- Bladder Cancer
- Bladder cancer
- Bladder Cancer: Practice Essentials, Background, Anatomy
- Bladder Cancer: Symptoms and Treatment
- Diagnosis & tests
- Treatment & medication
- About the bladder, renal pelvis, and ureter
- About bladder cancer
- Types of bladder cancer
- Other ways of describing bladder cancer
- Looking for More of an Introduction?
- Bladder Cancer Types
- Bladder Cancer Risk Factors
- What is Bladder Cancer?
- Options and Choices for Treatment
- Cystoscopic tumor resection
- What to expect from Intravesical Therapy
- Intravesical Immunotherapy Immunotherapy
- Intravesical Chemotherapy
- Repeat Intravesical Therapy
- Maintenance Intravesical Therapy
- Surgery to Remove the Bladder
- Partial Cystectomy(removal of part of the bladder)
- Radical Cystectomy(removal of the whole bladder)
- Urinary diversion after bladder removal
- Women & Bladder Cancer – Bladder Cancer Advocacy Network
- Why the disparity?
- What do women need to know?
- What can you do?
- Women & Bladder Cancer: Sharing Stories to Advance Research
- Advice from women survivors
If you or someone you care about has been diagnosed with bladder cancer, you may face a lot of difficult questions. Where should you go for care? What are your treatment options? How can you keep your quality of life?
Reading this guide is a good place to begin finding answers. From here, you can visit other sections of our bladder cancer guide for more in-depth information.
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Bladder cancer is a disease that usually begins in the cells that line the inside of the bladder. It typically affects people older than 70 and occurs more often in men. Bladder cancer is the fifth most common form of cancer overall and the fourth most common among men.
Bladder cancer usually responds well to treatment when diagnosed early. However, people who have been successfully treated for bladder cancer should be monitored afterward. Bladder cancer can return even years later.
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About 90 percent of bladder cancers begin in the cells on the surface of the bladder’s inner lining. This type of cancer is called urothelial carcinoma (also called transitional cell carcinoma). Most urothelial carcinoma is non-muscle invasive.
That means the cancer stays within the bladder’s inner lining. Less common types of bladder cancer include squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. These types can develop in the inner lining as a result of chronic irritation and inflammation.
They usually grow into the muscle of the bladder over time.
Learn more about the types of bladder cancer.
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In most cases, the first sign of bladder cancer is blood in the urine. Other symptoms may include feeling pain or burning during urination or a change in urination habits. This can include frequent urination or a need to go but being unable to pass urine.
More-advanced bladder cancer may involve lower back pain on one side, feeling tired or weak, or having no appetite and losing weight. All of these symptoms may be caused by something other than bladder cancer, but it’s important to have them checked out.
Learn more about the symptoms of bladder cancer.
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Tobacco use is by far the biggest risk factor for developing bladder cancer. People who smoke cigarettes are up to four times more ly than nonsmokers to develop the disease. Studies have shown that smoking is responsible for approximately 50 percent of bladder cancers.
People who work in the textile, dye, rubber, leather, paint, or printing industries may also be at an increased risk of bladder cancer.
Learn more about the risk factors for bladder cancer.
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Doctors use several tests to diagnose bladder cancer. One common method is a cystoscopy. In this procedure, a small tube with a camera is inserted into the urethra (the duct through which urine leaves the body) and slowly moved into the bladder.
A doctor can then examine the lining and take a sample, called a biopsy.Another method is a urine cytology. This test analyzes a urine sample to see if it contains tumor cells. Doctors also use a variety of imaging tests to examine the urinary tract.
Learn more about how bladder cancer is diagnosed.
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We may recommend surgery, chemotherapy, radiation therapy, or a combination of these. We always want to preserve the urinary and sexual function of people with bladder cancer. Sometimes the bladder needs to be removed. This is called a cystectomy. When we do this surgery, we can often create a new bladder at the same time. This is called a neobladder.
It eliminates the need for a pouch outside the body that collects urine. In addition, there are a growing number of immunotherapy treatments for bladder cancer. These therapies help unleash the immune system’s ability to fight cancer. The chance of surviving bladder cancer is very good when it is caught early.
