Bladder Cancer

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What You Should Know About Bladder Cancer

Bladder cancer is a common cancer which is highly treatable when diagnosed early.

Overview

What is Bladder Cancer?

The bladder is the organ that stores and eliminates urine. Bladder tumors can arise from the bladder wall as well as the urethra. Treatment for bladder tumors vary and depend on the grade (low or high) and depth of tumor invasion of the bladder wall.

Most bladder cancers grow slowly, called non-muscle invasive bladder cancer (NMIBC). Less common is muscle invasive bladder cancer (MIBC) where the cancer has grown into the muscle layer of the bladder wall, and possibly deeper.

Bladder cancer is more common in men and rarely occurs in people younger than 40.

Symptoms

What are the symptoms of Bladder Cancer?

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.

Blood in the urine
Lower urinary tract symptoms: urinary frequency, urinary urgency
Bladder pain
Difficulty passing your urine

Cause

What causes Bladder Cancer?

The biggest risk factor for bladder cancer is smoking as well as environmental exposure to certain chemicals and genetic factors.

Patients who previously received radiation therapy to the pelvic region (prostate, colon, gynecologic cancers) have a four times greater risk of developing bladder cancer. Those who took the chemotherapy drug cyclophosphamide (Cytoxan) may be at nine times greater risk.

Diagnosis

How is Bladder Cancer diagnosed?

During your initial visit to MidLantic Urology, your doctor will ask you questions regarding your medical history and will perform a physical exam including the pelvis and rectum.

Other tests that may be performed during or after your visit:

Urinalysis: This evaluates for any blood in the urine or infection
Labs: Urine culture and cytology may be obtained. A urine cytology evaluates the urine cells for evidence of cancer on a microscopic level. Blood work to assess kidney function may also be obtained.
Imaging: A CT scan or MRI scan is likely, allowing us to evaluate the urinary tract and look for any spread of disease. When needed, our patients may receive a FDG PET/CT scan at our Imaging Center in Wayne. This highly specialized scan, typically available only in hospitals, provides detailed insight into how your body is functioning at the cellular level. The scan plays a critical role in the detection, staging, restaging and treatment response to bladder cancer.
Cystoscopy: This procedure is performed in the office. Your physician inserts a small scope into the urethra to evaluate the urethra, prostate (for males) and bladder.
If tumors have been confirmed, a transurethral resection of bladder tumors (TURBT) is likely needed. In this procedure the doctor removes any tumors from the bladder lining, as well as some nearby bladder muscle, to determine if cancer exists, and if so, the extent of the cancer.

These test results can indicate the presence of cancer, and how deeply the cancer has grown into the bladder wall.

Staging

Bladder cancer’s stage – from 0 to IVB – indicates how far the cancer has spread.

TNM System

These categories each indicate the severity of the bladder cancer.

T describes how far the primary tumor has grown
N indicates if cancer has spread to nearby lymph nodes
M indicates if the cancer has spread (metastasized) to distant body parts

Grade

Bladder cancer’s grade indicates how abnormal and aggressive the cancer cells appear.

Treatment

How is Bladder Cancer treated?

From diagnosis to treatment to follow-up care, MidLantic Urology is there every step of the way to support you on your journey.

We offer the latest in bladder cancer treatment options. Treatments are based on the grade and stage of the tumor, severity of symptoms, likelihood of recurrence, and the presence of other medical conditions.

Non-Muscle Invasive Bladder Cancer treatment:

Surgery is a typical first step to remove any visible cancer from the bladder. An immunotherapy known as BCG (Bacillus Calmette-Guerin) follows surgery. BCG places medicine directly into the bladder to stimulate your immune system to attack any existing cancer cells. Although BCG is sometimes in short supply throughout the U.S., this has not been the case at MidLantic Urology offices. Our patients have not been forced to consider an alternate treatment due to a BCG shortage.

If BCG has not been a successful treatment for you, we have many new, second-line options including: Inlexzo, Anktiva, Adstiladrin, and Keytruda. Such drugs may prevent the removal of a patient’s bladder, preserving quality of life. New drugs in development become available to patients as soon as they receive FDA approval.

Also available at MidLantic Urology is Zusduri, a new, prescription gel treatment for some NMIBC patients, offering a non-surgical alternative to repeated tumor removal procedures.

Muscle Invasive Bladder Cancer treatment:

If cancer has invaded the bladder muscles, more extensive treatment is needed. Wherever possible, we aim to preserve the bladder. Depending on the severity of the cancer, options include:

Transurethral Resection of the Bladder Tumor (TURBT) with Radiation: Scraping the bladder to remove as much cancer as possible, followed by radiation therapy to destroy remaining cancer cells.
Immunotherapy: Drugs to help your body better fight the cancer.
Radical cystectomy: the entire bladder, nearby lymph nodes, and sometimes nearby organs are removed and a new pathway is created for urine to leave the body. At MidLantic Urology, cystectomy may be performed robotically. A robotic procedure minimizes blood loss, is less painful, and provides a faster recovery. A neo-bladder (made from a section of the intestine) may be created to replace the natural bladder.

Cutting Edge Research Improves Care

Our robust clinical research department puts MidLantic Urology bladder cancer patients ahead of the treatment curve. We have clinical trials for patients with NMIBC and MIBC. Drugs that may not be available elsewhere may be available to our patients in research trials. By participating, patients are introduced to the newest treatment options that aim to help the body better fight the cancer. Learn more about the benefits of our current bladder cancer research trials and ask your physician if one may be right for you.

For more information about bladder cancer, visit the National Cancer Institute website and the Bladder Cancer Network.

Healing

Who will treat my Bladder Cancer?

Bladder cancer is complex. You want the right team to treat your bladder cancer. That means urologists, oncologists, and surgeons who specialize in bladder cancer.

MidLantic Urology’s team of Bladder Cancer Champions include multiple urologists with special training and experience in treating bladder cancer. The team also includes radiation oncologists and medical oncologists who are fellowship-trained in the nuances and complexities that bladder cancer presents. These layers of expertise provide patients with the knowledge that their personal treatment plan is the best one for them.

Our Bladder Cancer Champions regularly collaborate on challenging cases, share perspectives, and help guide treatment decisions – giving patients the benefit of collective experience rather than a single viewpoint. This centralized expertise has been shown to improve patient outcomes. They also have the advantage of knowing about drugs being researched in numerous bladder cancer research trials underway in our Clinical Research Department.