What is bladder cancer?
Bladder cancer, also known as urothelial cancer, is currently the 6th most common cancer in the United States with an estimated 68,000 new cases in 2008. It is more likely to occur in men than women and usually occurs after the age of 55. According to the American Cancer Society, the chances of a man getting the disease is about 1 in 27 and for a woman is about 1 in 85. Bladder cancer develops in the cells that line the inside of the bladder, also known as urothelial cells. This type of cell also lines the ureters and the inner portion of the kidney known as the collecting system and urothelial cancer can occur anywhere in the urinary tract. However, the bladder is by far the most common location.
What are the symptoms?
The classic presentation of bladder cancer is blood in the urine (hematuria) without any accompanying pain. This is often diagnosed on a routine urinalysis which prompts a work-up to find the cause of the hematuria. Other symptoms that can occur depending on the type, size, and location of the tumor include urinary frequency, urinary urgency, and dysuria (pain or burning with urination)
How is bladder (urothelial) cancer diagnosed?
Bladder cancer is typically diagnosed during the evaluation of blood in the urine (hematuria). This evaluation includes a cystoscopy, which is an office procedure during which a small scope is placed into the bladder, and some type of imaging of the urinary tract typically a CT scan is recommended. Once a suspected tumor is identified during cystoscopy, a biopsy is required to confirm the diagnosis and stage the tumor.
How is bladder (urothelial) cancer staged?
Bladder cancer is staged with a combination of a biopsy and abdominal imaging. At the time of biopsy, the entire tumor is resected (if possible) with a procedure known as a transurethral resection of bladder tumor or TURBT. An attempt is made to not only remove the entire tumor, but to sample some of the muscle in the bladder wall at the base of the tumor. If the tumor is only on the bladder surface and does not invade the lining or lamina propria, it is a stage Ta tumor. If the tumor invades into the lining layer but not into the muscle of the bladder, it is referred to as a stage T1 tumor. Invasion into the bladder muscle is a stage T2 and when the tumor extends to surrounding structures or there are metastases, it becomes a T3 or T4. In addition to the stage, the pathologist will also report a tumor grade. Low grade bladder cancers are less likely to progress or spread whereas high grade tumors are more aggressive and need to be monitored more closely.
How is bladder cancer treated?
The majority of bladder cancers do not invade into the muscle of the bladder and can be managed with transurethral resection (TURBT). Tumors that invade into the bladder lining, are high grade, or are in multiple locations, may require intravesical therapy after surgery to help prevent recurrence or progression of the cancer. Bladder cancers that invade into the bladder muscle, usually require a larger operation called a cystectomy where the entire bladder is removed. During a cystectomy, the urine is diverted using a segment of small intestine which is used to create a conduit to the skin (urostomy) or the bowel can be made into a new bladder (neobladder). For more advanced bladder cancer, chemotherapy may also be required.
How is bladder cancer followed?
One of the most important aspects in managing bladder cancer is surveillance. Bladder cancer has a high rate of recurrence and can also occur anywhere else in the urinary tract so patients require lifelong monitoring to prevent and treat any recurrences. This is accomplished with periodic urine testing, imaging, and cystoscopy.