Treatments also can be effective for bladder cancer that has advanced.
Learn more about treatments for bladder cancer.
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Memorial Sloan Kettering’s team of bladder cancer experts delivers the highest quality compassionate cancer care. We take into account each individual’s needs and develop a personalized treatment plan.
At MSK, we offer:
How I Took the Stage after Bladder Cancer: Mark's Story Meet Mark McIntosh, who is disease-free and back to work as a actor after being treated for bladder cancer at Memorial Sloan Kettering. Learn more Back to top
Bladder cancer is a disease in which certain cells in the bladder become abnormal and multiply uncontrollably to form a tumor. The bladder is a muscular organ in the lower abdomen that stores urine until it can be removed (excreted) from the body.
Bladder cancer may cause blood in the urine, pain during urination, frequent urination, the feeling of needing to urinate without being able to, or lower back pain.
Many of these signs and symptoms are nonspecific, which means they may occur in multiple disorders.
People who have one or more of these nonspecific health problems often do not have bladder cancer, but another condition such as an infection.
The most common type of bladder cancer, called non-muscle invasive bladder cancer (NMIBC), involves cells lining the inside of the bladder.
NMIBC generally does not spread to other tissues (metastasize), but it often does recur after it has been treated.
The other type, called muscle-invasive bladder cancer (MIBC), involves cells of the muscle wall of the bladder. MIBC generally does metastasize and is often life-threatening.
In the United States, bladder cancer is the fourth most common type of cancer in men. Bladder cancer occurs four times more often in men than in women, with about 60,000 men and 18,000 women diagnosed with the condition each year.
Cancers occur when genetic mutations build up in critical genes, specifically those that control cell growth and division (proliferation) or the repair of damaged DNA. These changes allow cells to grow and divide uncontrollably to form a tumor.
In nearly all cases of bladder cancer, these genetic changes are acquired during a person's lifetime and are present only in certain cells in the bladder. These changes, which are called somatic mutations, are not inherited. Somatic mutations in many different genes have been found in bladder cancer cells.
It is unclear whether genetic changes that are inherited and present in all of the body's cells (germline mutations) play a significant role in causing bladder cancer.
Somatic mutations in the FGFR3, PIK3CA, KDM6A, and TP53 genes are common in bladder cancers. Each of these genes plays a critical role in regulating gene activity and cell growth, ensuring cells do not grow and divide too rapidly or uncontrollably.
It is ly that variants in these genes disrupt normal gene regulation, contributing to the uncontrolled cell growth that can lead to tumor formation in bladder cancer. Mutations in many other genes have been found to be associated with bladder cancer; each of these additional genes is associated with a small percentage of cases.
Most of these genes are also involved in regulating the normal activity of genes and the growth of cells.
Additionally, deletions of part or all of chromosome 9 are commonly found in bladder cancer, particularly in NMIBC. Research shows that several genes that control cell growth and division are located on chromosome 9. It is ly that a loss of one or more of these genes plays a role in the early development and progression of bladder cancer.
Researchers have identified many lifestyle and environmental factors that expose individuals to cancer-causing compounds (carcinogens), which increase the rate at which somatic mutations occur, contributing to a person's risk of developing bladder cancer. The greatest risk factor is long-term tobacco smoking.
It is estimated that half of people with bladder cancer have a history of tobacco smoking.
Other environmental risk factors include chronic bladder inflammation, exposure to certain industrial chemicals, certain herbal medicines common in Asia, a parasitic infection called schistosomiasis, and long-term use of urinary catheters.
Bladder cancer is typically not inherited. It is usually associated with somatic mutations that occur in certain cells in the bladder during a person's lifetime.
In rare families, the risk of bladder cancer is inherited.
In these cases, the cancer risk follows an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to increase a person's chance of developing the disease.
It is important to note that people inherit an increased risk of cancer, not the disease itself. Not all people who inherit mutations in these genes will develop bladder cancer.
