Bladder Cancer

The urinary bladder is a muscular sac located in the pelvis, just above and behind the pubic bone. Urine, which is made in the kidneys, travels down two tubes to the bladder and exits into the urethra which carries it out of the body. Bladder cancer is a malignant tumor growth within the bladder.

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

Bladder cancer rarely occurs in people younger than 40 and rates are higher among those who live in the northern half of the United States.

The exact cause of bladder cancer is uncertain. Several factors can contribute to the development of bladder cancer, however, including cigarette smoking (the most common factor), industrial exposure to known carcinogens, exposure to radiation and more.

Women who received radiation therapy to treat cervical cancer have a fourfold increased risk, and those who took the chemotherapy drug cyclophosphamide (Cytoxan) may be at nine times greater risk.

Bladder cancer can exist without any of the symptoms listed below, although it is more common to experience one or more of them. The presence of these symptoms does not necessarily indicate cancer.

• Hematuria (blood in the urine) is the most common symptom of bladder cancer
• Urgent need to urinate
• Increased urinary frequency (more than every two hours)
• Painful urination

A urologist performs a detailed patient history and physical exam, including the rectum and the pelvis. Other tests include:

• Urinalysis: Examines the urine by dipstick or by microscopic exam to reveal blood in the urine.
• Urine cytology test: Microscopic exam looks for cancerous cells in the urine.
• Blood work: A blood sample is taken to check for renal function and blood count.
• Imaging or x-ray tests:
  • Intravenous pyelogram (IVP): Evaluates the upper urinary tract (kidneys and ureters) for tumors or blockage.
  • CT scan (abdomen and pelvis): Determines the extent of disease, including involvement of bladder, lymph nodes, kidneys and other intra-abdominal organs.
  • Bone scan: Determines if the cancer has spread to the bone.
  • Chest x-ray or chest CT scan: Determines if the cancer has spread to the lungs.
• Cystoscopy: A lighted instrument views inside the bladder. We offer nitrous oxide (N20) as an optional form of relaxation during this procedure.
• Bladder biopsy: Takes a small tissue sample to test for cancer cells; usually performed during cystoscopy.
• Transurethral resection of bladder tumor (TURBT): A more extensive biopsy to remove the entire visible tumor from the bladder.

The choice of treatment for bladder cancer is based on the grade and stage of the tumor, severity of symptoms, likelihood of recurrence and the presence of other medical conditions. Unlike other cancers, bladder tumors have an unusual propensity to recur.

Depending on the stage, treatment may include:

Superficial (T1):

• Tumor resection: Removes tumor through a scope, with follow-up cystoscopies (scope tests) to detect regrowth.
• Intravesical therapy: Medicine is administered through a catheter, typically given weekly for six weeks and possibly followed by a series of periodical booster treatments.

Invasive (T2-T4):

• Surgery: Removal of the bladder and lymph nodes. For men this may involve removing the prostate and bladder; for women this may involve removing the ovaries, uterus and bladder, and possibly a portion of the top part of the vagina. The urinary stream is diverted into either an isolated bowel segment (called an ileal conduit) or a substitute bladder made from a segment of bowel (called a neobladder).
• Chemotherapy: With T2 and T3 cancers, chemotherapy is sometimes advised before bladder removal.
• Chemotherapy and radiation therapy.