Cancer Care
Bladder Cancer
Bladder cancer is the most common cancer of the urinary tract and is highly treatable with options such as surgery, chemotherapy and radiation.
The bladder is an organ located in the pelvis. It stores and eliminates urine. Urine is produced by the kidneys, carried to the bladder by the ureters, and discharged from the bladder through the urethra.
Bladder cancer is the most common cancer of the urinary system. It is more common in older adults, and men are diagnosed more often than women. It can be an aggressive cancer and therefore it is important to see your doctor with any new signs or symptoms. If caught early, it is highly treatable. However, bladder cancer often has a high rate of recurrence. Therefore, surveillance programs which require frequent office visits and repeat evaluations are common.
In order to provide high quality care and excellent patient outcomes, the Urology of Indiana bladder cancer team references national guidelines to inform current and best practices. In addition, they offer access to clinical trials. This may allow a bladder cancer patient to be treated with new and promising medicines that are not yet available to all bladder cancer patients.
Risk Factors
Cancer-causing agents (carcinogens) in the urine may lead to the development of bladder cancer. Cigarette smoking contributes to more than 50% of cases. Smoking cigars or pipes and exposure to second-hand smoke also increase the risk.
Symptoms
Blood in the urine (known as hematuria) is the primary symptom of bladder cancer. Hematuria may be visibly seen as red urine, (gross hematuria) or it may only be visible under a microscope (microscopic hematuria) and is usually painless. Other symptoms include frequent urination and pain upon urination (dysuria).
Diagnosing bladder cancer often requires several unique steps. A complete medical history is used to identify potential risk factors (i.e., smoking, exposure to dyes, etc.).
Laboratory Tests
Common laboratory tests used during the evaluation fore bladder cancer may include:
- Urinalysis to detect microscopic hematuria
- Urine cytology to detect cancer cells by examining cells flushed from the bladder during urination
- Urine culture to rule out urinary tract infection
Imaging Tests
Imaging tests are performed to examine the kidneys and ureters to look for tumors, stones or cysts. This is most often with a specialized CT scan called a CT Urogram. Other options include kidney ultrasounds, retrograde pyelograms or MR Urograms.
Cystoscopy
Cystoscopy is performed to examine the inside of the bladder to rule out bladder tumors. Local anesthesia is administered and a cystoscope (thin, telescope-like tube with a tiny camera attached) is inserted into the bladder through the urethra to allow the physician to detect abnormalities.
If a tumor is seen, it is then biopsied and removed under general anesthesia. Surgical removal allows the pathologist to assess the depth of invasion of the tumor into the bladder wall, which is the key element in bladder cancer staging.
Treatment – Surgical
In patients where cancer has invaded into or through the muscle of the bladder wall, removal of the bladder may be indicated. This procedure is known as radical cystectomy. Once the bladder is removed, urinary diversion is performed to re-route the urine that was previously stored and voided through the bladder.
There are several types of urinary diversion available. The specific type of diversion performed depends upon numerous factors including stage of cancer as well as the functional status and physical build of the patient.
Treatment – Non-Surgical
Radiation
Radiation uses high-energy rays to destroy cancer cells. External beam radiation is produced from a machine outside the body, and internal radiation is produced from radioactive “seeds” implanted into the tumor. External beam radiation can be used in certain cases of bladder cancer that have invaded into or through the muscle wall in order to try to cure a patient while enabling them to keep their bladder. Either type of radiation therapy may be used after surgery to destroy cancer cells that may remain. Radiation therapy is also used to ease symptoms in advanced cases of bladder cancer.
Immunotherapy
Immunotherapy is used to enhance the immune system’s ability to fight cancer. In this treatment, BCG, a vaccine derived from the bacteria that causes tuberculosis, is infused through the urethra into the bladder, once a week for 6 weeks. This vaccine stimulates the immune system to destroy cancer cells. BCG is often used for recurrent superficial bladder cancer as well as non-muscle invasive bladder cancer that harbors aggressive features. BCG has been shown in randomized clinical trials to decrease the recurrence rate of bladder cancer as well and progression of bladder cancer to higher stages of disease. Immunotherapy may also come in the form of an intravenous infusion and is used in both recurrent superficial bladder cancer after BCG has failed and also in certain patients with advanced bladder cancer.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells. When given by mouth or through a vein it is considered a systemic treatment (i.e., destroys cancer cells throughout the body). In early bladder cancer, intravesical chemotherapy (infused into the bladder through the urethra) may be recommended when BCG has failed. In patients with more advanced disease, chemotherapy may given either before (neoadjuvant) or after (adjuvant) surgery or radiation.