Treating bladder cancer: What patients need to know
While bladder cancer doesn’t get as much press as colon or lung cancer, it’s the fourth-most common type of cancer among men. I see about 10 to 20 new patients each month who are diagnosed with bladder cancer, and MedStar Washington Hospital Center performs more bladder cancer surgeries than any other center in Washington, D.C. The disease accounts for about five percent of all cancer cases in the United States, and the American Cancer Society estimated that more than 79,000 new cases would be diagnosed in 2017 alone.
Finding out you have bladder cancer can be scary, but today’s advances in detecting and treating the disease mean it’s possible to beat the disease. Let’s go through how we first detect bladder cancer, how we treat it and what comes next for patients.
LISTEN: Dr. Stamatakis discusses bladder cancer care further on the Medical Intel podcast.
Bladder cancer symptoms and diagnosis
The most common reason patients come to see me is because they’ve noticed blood in their urine. However, this is not a foolproof indicator for bladder cancer. Blood in the urine also is a symptom of several noncancerous conditions, such as an enlarged prostate, kidney stones or a urinary tract infection.
Often, patients report having to go to the bathroom more often than normal or needing to go more urgently, and the treatments their primary care doctors have tried haven’t helped. Every now and then, patients come in who have had a computed tomography (CT) scan for some other reason (such as after a car accident), and the radiologist has seen a bladder tumor in the scan images.
Primary care doctors and other urologists often refer their patients to MedStar Washington Hospital Center because of our expertise in diagnosing and treating bladder cancer. The diagnostic process starts with a special kind of CT scan called a CT urogram, which creates images of the entire urinary tract. This includes the:
- Ureters, the tubes that carry urine from the kidneys to the bladder
This tells us two things: whether the patient has a bladder tumor and, if so, where it’s located. The location of a bladder cancer tumor plays an important role in treatment. About 75 percent of all bladder cancers appear in the urothelium, which is the bladder’s inner layer. These tumors tend to grow from this layer toward the bladder muscle, also known as the detrusor muscle, a layer of muscle fibers that relaxes to allow urine into the bladder and contracts to push urine out of the body.
Another way we view a patient’s bladder is through a procedure called a cystoscopy. This involves placing a tiny camera into the bladder to directly view the bladder’s surface, and it gives us more information about a patient’s cancer and where it’s located.
How we treat bladder cancer
The next step is to get the patient’s tumor out of the bladder with a procedure called transurethral resection of bladder tumor (TURBT). For many patients, this is the main part of their treatment.
TURBT surgery uses an instrument called a resectoscope, which we place through the urethra (the tube through which urine leaves the body) and into the bladder. The resectoscope allows us to see inside the bladder and remove suspicious tissue or tumors. Patients usually go home the same day or the day after TURBT surgery.
We often combine TURBT with blue-light cystoscopy. About an hour before the tumor-removal procedure, we put an imaging agent into the patient’s bladder. This imaging agent is absorbed by cancer tissue, and once we’ve removed the tumor, we shine a blue light that causes the imaging agent to look pink. This lets us see any additional tumors that were too small to detect on previous scans and confirm that we’ve removed all the tumor tissue from the patient’s bladder.
Related reading: Blue Light Cystoscopy: A Better Way to Detect Bladder Cancer
Once the tumor is out, a pathologist examines it to confirm the cancer diagnosis and determine whether it has invaded the bladder muscle. If it hasn’t, the main part of that patient’s treatment is complete. If the cancer has invaded the muscle, patients often will need advanced treatment for their cancer.
The usual treatment for muscle-invasive bladder cancer is radical cystectomy, which involves removing the entire bladder. Many patients can qualify for minimally invasive robot-assisted surgery for bladder removal, a procedure known as robotic-assisted cystectomy. This surgery is more intensive than TURBT. Patients may need to stay in the hospital for four or five days afterward, and it may be a few months before they feel like they’re back to normal.
Traditionally, because they no longer have a bladder to collect urine from the kidneys, patients who have bladder-removal surgery also have needed a procedure called urostomy. This involves creating an artificial opening through a small piece of intestine for urine to drain into a bag outside of the body, which the patient has to change regularly.
A newer option for some patients is called neobladder construction, which involves taking a larger piece of intestine and connecting it to the patient’s urethra. All of this is done inside the body without the need for an external appliance. Neobladder construction is a more natural-looking solution that my patients appreciate.
Careful monitoring for bladder cancer that comes back
Unfortunately, it’s not possible to completely eliminate the risk of bladder cancer returning after treatment (also known as recurrent bladder cancer). One way we lower the risk is by offering chemotherapy either before or after surgery. Research suggests that chemotherapy offered before bladder cancer surgery, known as neoadjuvant chemotherapy, improves patients’ overall survival rates.
Recurrence rates for bladder cancer are quite high, so we have to closely monitor patients with regular cystoscopies. We can do these in the office as an outpatient procedure with little or no discomfort. If we see cancer cells returning after treatment, we often can use intravesical treatment to destroy them. This involves cancer medication given directly into the bladder. We can give chemotherapy medication to kill cancer cells, or we can give immunotherapy treatments to increase the immune system’s ability to target and destroy the cancer cells.
We’ve made great strides in bladder cancer treatment and awareness in recent years, thanks in part to advocacy groups like the Bladder Cancer Advocacy Network (BCAN), which was founded here in Washington, D.C. And we’re working closely with local primary care doctors, so they better understand how to spot what the symptoms of bladder cancer and they know when it’s time to send their patients to a specialist.
With more awareness, and with more advanced treatments available and in development, I’m confident in our ability to help patients deal with this terrible disease.
Request an appointment with one of our urologic oncologists to learn about our treatments for bladder cancer.