Bladder Cancer I

http://www.apjohncancerinstitute.org/cancer/bladder.htm

What is Bladder Cancer?
The bladder is an expandable, hollow organ in the pelvis that stores urine (the body's liquid waste) before it leaves the body during urination. The urinary tract, made up of the kidneys, ureters, bladder, and urethra, is lined with a layer of transitional cells called the urothelium. This layer of cells is separated from the bladder muscles (called the muscularis propria) by a thin, fibrous band called the lamina propria. The lamina propria separates tumors that have spread into muscle (called invasive cancer) from those that have not (superficial or non-invasive cancers).
Bladder cancers are malignant tumors that begin in the bladder. Different bladder cancers are described by how deep they grow and if they grow into the bladder or through the muscles around the bladder (superficial or invasive).
There are three types of bladder cancer: transitional cell carcinoma, or TCC (about 90% of bladder cancer cases); squamous cell carcinomas (about 8%); and adenocarcinomas (about 2%). There are other less common types of cancer that arise in the bladder, including sarcomas (which begin in the muscle layers of the bladder) and small cell anaplastic cancers (a rare type very likely to spread to other parts of the body).
All three types can metastasize beyond the bladder. The tumor can grow into the surrounding organs (uterus and vagina in women; prostate in men), called locally advanced disease. It can also spread to the nearby lymph nodes, and/or into the liver, bones, or lungs; this is called distant metastasis. In some cases, it can spread to other parts of the body.
As we well know, there are many kinds of cancer; unfortunately they all come about because of the out-of-control growth of abnormal cells.Leading Cancers in Women, Men, & ChildrenFor Women: Breast cancer is the leading cancer for women in the US. Lung cancer is the second most common form of cancer and colorectal cancer is third among white women. The number 2 and 3 cancers are reversed among black and Asian/Pacific Island women. For all women, the fourth leading cancer is cancer of the uterus.For Men: Prostate cancer is the leading cancer for men in the US. It is followed by lung cancer and then colorectal cancer. The fourth most common cancer is race-dependent. It is bladder cancer for white men, cancer of the mouth and throat for black men; and stomach cancer for Asian/Pacific Island men.For Children: The most common malignancies in childhood are leukemia, followed by brain tumors, and lymphoma.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.Bladder cancer is a fairly common form of cancer in the United States. Whites contract bladder cancer twice as often as blacks, and men are affected two to three times as often as women. Most bladder cancers occur after the age of 55, but the disease can also develop in younger people. Each year, more than 50,000 people in the United States find out they have bladder cancer. The outlook for patients with early bladder cancer is very good. The chances of recovery from more advanced bladder cancer are improving as researchers continue to look for better ways to treat this disease.Smoking, gender, and diet can affect the risk of developing bladder cancer. Risk factors include the following:
Smoking.
Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies.
A diet high in fried meats and fat.
Being older, male, or white.
Having an infection caused by a certain parasite. Possible signs of bladder cancer include blood in the urine or pain during urination.
These and other symptoms may be caused by bladder cancer or by other conditions. 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.
What is hematuria?
Hematuria means blood in the urine. Microscopic hematuria indicates that the blood is only seen when the urine is examined under a microscope, while gross hematuria means that there is enough blood in the urine so that it can be seen with the naked eye. Despite the quantity of blood in the urine being different, the types of diagnoses that can cause the problem are the same, and the workup or evaluation that is needed is identical. Since blood in the urine must come from one of the organs involved in making or transporting the urine, the evaluation of hematuria requires that we consider the entire urinary tract. This organ system includes the kidneys, ureter (the tube that carries the urine from the kidney to the bladder), bladder, prostate, or urethra (tube leading out of the bladder). It must be emphasized that even a single episode of hematuria requires evaluation, even if it resolves spontaneously. What are the causes of hematuria?
There are multiple causes of hematuria. Some are serious, including cancers, trauma, stones, infections, and obstructions of the urinary tract. Others are less important, and may require no treatment. These may include viral infections, nonspecific inflammations of the kidney, medications which thin the blood's clotting ability, and benign prostate enlargement. How is hematuria evaluated?
The evaluation for hematuria consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and finally, obtaining a culture of the urine. A significant history would include whether or not there was any pain or discomfort associated with the hematuria; whether the blood was in the beginning, end, or throughout the urinary stream; and finally, whether there is a personal history of smoking, kidney stones, injuries to the urinary tract, trouble urinating, or previous urologic evaluation. No matter how obvious the reason for hematuria appears to be, a complete evaluation is almost always necessary to rule out a serious underlying disease, such as a cancer. There are usually three diagnostic tests necessary to give us a look at the entire urinary tract, and these include the intravenous pyelogram (IVP), cystoscopy, and urine cytology. The intravenous pyelogram, or IVP, is an x-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of x-rays are then taken over a thirty-minute period, looking for abnormalities. This study is especially useful for evaluating the kidneys and ureter, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. In this procedure, a small viewing tube, or cystoscope, is used to visually inspect the bladder and the urethra. In most instances, this can be done without discomfort by the use of local anesthetic jelly. The cystoscope is passed up the urethra into the bladder, and the inspection is carried out. The entire examination takes less than ten minutes. The final test is a urine cytology, which involves voiding urine into a cup and having that urine examined by a pathologist to look for cancer cells. How is hematuria treated?
Management of hematuria depends upon the underlying cause. Many times a cause cannot be found, which is fortunate, because it generally suggests that there is not a harmful situation present. Remember that the real reason for a hematuria workup is not to prove a specific cause, but to rule out a serious problem. If no cause is found for the hematuria, the urine should be checked on a yearly basis to make certain that no changes are occurring. However, if gross hematuria were to recur, repeat evaluation may be necessary, and a physician should be consulted. A blood test to check kidney function and a blood pressure check should be done as well. Men over fifty should have a yearly PSA, or prostate specific antigen, to screen for prostate cancer. Further discussion of the treatment for hematuria would depend upon the results of the previously mentioned workup and the exact cause for the hematuria. The urologist who performs this examination would direct any further treatment or workup that would be necessary. 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 has spread to 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 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. Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis (chance of recovery) depends on the following:
The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
The type of bladder cancer cells and how they look under a microscope.
The patient’s age and general health. Treatment options depend on the stage of bladder cancer.
Healthy Cells vs. Cancer Cells
Healthy cells are like a cat. They need structure to determine the size of bones and shape of the body, tail and whiskers. The DNA in genes and chromosomes determine this. They need energy to play and prowl and sustain life. This is derived from chemicals in food. Cats need a system to deliver chemicals (food nutrients like amino acids, carbohydrates, fats, vitamins and minerals) to all parts of their body. These are the blood vessels. Growth factors take a kitten into a lazy old cat, all the while helping it to function normally.
The body and its cells are mostly made up of protein. The building blocks of proteins are substances called amino acids that in the form of enzymes and hormones literally control every chemical reaction within the cells. When these are modified, different messages are sent to a complex control system that can alter their function. There are twenty different kinds of amino acids that are essential to life. Twelve of these can be synthesized within the body however; eight must be supplied by the daily diet.

