Bladder Cancer

Bladder cancer is common and highly treatable when found early.

Your bladder stores and eliminates urine. Bladder tumors can develop on the bladder wall or the urethra. Treatment for bladder tumors varies and depends on the grade (low or high) and how deep the tumor has invaded the bladder wall.

Tumors are classified based on their growth patterns. Papillary tumors are wart-like lesions attached to a stalk. Non-papillary tumors are solid lesions with a broad base. Non-papillary tumors are less common (10%) but tend to be more invasive.

Bladder cancer rarely occurs before age 40. Rates are higher for people who live in the northern half of the United States and in those who smoke.

Sometimes there are no symptoms, but if you have bladder cancer you may notice one or more of these. It’s important to understand that the presence of these symptoms doesn’t necessarily mean you have cancer.

• Blood in the urine
• Urinating more frequently and with urgency
• Bladder pain
• Difficulty passing your urine

Researchers have found that key contributors of bladder cancer include smoking, some environmental toxins, age, and gender. Men are three times more likely than women to develop the disease, and 90% of those diagnosed are older than 55.

Research also has shown that exposure to certain chemicals, typically at industrial job sites, can contribute to the formation of tumors. A long-term bladder infection might also put you at risk.

What to know before your visit to the Advanced Urology Institute:

• During your visit, your doctor will ask you questions regarding your medical history and will perform a physical exam including the pelvis and rectum.

Other tests that may be performed during or after your visit:

• Urinalysis: A test that looks for blood in the urine or infection.
• Labs: Urine culture and cytology may be requested. Cytology examines the urine cells for evidence of cancer. FISH (fluorescence in situ hybridization) testing uses voided urine to detect DNA probes that give risk to bladder cancer. Blood work may be needed to assess kidney function.
• Imaging: A CT scan or MRI scan may be needed depending on your history and kidney function. These tests evaluate the urinary tract and look for any spread of disease.
• Cystoscopy: This test is performed in the office in which your physician inserts a small scope into the urethra to examine the urethra, prostate (for men) and bladder.

Fortunately, the rate of bladder cancer cases and deaths have declined an estimated 2% a year since 2015. Survival rates should continue to climb thanks to research studies that test new treatments, including drug therapies.

One significant advancement in treatment involves a group of drugs that guide your immune system to kill the cancer cells. These drugs, called immune checkpoint inhibitors, essentially teach your body to fight the disease itself.

Among minimally invasive treatments for patients in the earliest stages of the disease:

• Transurethral resection of the bladder tumor (TURBT): This procedure removes the small tumors from your bladder lining using a surgical instrument inserted through the urethra.
• Bladder instillation treatments: This procedure includes instilling immunotherapies or chemotherapy directly into your bladder using a catheter and then voiding them out.
• In some less common instances, complete removal of the bladder may be an option for repeat recurrences of certain tumors even if they are not invasive.

For patients in stages II and III, we offer these treatments:

• Partial bladder removal: This surgery involves surgically removing a part of the bladder invaded by tumors. Radiation and chemotherapy may follow if indicated.
• Total bladder removal (radical cystectomy): Here, the entire bladder and surrounding lymph nodes are removed. In men, this procedure often includes removing the prostate and seminal vesicles. In women, the urethra and uterus are removed. Following the removal, the surgeon creates an artificial bladder, using parts of the intestine.
• Chemotherapy: Patients receive a single drug or combination of drugs designed to shrink the tumor before surgery, and reduce the chances of the tumor growing back.
• Chemotherapy and radiation: This treatment includes a combination of chemotherapy and radiation for patients who choose not to have surgery or who cannot have surgery.
• Immunotherapy: Bacillus Calmette-Guerin (BCG) is an immunotherapy that attracts the normal cells of the immune system to the bladder where they destroy the bladder cancer cells. The medication causes the patient’s own immune system to attack and kill the tumor cells and reduces the chances of new tumors. It is given through a Foley catheter through the urethra and into the bladder.

If you’ve entered stage IV:

• Chemotherapy: If the cancer is too advanced to treat with surgery, the doctor will consider chemotherapy treatments. There are several drug options available based on the patient’s condition.