Expert Bladder Cancer Care By Fellowship Trained Specialist in Bladder Cancer Treatment
Bladder cancer comes in two varies: superficial or non-invasive disease and more aggressive, invasive disease that is more likely to spread. Bladder tumors can be superficial involving the surface of the bladder or more invasive invading the bladder muscle.
Bladder cancer typically presents in men and women aged 50 and above but can present at earlier age. The rates of bladder cancer increase with age. Smoking is a major risk factor for bladder cancer.
Symptoms of bladder cancer can be vague and can be confused with other problems such as BPH or enlarged prostate in men or frequent UTIs or overactive bladder in females. People with exposure to carcinogens or history of smoking are at increased risk. If you think you have symptoms of bladder cancer, seek an appointment with a urologist.
Signs and Symptoms Suggestive of Bladder Cancer:
- Blood in urine (hematuria) can be visible or detected via microscopic examination of urine specimen.
- Frequent urination
- Frequent urge to urinate
- Difficulty passing urine, clots in urine
Evaluation of bladder cancer involves a comprehensive medical history and a physical exam. Urine and blood tests to test for UTI and to evaluate kidney function as well as blood count will be performed. Cystoscopy, an office procedure to evaluate the bladder will be performed on a regular basis. Additional testing such as ultrasound, CT scan, MRI or PET scan may be performed based on individual need.
Allows direct visualization of the bladder; provides information on the number of lesions, appearance of lesions, appearance and capacity of the bladder.
Bladder Cancer Staging and Classification:
- Ta = papillary epithelium-confined tumors
- Tis = flat in-situ carcinoma (CIS)
- T1 = invasion of lamina propria
- T2a = invasion of superficial muscle
- T2b = invasion of deep muscle
- T3a = microscopic invasion of perivesical fat
- T3b = macroscopic invasion of perivesical fat
Bladder Cancer Lesions can be:
- Submucosal – least common; most aggressive
Distribution of Newly diagnosed Superficial Bladder Cancer: Ta, T1, Tis. 70% of bladder cancer presents as superficial disease (Ta, T1, Tis)
- 70% Ta
- 20% T1
- 10% Tis (CIS)
Low grade Ta lesions:
- 50-70% recurrence rate
- 5% chance of progression
High grade T1:
- 80% recur
- 50% progress within 3 years
- Based on patient characteristics, can be managed as T2 disease.
Treatment of Bladder Cancer
Once a urologist visualizes a suspicious appearing bladder lesion or bladder tumor during cystoscopy, bladder biopsy would be recommended which can be performed in the office or in the operating room. If the procedure is performed in the operating room, the urologic surgeon may perform bladder cancer surgery to remove the bladder tumor and to obtain pathological tissue for biopsy. The procedure, TURBT (Transurethral resection of bladder tumor) can take 1-2 hours. If indicated, the urologist will administer mitomycin C in the bladder at the end of the procedure to minimize the risk of bladder carcinoma recurrence rate.
Surgical Treatment Options for Bladder Cancer (Carcinoma):
– TURBT – is a surgery for bladder cancer. It is both diagnostic and therapeutic procedure. Stage 1 bladder tumors can be treated with TURBT.
– intravesical administration of BCG is often recommended for high grade recurrent Ta, as well as T1 stage bladder cancer.
– Radical Cystectomy which can be performed openly or robotically can be performed for T2, T3 and T4 stage of bladder cancer. Urinary tract reconstruction using bowel can be performed. Neobladder, Studer T Pouch or Ileal conduit are standard reconstructions after surgery for bladder cancer.