Most Asian Men Have Better Prostate Cancer Survival Rates

Asian men have better survival rates than white males, while South Asians have the worst survival rates, according to results of a study of men living in California.
"Nearly all Asians do far better when they get prostate cancer," said study lead author Dr. Anthony Robbins, of the California Cancer Registry in Sacramento. "But Indian men didn't do as well as other Asian men, and they did worse than all other men, including blacks and whites," he added.
The reasons for these racial and ethnic differences in prostate cancer survival aren't known, Robbins said, adding, "We just couldn't explain it."
Not only couldn't the researchers explain the finding, they were left with an apparent paradox. The Asian men were usually older and had more advanced disease at the time of diagnosis, Robbins said. "Based on their risk factors, you would think they were going to do worse," he said.
In the study, Robbins and his colleagues collected data on 116,916 men (108,076 whites and 8,840 Asians from the six largest represented Asian ethnicities -- Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese) diagnosed with prostate cancer. The researchers compared prognostic factors and survival rates among the men.
The researchers found that for Asians, risk profiles were worse compared with whites. For example, Asians were more likely to have more advanced disease and use non-curative therapies. But, for Asians -- except for South Asians -- survival rates were equal to or better than rates for whites.
Japanese-American men were 34 percent less likely to die from prostate cancer compared with whites. But South Asian men -- those from India, Pakistan,Bangladesh, Sri Lanka, Nepal, and Bhutan -- were 40 percent more likely to die from the disease, Robbins said.
The study was published online Monday in the journal Cancer.
Some of the factors that may influence the findings include diet, exercise and genetics, Robbins speculated.
"Doctors that are seeing patients for prostate cancer need to be aware that these differences can be used as factors in planning the patient's treatment and telling the patient what their survival might be," Robbins said.
Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, thinks this study demonstrates the need to better understand how different racial and ethnic groups respond to diseases.
"This study points out the potential misleading conclusions we can come to when we use these large groups to lump different subpopulations into," he said.
"If you lump in the South Asian subgroup with other Asians, as is traditionally done, you totally miss the fact that these folks have a strikingly higher chance of dying from prostate cancer," Brooks said.
Brooks said the study finding can provide a basis for research to try to understand why these differences exist between populations.
Prostate cancer is the most common type of cancer to strike American men, other than skin cancer, according to the American Cancer Society, which estimates there will be about 218,890 new cases of prostate cancer in the United States in 2007, and about 27,050 men will die of the disease. Prostate cancer is the second leading cause of cancer death in males. While one in six men will get prostate cancer during his lifetime, only one man in 34 will die of the disease. The death rate for prostate cancer is declining, due in large part to earlier diagnoses, the society said.
Another paper in the same issue of the journal also found racial differences among women who survive breast cancer; with black women having poorer survival regardless of the stage of the disease.
It is known that black women had larger tumors and are more likely to have invasive breast cancer. But the study, lead by Dr. Alfred Neugut from Columbia University Medical Center and Russell McBride from Mailman School of Public Health, found that mortality among black women was up to 56 percent higher than whites.
Neugut's team says that the disparities in survival were surprising and suggest that non-clinical factors, such as access to and quality of care, may play a part.
SOURCES: Anthony Robbins, M.D., Ph.D., California Cancer Registry, Sacramento; Durado Brooks, M.D., director, prostate and colorectal cancer, American Cancer Society, Atlanta; Aug. 13, 2007, Cancer, online