- bladder carcinoma urinary
- bladder tumor
- cancer of the urinary bladder
- cancer, bladder
- cancer, urinary bladder
- malignant bladder neoplasm
- malignant bladder tumor
- neoplasm of the bladder
- neoplasm of the urinary bladder
- tumor of the urinary bladder
- urinary bladder carcinoma
- urinary bladder neoplasm
Bladder Cancer: Practice Essentials, Background, Anatomy
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Bladder Cancer Version 3.2019. NCCN.org. Available at http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf. April 29, 2019; Accessed: June 22, 2019.
Escudero DO, Shirodkar SP, Lokeshwar VB. Bladder Carcinogenesis and Molecular Pathways. Lokeshwar VB. Bladder Tumors: Molecular Aspects and Clinical Management. New York: Springer Science; 2010. 23-41.
Spruck CH 3rd, Ohneseit PF, Gonzalez-Zulueta M, Esrig D, Miyao N, Tsai YC, et al. Two molecular pathways to transitional cell carcinoma of the bladder. Cancer Res. 1994 Feb 1. 54(3):784-8. [Medline].
Trias I, Algaba F, Condom E, Español I, Seguí J, Orsola I, et al. Small cell carcinoma of the urinary bladder. Presentation of 23 cases and review of 134 published cases. Eur Urol. 2001 Jan. 39(1):85-90. [Medline].
Bessette PL, Abell MR, Herwig KR. A clinicopathologic study of squamous cell carcinoma of the bladder. J Urol. 1974 Jul. 112(1):66-7. [Medline].
Faysal MH. Squamous cell carcinoma of the bladder. J Urol. 1981 Nov. 126(5):598-9. [Medline].
Lagwinski N, Thomas A, Stephenson AJ, Campbell S, Hoschar AP, El-Gabry E, et al. Squamous cell carcinoma of the bladder: a clinicopathologic analysis of 45 cases. Am J Surg Pathol. 2007 Dec. 31(12):1777-87. [Medline].
El-Sebaie M, Zaghloul MS, Howard G, Mokhtar A. Squamous cell carcinoma of the bilharzial and non-bilharzial urinary bladder: a review of etiological features, natural history, and management. Int J Clin Oncol. 2005 Feb. 10(1):20-5. [Medline].
Heyns CF, van der Merwe A. Bladder cancer in Africa. Can J Urol. 2008 Feb. 15(1):3899-908. [Medline].
Tomlinson DC, Baldo O, Harnden P, Knowles MA. FGFR3 protein expression and its relationship to mutation status and prognostic variables in bladder cancer. J Pathol. 2007 Sep. 213(1):91-8. [Medline]. [Full Text].
Eswarakumar VP, Lax I, Schlessinger J. Cellular signaling by fibroblast growth factor receptors. Cytokine Growth Factor Rev. 2005 Apr. 16(2):139-49. [Medline].
Fadl-Elmula I. Chromosomal changes in uroepithelial carcinomas. Cell Chromosome. 2005 Aug 7. 4:1. [Medline]. [Full Text].
Knowles MA. Molecular subtypes of bladder cancer: Jekyll and Hyde or chalk and cheese?. Carcinogenesis. 2006 Mar. 27(3):361-73. [Medline].
Salinas-Sánchez AS, Lorenzo-Romero JG, Giménez-Bachs JM, Sánchez-Sánchez F, Donate-Moreno MJ, Rubio-Del-Campo A, et al. Implications of p53 gene mutations on patient survival in transitional cell carcinoma of the bladder: a long-term study. Urol Oncol. 2008 Nov-Dec. 26(6):620-6. [Medline].
Miyamoto H, Shuin T, Ikeda I, Hosaka M, Kubota Y. Loss of heterozygosity at the p53, RB, DCC and APC tumor suppressor gene loci in human bladder cancer. J Urol. 1996 Apr. 155(4):1444-7. [Medline].
Karam JA, Lotan Y, Karakiewicz PI, Ashfaq R, Sagalowsky AI, Roehrborn CG, et al. Use of combined apoptosis biomarkers for prediction of bladder cancer recurrence and mortality after radical cystectomy. Lancet Oncol. 2007 Feb. 8(2):128-36. [Medline].
