Bladder Cancer

What are the risk factors for bladder cancer?

Several factors can increase the risk of developing bladder cancer, including smoking tobacco, exposure to certain chemicals in the workplace (those used in the dye industry or rubber manufacturing), chronic bladder inflammation or infections, and a family history of bladder cancer.

What are the signs and symptoms of bladder cancer?

Bladder cancer is typically detected after a patient is found to have blood in the urine. Other signs and symptoms may include frequent urination, pain during urination, urinary urgency, pelvic pain, and difficulty with urination; however, these symptoms can also be caused by other conditions as well.

How is bladder cancer diagnosed?

If bladder cancer is suspected, a series of tests will typically be performed to make a diagnosis. These may include a urine sample to check for blood or cancer cells, imaging tests (such as ultrasound or CT scan) to visualize the bladder and urinary tract, and a cystoscopy, which involves inserting a small camera into the bladder to examine it more closely. If a tumor is seen during the cystoscopy, then the patient is taken to the operating room to resect tumor and confirm cancer.

What are the treatment options for bladder cancer?

If tumors are visualized in the bladder, the patient is taken to the operating room for a transurethral resection of. bladder tumor (TURBT) to scrape away the tumor— while removing the tumor, this can also provide information on the grade and stage of the tumor. The pathology report from this procedure helps to guide subsequent treatment, which can include a repeat TURBT, chemotherapy inserted into the bladder, intravenous chemotherapy, or surgical removal of the bladder. As bladder cancer is a very recurrent condition, a combination of these approaches may be utilized, and continued surveillance of the bladder is required over the patient’s lifetime to ensure that it does not recur.

Transurethral resection of bladder tumor (TURBT)

In most cases, a TURBT is an outpatient procedure, and the patient is able to go home the same day, possibly with a catheter. During the procedure, the urologist passes a camera through the urethra and enters the bladder. An effort is made to resect all the tumor that is visible, however in cases where there is a lot of tumor this requires a second procedure to remove the remaining tumor. The risks of the procedure include having blood in the urine, a urinary tract infection, perforation of the bladder, and urethral stricture disease. Following some procedures, chemotherapy is instilled into the bladder in the recovery room to help decrease the recurrence of the disease.

Intravesical chemotherapy (chemotherapy instilled into the bladder)

Bladder cancer which has not invaded the bladder is typically treated with a regimen of intravesical chemotherapy. Typical agents include mitomycin, docetaxel, gemcitabine, and the Bacillus Calmette–Guérin (BCG) vaccine. A typical regimen involves receiving the agent weekly for up to 6 weeks, and may be repeated with less frequency if there continues to be no evidence of recurrence. During each session, the patient comes to the office and has a catheter inserted. The medication is then instilled via the catheter, and the catheter is removed. The drug is allowed to dwell in the bladder for about an hour, after which the patient can urinate and eliminate the drug. Because the drug is instilled in the bladder, side effects which are typically seen with systemic chemotherapy are rare, however patients may experience urinary discomfort.