Bladder Cancer

Bladder cancer is the fifth most commonly diagnosed cancer in the US, but is rarely discussed among the general public. According to the American Cancer Society, more than 70,000 Americans are diagnosed with bladder cancer each year. Bladder cancer is more common among men than women. Incidence of the disease increases with age; people over the age of 70 are two to three times more likely to develop the disease than individuals between the ages of 30-54.

Cigarette smoking is a contributing factor of more than 50 percent of bladder cancer cases. Other causes and risk factors of the disease include:

• Age
• Chronic bladder inflammation
• Consumption of Aristolochia fangchi herb
• Diet high in saturated fat
• Exposure to second-hand smoke
• Family history
• Exposure to carcinogens in the workplace
  • Such as rubber factory or textile workers who may be exposed to analine dyes
• Certain medications
• Infection of Schistosoma haematobium parasite

The primary symptom of bladder cancer is hematuria (blood in the urine). Other potential symptoms include frequent and painful urination.

Diagnosis:

Bladder cancer may be diagnosed through urologic laboratory tests, imaging tests or a cytoscopy and biopsy procedure.

Laboratory tests useful in diagnosing bladder cancer include:

• Urinalysis which detects microscopic (invisible to the naked eye) hematuria.
• Urine cytology to detect cancer cells flushed from the bladder during urination.
• Urine culture to rule out a urinary tract infection diagnosis.
• NMP-22 or BTA urine tests.

Imaging tests used to diagnose bladder cancer include:

• Intravenous pyelogram (IVP) x-ray procedure
• CT Scan
• MRI
• Ultrasound

If a urologist suspects bladder cancer, a cytoscopy and biopsy are performed to detect abnormal cancer cells.

Staging of bladder cancer is determined through the tumor, node and metastasis classification system. The stages refer to the physicial location of the tumor and its depth of cell penetration. Generally, tumors of the bladder can be classified as superficial (surface tumors) or as invasive (deep-spreading) tumors. Invasive tumors are much more likely to metastasize away from the bladder than superficial tumors. Grades estimate how aggressive the cancer cells appear under the microscope. Higher tumor grades (i.e – grades 3-4) indicate a more aggressive form of the disease.

Treatments:

Bladder cancer may be treated with surgery, chemotherapy, radiation therapy, immunotherapy or a combination of treatments depending on the stage of the disease. Click here to learn more about various treatments for bladder cancer.

Surgery:
Transurethral Resection of Bladder Tumor (TURBT)
This surgical procedure is done completely through a scope. It is typically performed as an outpatient procedure, but does require a general or spinal anesthetic. Through the scope, the bladder tumor is 'scraped' from the inside of the bladder.

Cystectomy/ Partial Cystectomy
Depending on the depth of the cancer in the bladder, part or all of the bladder may be removed. With complete bladder removal, the urine is diverted. Both continent (neo-bladder, catheterizable pouches) as well as non-continent (ileal loop) urinary diversions can be performed. TUCC surgeons perform open and robotic cystectomies for bladder cancer patients.

Chemotherapy:
Chemotherapy drugs are used to destroy cancer cells. These may be adminstered orally, intravenously or infused into the bladder through the urethra. Side effects of chemotherapy are common and may include:

• Abdominal pain
• Anemia
• Bladder irritation
• Blurred vision
• Excessive bleeding or bruising
• Fatigue
• Headache
• Infection
• Loss of appetite
• Nausea or vomiting
• Weakness

Chemotherapy may be administered to treat bladder cancer before or after surgery.

Radiation:
Radiation therapy destroys cancer cells through high-energy x-rays. In the case of bladder cancer, treatment may be administered before or after surgery, or as a primary form of treatment in non-surgical patients. External beam radiation directs a carefully targeted beam of radiation to the bladder and other selected tissues. Side effects of radiation therapy may include inflammation of the rectum, incontinence, skin irritation, hematuria, fibrosis and impotence.

Immunotherapy:
Immunotherapy is a form of treatment used to enhance the body's immune system. In the case of superficial bladder cancer, a vaccine is infused through the urethra into the bladder once a week for six weeks with the hope of stimulating the immune system to destroy the cancerous cells. Side effects of immunotherapy may include flu-like symptoms, cystitis and prostatitis.

Because bladder cancer has a high recurrence rate, a urine cytology and cytoscopy are performed on a patient every three months for the first two years following treatment. The procedures are then performed every six months for the next two years before being performed yearly.