Campbell SC, Volpert OV, Ivanovich M, Bouck NP. Molecular mediators of angiogenesis in bladder cancer. Cancer Res. 1998 Mar 15. 58(6):1298-304. [Medline].
Bladder Cancer: Symptoms and Treatment
Bladder cancer is a cancer of the lining of the bladder, a piece of muscle that has multiple layers. Bladder cancer occurs more frequently among older men, with the median age of diagnosis being 73 and the media age of death being 78, data collected in the United States from 2003 to 2007.
The National Cancer Institute estimates that that there will be 74,690 new cases and 15,580 deaths from bladder cancer in the United States in 2014.
About 70 to 80 percent of new diagnoses for bladder cancer are superficial, noninvasive bladder cancer, according to the National Cancer Institute.
If the cancer spreads further into the muscle wall of the bladder or to nearby lymph nodes and organs, it is called invasive bladder cancer.
Smoking is the greatest risk factor for bladder cancer, according to the Centers for Disease Control and Prevention, causing approximately 30 percent of bladder cancers among women and 50 percent of bladder cancer among men.
Certain professionals, such as bus drivers and auto mechanics, leather workers and hairdressers, may also be at increased risk because of chemicals they work with, such as benzene, naphthylamine and ortho-toluidine.
Family history of bladder cancer can also increase risk, said Dr.David Samadi, the chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City.
Blood in the urine (hematuria) is the most common symptom of bladder cancer. It is characterized by urine that may appear dark yellow, bright red or cola-colored, according to the Mayo Clinic. However, hematuria can be intermittent, even when caused by serious disease, and its severity is not correlated to the severity of the underlying cancer.
Hematuria can indicate a number of maladies, including urinary tract infections, bladder stones, kidney stones and kidney cancer, but “a lot of times bladder cancer should be the hallmark of hematuria,” Samadi told Live Science. “If they see blood in the urine, they should think bladder cancer until they rule out other things.”
Other symptoms of bladder cancer may also include frequent urination, painful urination, urinary tract infection and lower back pain, Samadi said.
Diagnosis & tests
When a patient comes to the office, doctors may take a urine test to look for blood in the urine or for any abnormal cells that are shed by the bladder. Other tests include a cystoscopy — involving a long tube with a camera at the tip — that the doctor inserts into the body to see the inside of the urethra and the bladder.
“[Superficial] bladder cancer has a very typical look,” Samadi said. “It has a stem. It's almost broccoli- or cauliflower-looking.”
If the cancer cells are flat, it indicates that the cancer is aggressive and has a tendency to spread, he said. If invasive bladder cancer is suspected, the doctor may also order MRIs, CT scans and X-rays in order to determine if the cancer has spread to the kidneys, ureters and other internal organs.
Treatment & medication
Superficial bladder cancer, which originates from the lining of the bladder, can often be treated, according to the National Cancer Institute. data collected by the SEER Cancer Statistic Review between 2004 and 2010, the five-year survival rate for those with superficial bladder cancer was 96.2 percent while the overall five-year survival rate of bladder cancer was 77.4 percent.
Transurethral resection (TUR), with or without radiation therapy or chemotherapy, is one of the main treatments for superficial cancer, according to the Mayo Clinic. In this procedure, a tool with a small wire loop on the end is inserted into the bladder through a cystoscope.
The tumor and the surrounding area are then burned with an electric current (fulguration) or special high-energy laser.
Although the surgery has a high rate of success, patients are still advised to undergo regular cystoscopy every three months afterwards to monitor for any relapses, Samadi said.
“Bladder cancer is highly treatable if it's contained and it's in the early stage,” he said. “But these superficial bladder cancers, they can recur a lot. And that's part of the reason why the follow-up has to go on for many years after that.”
Segmental cystectomy, where only one part of the bladder is removed, may be used to treat invasive cancer that is low grade and has invaded only one area of the bladder wall.
However, radical cystectomy, where the entire bladder is removed, is the most common type of surgery for invasive bladder cancer according to the National Cancer Institute. Some surrounding tissues, nearby lymph nodes and organs may also be removed during the procedure in order to get rid of any remaining cancerous growth.
