Bladder Cancer

The most common type of bladder cancer is Transitional Cell Carcinoma (TCC) and starts in the lining of the bladder. Bladder cancer is the sixth most common cancer in the United States. In recent decades there has been a steady increase in the incidence of bladder cancer. While there are several risk factors, cigarette smoking alone has been estimated to cause 50 percent of all bladder cancer cases in the United States.

Symptoms

Early stages of bladder cancer often produce no symptoms. The first warning sign may be trace blood in the urine found on routine urine checks done by your doctor. Other common symptoms include:

  • Painful urination
  • Frequent urination or feeling an urge to urinate without results
  • Slow or intermittent urine stream
  • Pelvic pain

Risk Factors

The following factors increase your risk of bladder cancer:

  • Cigarette smoking - the single greatest risk factor
  • Exposure to industrial chemicals
  • Age - the average age is 67
  • Sex - men are at much higher risk
  • Race - Caucasians are at higher risk
  • Family or personal history of bladder cancer
  • Chronic bladder inflammation or foley catheter use
  • Chemotherapy or radiation therapy for other cancers

Diagnosis and Staging

Your doctor will first perform a thorough history and physical exam. Other tests may include:

  • Urine Cytology - examining urine cells under the microscope to check for cancer cells
  • CT Urography (CTU) – a special CT scan that includes contrast dye to better view the kidneys, bladder and ureters
  • Cystoscopy - putting a small camera into the bladder through the urethra. If a mass is seen, a biopsy may be performed at that time.
  • Tumor Marker Tests – several markers are available to further evaluate cancer cells in the urine
  • FISH (Flourescence In Situ Hybridization) - a urine test that looks for chromosomal abnormalities and may provide early detection or recurrence of bladder cancer

Staging is based on a combination of surgical pathology and imaging. The depth of invasion of the tumor into the bladder wall determines the next appropriate step beyond resection. You can read more about bladder cancer staging here.

Treatment

Determining the appropriate treatment depends on a number of factors, including your health, age, type of tumor, tumor grade, and the stage of the tumor (how deeply it invades the wall of the bladder).

Surgical treatment is usually recommended for patients with bladder cancer. Some patients will receive radiation, chemotherapy, or immunotherapy in addition to surgery.

Surgery - there are several surgical approaches:

Transurethral Resection (TURBT) - using an instrument called a cystoscope that is placed through the urethra to remove cancerous tissue from the bladder. This is the initial step required in staging the tumor, but also may be used for recurrent disease.

Radical Cystectomy – removing the entire bladder and surrounding tissue. This may be required when the cancer has invaded deep into the wall of the bladder.

Segmental Partial Cystectomy - removing only part of the bladder. This is usually only offered on certain rare types of bladder cancer that affect only one area.

Radiation Therapy - sometimes used with intravenous chemotherapy in patients with invasive cancer who may not be ideal surgical candidates.

Chemotherapy - one or more drugs kill the cancer cells, either through instillation into the bladder (intravesical) or into a vein (intravenous). Intravenous chemotherapy is may be indicated in preparation for surgery (neoadjuvant) or when the cancer has spread beyond the bladder.

Immunotherapy - a substance called BCG is injected into the bladder to trigger the body's immune response against the cancer cells. It is often used to prevent superficial cancer from recurring.

Follow Up

Since bladder cancer can be highly recurrent, your doctor will likely need to perform a cystoscopy in the office on a regular basis with annual imaging when appropriate. Urine studies to look for cancer cells will also be checked on a regular basis and may be an early sign of recurrence.

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