Prostate Cancer Prevention

Introduction:

The male hormone testosterone is considered a major factor in the development of prostate cancer. In the January l997 issue of the Journal of the National Cancer Institute is a report showing that testosterone stimulates cells in the prostate to produce the cancer causing free radicals.

In the December l996 issue of the Journal of the American Medical Association, a report shows that men who took a nutritional supplement called selenomethionine over a seven year period had a 67 percent reduction in the incidence of cancer of the prostate.

Selenium is a mineral and a major component of the enzyme called glutathione, which is considered one of the most potent anti-oxidants in existence, and one of the most powerful members of the Cancer Detox System. Methionine through its production of cysteine makes possible the synthesis of glutathione within the cells of the body. Selenomethionine therefore protects the prostate against cancer by neutralizing or destroying the toxic, cancer causing free radicals produced in the cells by testosterone and other metabolic factors.

Other major factors that stimulate the cells of the prostate to produce an excess of the oxygen free radicals, which increase one's risk of developing cancer of this gland, include:
OBESITY & ISCHEMIA. Overeating, regardless of whether carbohydrates, fats or proteins, leads to obesity. Excess fat cells impair the flow of blood to the cells of the prostate (ischemia), which prevents these cells from synthesizing a chemical called ATP. This deficiency causes a whole series of chemical reactions to take place in the cells, causing them to produce an excess of the cancer-causing free radicals. Constipation can also cause ischemia. Large fecal stools with delayed elimination can reduce blood flow to the prostate. After the elimination the ischemia is broken, resulting in a rush of flow of blood to the prostate. This process of occlusion and reperfusion of blood results in a build up of the cancer causing free radicals, henceforth, increasing the risk of prostate cancer.

OVER-THE-COUNTER & PRESCRIPTION DRUGS. The daily abuse of these drugs depletes the body's stores of glucuronic acid. The Cancer Detox System uses glucuronic acid to regulate blood levels of testosterone and to eliminate cancer causing chemicals from the body. A phytochemical found in fruits and vegetables called d-glucarate enhances the process known as glucuronicidation (a process by which glucuronic acid is conjugated with testosterone or a cancer causing chemical and flushed out of the body). This helps to prevent against cancer of the prostate. We recommend every man over the age of 35 take supplements of calcium d-glucarate daily as a preventative to prostate cancer.

SMOKING. The chemicals in cigarette smoke can produce ischemia to the prostate and thereby increase one's risk of developing cancer of this gland by increasing production of free radicals in the cells.

ALCOHOl. Abuse of alcohol can impair the liver's production of glucuronic acid. This increases the risk of prostate cancer.

DIETARY DEFICIENCIES. Poor eating habits can weaken the Cancer Detox System. This increases the risk of prostate cancer. A recent study published in the Journal of the American Medical Association shows that vitamin E supplements reduce the incidence of prostate cancer by 25%. A healthy Cancer Detox System is the key to the prevention of cancer of the prostate gland.

INSULIN-LIKE GROWTH FACTOR (ILGF). Most current studies now show that blood levels of the insulin-like growth factors (ILGF), to be a more accurate marker for determining the presence of cancer of the prostate than the PSA levels.

The Cancer Institute recommends that every man begin at the age of 35 to test his blood levels of the ILGF. He should then follow up with tests every 3 to 5 years, depending upon the results of each test.

The Cancer Institute also cautions men not to take a nutritional supplement called DHEA, or the growth hormone, without first testing blood levels of these compounds.

Following the Cancer Institute's dietary and nutritional supplements guidelines is the best possible means of maintaining a healthy and effective Cancer Detox System. Keep in mind that life-style abuses can overload the Cancer Detox System and increase the risk of cancer in any part of the body, including the prostate gland

Source: http://www.apjohncancerinstitute.org/prostate.htm