During the surgery, the surgeon will also need to reconstruct an artificial bladder and/or ureters in order to let the body store and pass urine.
“This is obviously a big operation,” Samadi said. “We do them robotically now.” Robotic surgery is less invasive and has less blood loss, he said.
With a robot, “I'm able to remove the bladder and build a new bladder small intestine,” Samadi said.
In addition to surgery, patients may also undergo biologic therapy, where the bacterium Bacille Calmette-Guérin (BCG) or synthetic immune proteins are used to boost, direct or restore the body's immune response against cancer, according to the May Clinic. These treatments are often administered directly into the bladder through the urethra.
Additional reporting by Iris Tse, MyHealthNewsDaily Contributor.
Follow Laura Geggel on @LauraGeggel and . Follow Live Science @livescience, & . Original article on Live Science.
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- Bladder Cancer: Introduction
ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Bladder Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.
About the bladder, renal pelvis, and ureter
The bladder is an expandable, hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra.
The renal pelvis is a funnel- part of the kidney that collects urine and sends it into the ureter. The ureter is a tube that runs from each kidney into the bladder. The urethra is the tube that carries urine the body.
In men, the prostate gland is also part of the urinary tract.
The bladder, other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.
About bladder cancer
Bladder cancer begins when healthy cells in the bladder lining—most commonly urothelial cells—change and grow control, forming a mass called a tumor. Urothelial cells also line the renal pelvis and ureters.
Cancer that develops in the renal pelvis and ureters is also considered a type of bladder cancer and is often called upper tract bladder cancer. It is treated in the same way as bladder cancer and is described in this guide. A tumor can be cancerous or benign.
A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Benign bladder tumors are rare.
Types of bladder cancer
The type of bladder cancer depends on how the tumor’s cells look under the microscope. The 3 main types of bladder cancer are:
- Urothelial carcinoma. Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells found in the urinary tract. Urothelial carcinoma is sometimes also called transitional cell carcinoma or TCC.
- Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time, these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.
- Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.
There are other, less common types of bladder cancer, including sarcoma of the bladder and small cell bladder cancer. Sarcomas of the bladder often begin in the fat or muscle layers of the bladder. Small cell bladder cancer is a rare type of bladder cancer that is ly to spread to other parts of the body.
Other ways of describing bladder cancer
In addition to its cell type, bladder cancer may be described as noninvasive, non-muscle-invasive, or muscle-invasive.
- Noninvasive. Noninvasive bladder cancer includes noninvasive papillary carcinoma and carcinoma in situ (CIS). Noninvasive papillary carcinoma is a growth found on a small section of tissue that is easily removed. This is called stage 0a. CIS is cancer that is found only on or near the surface of the bladder, which is called stage 0is. See Stages and Grades for more information.
- Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria and not into muscle, also called stage I. Non-muscle-invasive cancer may also be called superficial cancer, although this term is being used less often because it may incorrectly suggest that this type of cancer is not serious.
- Muscle-invasive. Muscle-invasive bladder cancer has grown into the bladder's wall muscle and sometimes into the fatty layers or surrounding tissue outside the bladder.
It is important to note that non-muscle-invasive bladder cancer has the possibility of spreading into the bladder muscle or to other parts of the body. Additionally, all cell types of bladder cancer can spread beyond the bladder to other areas of the body through a process known as metastasis.
If a bladder tumor has spread into the surrounding organs, such as the uterus and vagina in women, the prostate in men, and/or nearby muscles, it is called locally advanced disease.
Bladder cancer also often spreads to the lymph nodes in the pelvis. If it has spread into the liver, bones, lungs, lymph nodes outside the pelvis, or other parts of the body, the cancer is called metastatic disease.
This is described in more detail in Stages and Grades.
Looking for More of an Introduction?
If you would more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net.
The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with bladder cancer and general survival rates. Use the menu to choose a different section to read in this guide.
