Bladder cancer is a malignant tumor growth within the bladder. Tumors may be classified based on their growth pattern as either papillary tumors (a 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.
Our bladder cancer treatment approach depends on each patient's situation.
The exact cause is uncertain, though several factors may contribute to its development, including: cigarette smoking (the most common factor), industrial exposure to known carcinogens, exposure to radiation, and exposure to high doses of the artificial sweetener saccharin.
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. 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 have one or more symptoms. The presence of these symptoms does not necessarily indicate cancer.
- Hematuria (blood in the urine) – this is the most common symptom of bladder cancer
- Urgent need to urinate
- Increased urinary frequency (more than every two hours)
- Painful urination
A urologist will perform a detailed history and physical exam, including a rectal and pelvic exam. Other tests include:
- Urinalysis: Examination of urine by dipstick or by microscopic exam.
- Urine cytology test: Microscopic exam of urine to look for cancerous cells.
- Blood work: To check renal function and blood count.
Imaging or X-ray tests:
- Intravenous pyelogram (IVP): A test to evaluate upper urinary tract (kidneys and ureters) for tumors or blockage.
- CT scan (abdomen and pelvis): Performed to screen for and determine extent of disease, including involvement of bladder, lymph nodes, kidneys and other intra-abdominal organs.
- Bone scan: A test to determine if the cancer has spread to the bone.
- Chest X-ray or chest CT scan: A test to determine if the cancer has spread to the lungs.
- Cystoscopy: The use of a lighted instrument to view inside the bladder.
- Bladder biopsy: Taking a small tissue sample to test for cancer; usually performed during cystoscopy.
- Transurethral resection of bladder tumor (TURBT): A more extensive biopsy in which an attempt is made 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:
- Tumor resection: Removal of 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.
- Surgery: Removal of the bladder and lymph nodes. For men this may involve removal of the prostate and bladder; for women this may involve removal of 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.
For more information on Bladder Cancer, visit the National Cancer Institute's Bladder Cancer page.
Other cancers our physicians are specially trained to treat: