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Bladder cancer is the fifth most commonly diagnosed cancer in the U.S. 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, although rates have been increasing among women over the past 10 years. 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.
The primary symptom of bladder cancer is often hematuria or blood in the urine. Other potential symptoms include frequent and painful urination. Smoking is a contributing factor in more than 50 percent of bladder cancer cases.
Other causes and risk factors of the disease include:
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:
Imaging tests used to diagnose bladder cancer include:
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 (spread) classification system. The stages refer to the physical 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.
There are several treatment options for bladder cancer. It may be treated with surgery, chemotherapy, radiation therapy, immunotherapy or a combination of treatments depending on the stage of the disease.
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 organ 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 drugs are used to destroy cancer cells. For bladder cancer patients, these drugs may be adminstered orally, intravenously or infused into the bladder through the urethra. Chemotherapy may be administered to treat bladder cancer before or after surgery. Side effects of chemotherapy are common and may include: abdominal pain, anemia, bladder irritation, blurred vision, excessive bleeding or bruising, fatigue, headaches, infection, loss of appetite, nausea or vomiting, weakness
Radiation Therapy, available at TUCC, 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 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 can have 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.
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