Bladder Cancer Types
Bladder cancer is classified the type of cells it contains. The main types of bladder cancer are:
Transitional cell bladder cancer: About 90% of bladder cancers are transitional cell carcinomas – cancers that begin in the urothelial cells, which line the inside of the bladder. Cancer that is confined to the lining of the bladder is called non-invasive bladder cancer.
Squamous cell bladder cancer: This type of bladder cancer begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation. These cancers occur less often than transitional cell cancers, but they may be more aggressive.
Adenocarcinoma: Bladder cancer that develops in the inner lining of the bladder as a result of chronic irritation and inflammation. This type of bladder cancer tends to be aggressive.
In rare cases, bladder cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Bladder Cancer Risk Factors
Anything that increases your chance of getting bladder cancer is a risk factor. These include:
Smoking tobacco: This is the greatest risk factor for bladder cancer. Smokers, including pipe and cigar smokers, are two to three times more ly than nonsmokers to get bladder cancer.
Chemicals in tobacco smoke are absorbed into the blood, and then they pass through the kidneys and collect in the urine.
These chemicals can damage the inside of the bladder and increase your chances of getting bladder cancer.
Age: The chance of developing bladder cancer increases with age, and it is uncommon in people under 40.
Race: Bladder cancer occurs twice as often in Caucasians as it does in African-Americans and Hispanics. Asians have the lowest rate of developing the disease.
Gender: Men are up to four times as ly as women to get bladder cancer.
Personal history of bladder cancer: Bladder cancer has a 50% to 80% chance of returning after treatment. This is the highest of any cancer, including skin cancer.
Exposure to chemicals: People who work around certain chemicals are more ly to get bladder cancer. These include:
- People who work in the rubber, chemical and leather industries
- Machinists and metal workers
- Textile workers
- Truck drivers
- People who work at dry cleaning businesses
Infections: People infected with certain parasites, which are more common in tropical climates, have an increased risk of bladder cancer.
Treatment with cyclophosphamide or arsenic: These drugs, which are used in the treatment of cancer and other conditions, raise the risk of bladder cancer. Arsenic in drinking water may increase risk too.
Chronic bladder problems: Infections and kidney stones may be risk factors, but no direct link has been established.
History of taking a fangchi, a Chinese herb
Having a kidney transplant
Hereditary nonpolyposis colon cancer (HNPCC, also called Lynch syndrome)
Not everyone with risk factors gets bladder cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.
Learn more about bladder cancer:
- Bladder cancer symptoms
- Bladder cancer diagnosis
- Bladder cancer treatment
What is Bladder Cancer?
A cancer diagnosis can be very frightening. However, your doctor and medical team are there to help you.
Talk with your healthcare team about all the available forms of treatment. They will tell you about possible risks and the side effects of treatment on your quality of life.
Your options for treatment will depend on how much your cancer has grown. Your urologist will stage and grade your cancer and assess the best way to manage your care considering your risk. Risks are classified as low, intermediate or high and suggests the lihood of tumor recurrence and/or progression. Treatment also depends on your general health and age.
Options and Choices for Treatment
Treatments for non-muscle invasive bladder cancer include:
- Cystoscopic resection of the tumor
- Intravesical immunotherapy
- Intravesical chemotherapy
If these options fail to treat your cancer, your doctor may recommend removing the complete bladder.
Cystoscopic tumor resection
During a tumor resection, your doctor will remove any cancer cells that can be seen at transurethral resection of bladder tumor (TURBT).
Transurethral resection of bladder tumor (TURBT) is usually done under anesthesia. The surgery is done during cystoscopy, so there is no cutting into the abdomen. You will be given general or spinal anesthesia.
A rigid cystoscope is what your doctor will use for this procedure. This scope is straight and does not bend. It has a light at the end and is bigger and allows surgical instruments to pass through it. Your doctor is able to see inside the bladder, take tumor samples and resect (cut away) the tumor.
If a tumor is clearly seen, the doctor will attempt to remove it all. The doctor may also remove very small samples of other areas of the bladder that may look abnormal. These samples will also be checked for grade and stage. You may be left with a Foley catheter in your bladder after this procedure to allow your bladder to heal.
