Bladder Cancer

The most common symptom of bladder cancer is bleeding in the urine (hematuria). Most often the bleeding is “gross” (visible to the naked eye), episodic (occurs in episodes), and is not associated with pain (painless hematuria). However, sometimes the bleeding may only be visible under a microscope (microscopic hematuria) or may be associated with pain due to the blockage of urine by formation of blood clots. There may be no symptoms or bleeding for prolonged periods of time between episodes, lulling the patient into a false sense of security (“I don’t know what the problem was, but it is fine now!”). Some types of bladder cancer may cause irritative symptoms of the bladder with little or no bleeding. The patients may have the desire to urinate small amounts in short intervals (frequency), inability to hold the urine for any length of time after the initial desire to void (urgency), or burning sensation while passing urine (dysuria). These symptoms occur more commonly in patients with high-grade, flat urothelial cancers called “carcinoma in situ” or “CIS” (described subsequently in the section on staging of bladder cancer).

Rarely, patients may present with signs and symptoms of more advanced disease such as a distended bladder (due to obstruction by a tumor at the bladder neck), pain in the flanks (due to obstruction of urine flow from kidney to the bladder by the growing tumor mass in the bladder), bone pains, or cough/blood in the phlegm (due to spread to cancer cells to bones or lungs).

Cancer treatment is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs). These doctors work with the cancer patient to decide on a treatment plan.

Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for bladder cancer are based on the following.

• Stage of the tumors
• Grade of the tumors
• Location of the tumors
• The person’s overall health

• Surgery
  • Transurethral resection (TUR) with fulguration – most often used for removal of superficial tumors.
    • The tumors is removed through a cystoscope.
    • The tumors bed is burned with high-energy electricity using heat or a laser.
  • Segmental (partial) cystectomy – removal of the tumors and part of the bladder.
  • Radical cystectomy – removal of the entire bladder, surrounding fatty tissue and nearby lymph nodes.
    • In men, the prostate, seminal vesicles and part of the urethra are also removed.
    • In women, the uterus, cervix, Fallopian tubes, ovaries, front of the vaginal wall and urethra are also removed.
  • Reconstructive surgery (urinary diversion) – Sometimes a diversion is created without removing the bladder to relieve blocked urine flow if the cancer has spread or cannot be removed by surgery.
    • Ileal conduit
    • Indiana pouch
    • Orthotopic neobladder
• Biological therapy
  • Intravesical – instilled into the bladder through a urinary catheter.
  • Most often used to treat superficial tumors.
  • Bacillus Calmette-Guerin (BCG) most often used.
• Chemotherapy
  • Intravesical
    • Instilled into the bladder through a urinary catheter.
    • Most often used when treatment with BCG is unsuccessful.
  • Systemic
    • Combination chemotherapy given intravenously.
    • May be a treatment option for locally advanced and metastatic bladder cancer.
• Radiation therapy
  • External beam radiation therapy
  • Brachytherapy
• Follow-up after treatment is finished
  • It is important to have regular follow-up visits, especially in the first 3 years after treatment.