Bladder Cancer Diagnosis & Treatment

What are the Symptoms of Bladder Cancer?

Hematuria (blood in the urine)
Blood in the urine is the most common symptom of bladder cancer. It is generally painless. Although blood may be visible, in most cases it is invisible except under a microscope. In these cases, blood is found when your urine is tested by your health care provider.

Blood alone does not mean that you have bladder cancer. There could be many reasons for blood in the urine, such as a urinary tract infection or kidney stones. Microscopic amounts of blood might even be normal in some people

What Causes Bladder Cancer?

Smoking
50% of all bladder cancer cases in the United States are caused by cigarette smoke. Bladder cancer develops in smokers 2 to 3 times more than in nonsmokers.

Chemicals in the Workplace
Long-term exposure to chemicals used to make plastics, paints, textiles, leather and rubber may also cause bladder cancer. Hairdressers, machinists, printers, painters and truck drivers may be at risk for bladder cancer.

Other Risk Factors

  • Frequent or long-lasting bladder infections
  • Certain drugs for other cancers, such as cyclophosphamide (Cytoxan®)
  • Radiation therapy in the pelvic area, such as for cervical cancer or prostate cancer
  • High levels of arsenic in drinking water

How is Bladder Cancer Diagnosed?

Medical History and Physical Exam
Your doctor will ask about your contact with things known to cause bladder cancer such as tobacco smoke (from your own use or secondhand smoke) or chemicals. You will also be asked if there is a family history of bladder cancer.

Urinalysis
For this test you will provide a urine sample. Specialists will check the color of the urine and its contents. They may also perform urine cytology. For this, your urine is viewed under a microscope to look for cancer cells. Urine can also be tested for other things linked with cancer cells (tumor markers).

Imaging Tests
Your doctor may request a computerized tomography (CT) scan of the kidneys, ureters and bladder to check for problems. If there is blood in the urine, it could have come from anywhere in the urinary tract. 

Cystoscopy
Cystoscopy allows your doctor to see directly inside the bladder and inspect the inner surfaces for signs of cancer. It is most often done in the doctor’s office. To make the test more comfortable, you will have local anesthesia (medicine to block pain in the area) or light sedation (to help you relax and to block pain). 

What are the Grades and Stages of Bladder Cancer?

Grading
The grade tells how fast the tumor can grow and spread.

  • Low-grade tumors grow more slowly. Though they may come back (recur) after treatment, they rarely spread to the muscle or outside of the bladder.
  • High-grade tumors grow more quickly. They often recur after treatment and are more likely to spread to other parts of the body.

Staging
Your doctor wants to find out:

  • if the tumor entered the muscle of the bladder (stage T2 and higher)
  • if the tumor has entered nearby tissues (stage T3 and higher)
  • if the cancer has spread to other parts of the body (stage T4)

In general, a higher stage cancer (4 is the highest) is more serious.

Ta: Tumor on the bladder lining. Most are low grade and do not enter the bladder muscle. May recur, but often at the same stage and grade.


Tis: Also called carcinoma in situ (CIS) a high-grade cancer that appears as a flat, reddish, velvety patch on the bladder lining. Tis can progress to enter the muscle layer.


T1: The tumor goes into the bladder  but often does not reach the muscle layer of the bladder. May recur at a higher grade and stage.


T2a and T2b: The tumor goes into the muscle layer of the bladder.


T3a and T3b: The tumor passed through the muscle layer and into the tissues surrounding the bladder. It may have reached the prostate, uterus, or vagina.


T4a and T4b: The tumor has spread to nearby lymph nodes or to other parts of the body away from the bladder (metastatic cancer).


How is Bladder Cancer Treated?

The best treatment for you will depend on the type, grade, and stage of your bladder cancer. It also depends on your general health and age.

  • Transurethral Resection of Bladder Tumor (TURBT)
    • TURBT is the usual treatment for tumors on the bladder lining (stage Ta and T1). The surgery is done under general anesthesia in the operating room with a cystoscope (no incisions made).
  • Intravesical (within the bladder) Therapy
    • Medication is put directly into your bladder through a catheter, which is then removed. The medicine remains in place for 1-2 hours.
    • This may also be done after TURBT to prevent tumors from coming back
    • This may be chemotherapy or immunotherapy
  • Partial Cystectomy (removal of PART of the bladder)
    • For patients with a small, single tumor in favorable location
    • Involves removal of the part of the bladder with tumor and surrounding lymph nodes
  • Radical Cystectomy (removal of the WHOLE bladder)
    • For stage 2 or greater bladder cancer
    • Involves removal of the whole bladder and surrounding lymph nodes, including the prostate (male) and uterus/vagina (female)
    • You will require a new way to empty urine. You may wear a flat bag outside the body (most common, ileal conduit) or your surgeons may use part of your intestine to create a pouch inside the body.
  • Chemotherapy
    • You may require chemotherapy BEFORE or AFTER surgery
  • Radiation
    • You may require radiation therapy instead of or after surgery

If you have questions regarding Bladder Cancer, please contact Potomac Urology at our Alexandria or Woodbridge office at (703) 680-2111 today!