You may need to have your tumor resectioned more than once. During your follow-up examinations your doctor will check to make sure all the cancer is removed.
What to expect from Intravesical Therapy
Intravesical (“within the bladder”) therapy, is when a treatment drug is put directly into your bladder. The drug is put into the bladder with the help of a catheter (a thin tube that is placed through the urethra). You will hold the drug in your bladder for one to two hours and then pass it out. Intravesical chemotherapy is usually given immediately after surgery.
Intravesical Immunotherapy Immunotherapy
Immunotherapy is a treatment that boosts the ability of your immune system to fight the cancer. Bacillus Calmette-Guerin (BCG) is the immunotherapy drug that is used for bladder cancer. BCG also has been used as a tuberculosis vaccine.
Your BCG therapy will probably last about six weeks for the first course. It is usually done in your doctor's office, not in the hospital or operating room. You may get BCG treatment more than once.
The BCG drug is inserted into the bladder through a catheter. The therapy triggers the immune system to attack bladder cancer cells. It is one of the most effective treatments for bladder cancer, especially carcinoma in situ (CIS). It is not recommended if you have a weak immune system or certain symptoms. Side effects can include:
- Urinating often
- Pain when urinating
- Flu- symptoms
- Joint pain
- Fever or chills
- Bacteria infecting whole body (less common)
Intravesical chemotherapy is usually given immediately after surgery.
With intravesical chemotherapy, drugs that are known to kill cancer cells are placed directly into the bladder, not in the bloodstream.
As a result, many common side effects of chemotherapy – hair loss – can be avoided. Because the drugs only reach the bladder lining, this type of treatment is only recommended for NMIBC.
Mitomycin C is the most common chemotherapy drug used for intravesical therapy. It is usually given after the initial TURBT. It helps stop cancer cells from going to another place and growing. It also reduces the recurrence rates. It can also be given as a six-week induction course similar to BCG. Common side effects include:
- The need to urinate often
- Painful urination
- Flu- symptoms
- Skin rash
Repeat Intravesical Therapy
Some patients may respond to repeat therapy if the cancer returns. If you have high-grade Ta or T1 cancer or CIS, or you tried BCG and it did not work, you may need something else to control the cancer. In this case, you should talk to your doctor about surgery to remove the bladder.
Maintenance Intravesical Therapy
After the bladder is free of disease, your doctor may suggest more treatment with the same drugs to keep the tumor from coming back. This may happen at the first three-month appointment after treatment.
Maintenance therapy is a good choice for people who have had BCG, less so for those who have had chemotherapy drugs. It is given for up to three years after treatment, and generally about every six months for three weeks at a time.
Your doctor will talk to you about whether you are a candidate for maintenance therapy. He/she will also talk about whether intravesical chemotherapy or BCG are good options for you.
Surgery to Remove the Bladder
If you have NMIBC, you may have to remove your bladder if intravesical BCG therapy fails. You may also need to remove it if you are at a greater risk of getting the cancer again or of it spreading. Cystectomy is being recommended more and more for tumors that are high-grade T1, T1+CIS (carcinoma in situ) and T1+LVI (lymphovascular invasion)
Partial Cystectomy(removal of part of the bladder)
Partial cystectomy is a good choice for some patients if the tumor is located in a specific part of the bladder and does not involve more than one spot in the bladder.
The surgeon removes the tumor, the part of the bladder containing the tumor, and nearby lymph nodes. After part of the bladder is removed, you may not be able to hold as much urine in your bladder as before surgery.
You may need to empty your bladder more often.
Radical Cystectomy(removal of the whole bladder)
For NMIBC, radical cystectomy is usually done if other therapies fail. The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra. In men, he/she may remove the prostate as well. In women, the surgeon may remove the uterus, ovaries, fallopian tubes, and part of the vagina. Other nearby tissues may also be removed.
Urinary diversion after bladder removal
When your bladder is removed or partly removed, your urine will be stored and made to leave your body by a different route. This is called urinary diversion. If you have a radical cystectomy, you will need to know about urinary diversion options.
Because the surgeon uses tissue from your intestines for bladder reconstruction, you must have sufficient bowel tissue for them to create your urinary diversion method.
