2, caspase-3, P53, and survivin.

The study found that those patients that had an altered expression of Bcl-2, caspase-3, P533 and survivin were associated with over four times the risk of cancer recurrence. Also, the altered expression of all of these bio-markers was associated with nearly seven times the risk of death from cancer.

The researchers conclude that these findings support other studies that show these bio-markers can help predict who will remain cancer free. They look at this as moving forward towards more individualized treatments for the patients.

It did not say in the article whether using this test after the surgery would help them to determine if chemotherapy or radiation would be something that could reduce the risk of recurrence if the markers would show a high risk category of recurrence. I think this these studies are great but we need to be moving forward to get the patients to benefit from this vital information.

A. Bladder cancer is more common than people realise.   Over 10,000 cases are diagnosed each year in the UK.  The majority of these (about 7,500) are diagnosed in men, meaning that, on average, one man in thirty will get bladder cancer at some time in his life.

Q. How dangerous is bladder cancer?

A. Over 3000 people die from bladder cancer each year in the UK.  Although the death rate amongst women has remained the same for a long time, the death rate amongst men is slowly dropping.

Q. Who is at risk from bladder cancer?

A. There are virtually no cases of bladder cancer in people under 40 and the vast majority of cases are diagnosed after the age of 55.   Caucasian (ie white) people are more at risk than others.  Significantly lower levels of this cancer are found in people of African or Asian origin.    There is a very high rate of bladder cancer in countries such as Iraq and Egypt, where it is associated with an infection of the bladder called schistomiasis, which is endemic in those countries.  Some industrial chemicals used in dying are known to be linked with a high risk of bladder cancer.  These chemicals are no longer in use.

Q. Is smoking linked to bladder cancer?

A. Smokers are two to five times more likely to get bladder cancer than normal.  The more they smoke, or the longer they smoke, the higher the risk.    It is estimated that half of all bladder cancers in men, and one third in women, are the result of smoking.

Q. What are the symptoms of bladder cancer?

A. The most common symptom is blood in the urine, although there are many other conditions (such as bladder infections) which can cause this.  The other less common symptoms (frequency of urination  and pain when urinating) can also have other causes.

Q. How is bladder cancer diagnosed?

A. First, a urine sample is taken and sent for analysis, too see if any abnormal cells can be found in it.   The next test is usually cytoscopy: under local anaesthetic a thin flexible tube is passed up the urethra (the tube that carries the urine out) and into the bladder.  Fibre-optics in the tube allow the doctor to inspect the inside of the bladder.  In some cases, X-rays and blood tests may also be required.

Q. How is bladder cancer treated?

A. This depends on how advanced the cancer is.  For early cancer, a simple operation, using a similar thin flexible tube inserted via the urethra, is followed by drug or vaccine treatment. Some cases of early bladder cancer can be treated by adding either cancer drugs, or the BCG vaccine, directly to the contents of the bladder. More advanced cancers require either radiotherapy or an operation to remove part or all of the bladder.  This type of operation has a serious side effect.  The patient is unable to urinate properly afterwards and has to use a catheter and urine bag.  Radiotherapy does not have this side effect, but it may not be as effective at curing the cancer.  Often these treatments will be followed by a course of anti-cancer drugs.

Q. How effective are these treatments?

A. This depends on how advanced the cancer is and the age of the patient.  Patients with early bladder cancer and patients under 40 have an 80 to 90% chance of surviving for five years and longer.  If the cancer has spread into the muscle wall of the bladder, or if the patient is over 80, only about half of them survive for five years after diagnosis.  Unusually, men seem to survive bladder cancer better than women, although we do not understand why.

Different types of treatment are available for patients with bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Surgery

One of the following types of surgery may be done:

* Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.

* Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.

* Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.

* Urinary diversion: Surgery to make a new way for the body to store and pass urine.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

New types of treatment are being tested in clinical trials. These include the following:

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk that cancer will recur (come back).

Photodynamic therapy

Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to deliver the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue.

These and other symptoms may be caused by bladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

* Blood in the urine (slightly rusty to bright red in color).

* Frequent urination, or feeling the need to urinate without being able to do so.

* Pain during urination.

* Lower back pain.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:

* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

* Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.

* Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.

* Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

* Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.

* Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.

* Urine cytology: Examination of urine under a microscope to check for abnormal cells.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

* Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.

* Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.

* Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the bladder make substances such as mucus.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.