Bladder Cancer

Factors that contribute to an increased risk for developing bladder cancer include:

• Lifestyle:
  • Smoking
  • Workplace exposure to chemicals
• Medical Issues:
  • Chronic bladder inflammation
  • Previous cancer treatment
  • Certain diabetes medication
• Other:
  • Age over 55
  • White male
  • Family history
  • Parasite infections

There are several types of bladder cancers, including the following:

• Transitional cell (urothelial) carcinoma begins in the cells lining the inside of the bladder. It occurs in 97 percent of bladder cancer cases.
• Squamous cell carcinoma occurs in one to two percent of bladder cancers and begins in thin, flat tissue cells found in bladder tissue.
• Adenocarcinoma accounts for one percent of bladder cancers and begins in the cells of glandular structures lining certain organs in the body.

The most common signs and symptoms of bladder cancer are:

• Blood in urine
• Frequent urination
• Painful urination
• Urinary urgency
• Pelvic pain
• Back pain

The survival rate for patients is good if bladder cancer is caught early. Your urologist will meet with you to discuss concerns and to conduct a thorough evaluation. Diagnostic tests and procedures may include:

• Medical history
• Physical examination
• Blood and urine tests
• Cystoscopy (cystourethroscopy), a small telescope passed through the urethra into the bladder to look at the urethra, prostate and bladder. Blue Light Cystoscopy with Cysview is now available! Click here to learn more.
• Biopsy removes suspicious cells and views them under a microscope for cancer.
• Bladder tumor marker studies determine cellular characteristics and markers or substances released by bladder cancer cells into the urine.
• CT Urogram, a CT-scan focused on the urinary tract.
• Magnetic resonance imaging (MRI) uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures.
• CT Positron Emission Tomography or Bone Scan (CT/PET) uses radiotracers to look for metastatic cancer cells elsewhere in the body.

Your urologist will order additional tests to determine the size of the cancer and whether cancer cells have spread within the body. This is called staging. Tests may include additional CT-scans or other imaging tests. Bladder cancer stages include:

• Stage I. Cancer is in the bladder's inner lining but has not invaded the muscular bladder wall.
• Stage II. Cancer has invaded the bladder wall but is still confined to the bladder.
• Stage III. Cancer cells have spread through the bladder wall into surrounding tissue, such as the prostate in men or the uterus or vagina in women.
• Stage IV. Cancer cells have spread to the wall of the abdomen or pelvis and may have spread to lymph nodes, and organs such as the bones, liver or lungs.

Treatment for bladder cancer depends on many factors including the stage of the cancer and where it is located. Your urologist will discuss the best treatment for your particular situation. Often a combination of therapies will be recommended. These include:

Surgery for Bladder Cancer

• Transurethral resection of the bladder (TURBT) uses special instruments attached to a cystoscope to cut the tumor and remove it with an electrical cautery device or laser.
• Segmental cystectomy or partial cystectomy removes only the part of the bladder containing cancer cells.
• Radical cystectomy for advanced bladder cancer removes the bladder, nearby lymph nodes, and organs that contain cancer cells. In men, radical cystectomy removes the prostate and seminal vesicles. In women, radical cystectomy removes the uterus, ovaries and part of the vagina.
  • There are 3 possible urinary diversions that can be created to drain your urine after your bladder has been removed. Your doctor will discuss the best option for you:
    • Indiana Pouch: The intestine is made into a pouch that is connected to the stomach. A sterile catheter is put through the stoma into the pouch to drain the urine.
    • Ileal Conduit: A piece of your intestine is used to make a tube to drain urine into a bag. The bag is connected to your stomach.
    • Neobladder: A neobladder is made from using a part of the small bowel. You will urinate through the urethra like you did before surgery.
• Robotic radical cystectomy uses a combination of high-definition 3D magnification, robotic technology and miniature instruments to enhance a urologic surgeon’s skills when removing a cancerous bladder.
  • Watch this video case study of a female robotic radical cystectomy by Dr. Steven Chang (please note: this video opens in a new window inside of Brigham and Women's Hospital's website).
• Incontinent diversion, also called urostomy, creates a new opening for urination with a bag worn on the outside of the body to collect urine.
• Continent urinary diversion creates a new bladder to control when urine leaves the body, eliminating the need for a urostomy bag.
  • Cutaneous continent diversion drains urine through a hole or stoma in the abdomen via a catheter.
  • Orthotopic neobladder creates a new bladder that is emptied via the urethra.

Immunological Therapy for Bladder Cancer

Biological therapy or immunotherapy signals the body's immune system to fight cancer cells. It is typically administered through the urethra and directly into the bladder. This is called intravesical therapy.

Biological therapy drugs used to treat bladder cancer include:

• Mitomycin C which kills the normal DNA function in cancer cells.
• Bacille Calmette-Guerin (BCG) forces the immune system to respond to the BCG drug in the lining of the bladder, forcing the body's immune system to fight the cancer.

Chemotherapy for Bladder Cancer

• Chemotherapy uses drugs to kill cancer cells.
• Involves a combination of chemotherapy drugs.

Radiation therapy for Bladder Cancer

• Radiation therapy may be used after bladder cancer surgery, often in combination with other therapies to kill any remaining cells.
• Less commonly, radiation combined with chemotherapy is used instead of surgery.

You will receive a thorough diagnostic evaluation and receive clinically-proven treatment by a board-certified urologist who specializes in bladder cancer. Your experience post-treatment will vary depending upon the stage of your cancer. Early detection – and the involvement of an experienced urologist – is important to the successful outcome for bladder cancer treatment. After treatment, routine surveillance by your urologist will be necessary.

Brigham and Women’s Faulkner Hospital practices a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. Specialists also include radiologists, pathologists, nurse specialists, social workers, palliative care specialists and dietitians.