Bladder Cancer

Bladder cancer is the fifth most common cancer in the United States. About 71, 000 Americans are diagnosed with bladder cancer each year and 12-14,000 die annually of the disease. In recent decades there has been a steady increase in the incidence of bladder cancer. However, urologists, including those at Georgia Urology, are making progress in treatment and survival rates are improving.

What happens under normal conditions?

The bladder is a hollow balloon-shaped mostly muscular organ that stores urine until ready for release. The urine is produced in the kidneys. It flows through tubes called the ureters into the bladder and is discharged through the urethra during urination. The bladder muscle aids urination by contracting (tightening) to help force out the urine. A thin surface layer called the urothelium lines the inside of the bladder.

What is the most common type of bladder cancer?

Most (90% of) patients diagnosed with bladder cancer have transitional cell cancer, also referred to as urothelial carcinoma which starts in the urothelium or lining the bladder. The majority of those bladder tumors are confined to the urothelium and have not invaded the bladder muscle.

Other types of bladder cancer include squamous cell carcinoma, adenocarcinoma, or small cell cancer.

What are the risk factors for bladder cancer?

  1. Cigarette smoking: Estimated to causes 50 percent of all bladder cancer.
  2. Chemical exposure: To compounds used in making rubber, leather, printing materials, textiles and paint product.
  3. Race: Caucasians have a higher risk
  4. Age: Risk increases with age
  5. Sex: Men develop bladder cancer at a higher rate than women
  6. Chronic bladder inflammations
  7. Personal or family history of bladder cancer
  8. Chemotherapy or radiation treatment: Previous treatment for other cancers

What are the symptoms of bladder cancer?

  1. Blood in the urine (hematuria): Most common symptom. Although the blood may be visible during urination and described as “painless”, in most cases, it is invisible except under a microscope and is usually discovered during routine examination.

Other symptoms of may include:

  1. Frequent urination
  2. Pain upon urination

The symptoms are similar or the same as symptoms of other medical condition such as infection, kidney stones and prostate disorders. You will need a thorough medical evaluation it find out the cause.

How is bladder cancer diagnosed?

The diagnostic evaluation begins with a thorough medical history and a physical examination. Our Georgia urologists will ask about past exposure to known causes of bladder cancer.

Other tests may include:

  1. Imaging studies of the kidneys, ureter and bladder to check for problems in these organs.
  2. Urine cytology: Urine is examined under a microscope to look for cancer cells
  3. Tumor marker tests: Urine test to look for protein substances in the urine known to be closely associated with cancer cells
  4. Cystoscopy: Thin instrument or scope is inserted the bladder through the urethra that allows the urologist to examine the bladder’s inner surfaces. If a tumor is seen, the urologist may remove a very small sample of the tissue (biopsy) to be examined by a pathologist who will determine the cause and type of tissue.
  5. Fluorescence-in-situ-hybridization (FISH): Urine test used to detect chromosomal abnormities associated with cancers.

What is meant by “staging and grading” a tumor?

When bladder cancer is diagnosed, the urologist needs to know the extent of the disease in order to recommend the best treatment plan.

Staging is based on how deeply a tumor has invaded the bladder wall and whether the disease has spread to other parts of the body.

Grade refers to how fast the tumor is likely to grow and spread

Staging of primary bladder cancer tumors (T)
Ta: Noninvasive papillary tumor (confined to urothelium)

Tis: CIS carcinoma (high grade “flat tumor” confined to urothelium)

T1: Tumor invades lamina propria

T2: Tumor invades bladder muscle

T2a: Tumor invades superficial bladder muscle

T2b: Tumor invades deep bladder muscle

T3: Tumor invades perivesical fat

T3a: Microscopic perivesical fat invasion

T3b: Macroscopic perivesical fat invasion (and progressing beyond bladder)

T4: Tumor invades prostate, uterus, vagina, pelvic wall or abdominal wall

T4a: Invades adjacent organs (uterus, ovaries, prostate)

T4b: Invades pelvic wall and/or abdominal wall

How is bladder cancer treated?

Our Georgia urologists will recommend a treatment plan based on the stage and grade of the tumor as well, type of tumor and overall health and age.

Transurethral resection of the bladder (TURBT) is treatment method typically used for tumors found to be Stage Ta and T1. While the patient is under general anesthesia, a cystoscope is placed in the bladder for the urologists to look at and remove the cancerous tumor. Specimens may also be taken and sent to the pathologist to provide further information and determine future treatments.

Intravesical immunotherapy: Involves placing special medications directly into the bladder through a catheter in the urethra, to destroy the cancer cells.

There are two main types of intravesical therapy:

  1. Chemotherapy: One or more anti cancer medications may be used prevent cancer reoccurrence.
  2. Immunotherapy: BCG is used to stimulate the body’s response and kill cancer cells in the lining of the bladder. BCG may also be recommended as a maintenance therapy to prevent the cancer from reoccurring.

There two types of surgery performed for bladder cancer which has invaded the muscle wall. A robotic assisted approach, which is performed by specialty trained urologists at Georgia Urology, P.A., may also be utilized in some cases.

Partial cystectomy: Removal of part of the bladder where the tumor is located; usually done if there is only one tumor

Radical cystectomy: Complete removal of bladder and usually, the surrounding lymph is done if a high-grade bladder tumor invades the muscle wall. In men, this usually involves removal of the prostate as well. For women, it may also involve remove the uterus, fallopian tubes, ovaries and cervix.

Reconstructive surgery: After removal of the bladder, a passage is created for the urine to go from the kidney to outside the body. In some cases, the urologists can construct a “neobladder” or new bladder, using part of the small intestines. In many cases, a piece of the small intestines is attached to an opening in the skin or “stoma” and an appliance or bag is used to collect urine.

The type of urinary diversion or reconstructive surgery is a highly individualized decision and depends on a number of factors including the age, overall health and the extent of the disease.

The highly skilled urologists of Georgia Urology, P.A. have performed organ sparing (preserving), reconstructive (maintaining function) surgery, which has been reported to be the “first of it’s kind” at the hospital and probably in the state of Georgia.

Chemotherapy: Intravenous anti-cancer drugs usually used when the cancer has metastasized or spread beyond the bladder.

Radiation Therapy: Sometimes used in combination with chemotherapy