Before this is done, your surgeon will explain the procedure to you so that you can understand what will be done and the adjustments you will need to make.
Here are some of the urinary diversion options your surgeon may offer:
- Ileal conduit: To make an ileal conduit, the surgeon will take a piece of your upper intestine and use it to create an opening (stoma) on the surface of your abdomen. The ureters are connected so that the urine leaves your body by the opening. A bag will be attached to collect the urine, and you will “dump” the bag several times a day. This is the most simple, and most commonly used diversion after bladder surgery.
- Continent cutaneous reservoir: Your surgeon creates a pouch inside your body and you will learn to use a catheter to remove the urine.
- Orthotopic neobladder: Your surgeon creates an internal pouch, much your bladder, to store urine. Your ureters are connected to this new “bladder” and you are able to empty through your urethra the same way you did before the surgery. In some instances, you may need to use a catheter to remove the urine.
Talk with your doctor about your options for a urinary diversion. Having a urinary diversion will greatly impact your quality of life. For more information on urinary diversion visit our Urinary Diversion article.
Women & Bladder Cancer – Bladder Cancer Advocacy Network
Bladder cancer has long been considered a disease of older men. Though it is more prevalent in men, studies have shown that women are more ly to present more advanced tumors and have a worse prognosis than men at almost every stage of the disease.
According to a report published by the National Cancer Institute, the survival rate for women with bladder cancer lags behind that of men at all stages of the disease. African-American women, particularly have poor outcomes when diagnosed with bladder cancer.
They present with the highest proportion of advanced and aggressive tumors when compared to African-American men and Caucasian men and women. In addition, the number of women diagnosed with bladder cancer has been increasing.
You can learn more about about the statistics, treatment and survival differences in our webinar: Women and Bladder Cancer.
It is important for women to understand their risks for bladder cancer and know what to ask their doctors. Awareness is the key: in most cases, bladder cancer is treatable, but prompt diagnosis is critical.
Why the disparity?
In many cases, there are significant delays in diagnosing bladder cancer in women. Many women ignore the most basic symptom—blood in the urine—which they may associate with menstruation or menopause and delay reporting this symptom to their doctors.
Even after reporting the problem to their doctors, blood in the urine may be initially misdiagnosed as a symptom of post-menopausal bleeding, simple cystitis or as a urinary tract infection.
As a result, a bladder cancer diagnosis can be overlooked for a year or more.
What do women need to know?
• Bladder cancer can affect women at any age.
• Smoking is the greatest risk factor. Smokers get bladder cancer twice as often as non-smokers.
• Bladder cancer symptoms may be identical to those of a bladder infection and the two problems may occur together.
If symptoms do not disappear after treatment with antibiotics, insist upon further evaluation to determine whether bladder cancer is present.
• Bladder cancer has the highest recurrence rate of any form of cancer—between 50-80 percent.
What can you do?
The most important thing for you is to know the signs and symptoms of bladder cancer and report them to your physician immediately.
The most common sign—blood in the urine—can be visible (though it may sometimes appear dark brown or orange) but could also only be detected under a microscopic examination. It is important to visit your doctor for routine examinations.
Most bleeding associated with bladder cancer is painless, however, about 30 percent of bladder cancer patients experience burning, frequent urination or a sensation of incomplete emptying when they urinate.
If you experience any of these symptoms, see your doctor as soon as possible.
Women & Bladder Cancer: Sharing Stories to Advance Research
BCAN was invited to share the experiences of women diagnosed with bladder cancer at the “Bladder Cancer in Women: Identifying Research Needs to Improve Diagnosis and Treatment” program sponsored by Johns Hopkins Greenberg Bladder Cancer Institute and the American Urological Association Translational Research Collaboration. Each of these women’s stories are memorable and unique. However their stories are repeated often around the country because women are not the “typical bladder cancer patient.” Read the the transcript of their presentation here.
Advice from women survivors
The good news is that in most cases, if caught early, bladder cancer is a manageable disease. There are tens of thousands of women bladder cancer survivors living today. Read their stories