Urinary Bladder Cancer

Cancer of the bladder can occur in the lining of the bladder, or the muscle layer. Like most other cancers, the treatment(s) depend on the stage of the cancer. The urolologist will participate with an oncologist (see glossary) and radiologist in determining the treatment(s) that would provide the patient with the greatest chance for a cure depending on the stage of the cancer. Transurethral resection (TUR), may be used for early-stage or superficial bladder cancer. A resectoscope, which is a thin tool with a wire loop on the end, is threaded through the urethra to the bladder, and then the tumor is scraped from the bladder wall. Fluorescence cystoscopy, a special way of looking at the bladder wall, may be used to enhance bladder cancer detection.

Treatment

If the urologist recommends cystectomy (excision of the urinary bladder), there are variations of this surgery. One method is called “open surgery”, in which a long incision is made for direct view of the surgery.

Under some circumstances, a cystectomy can be performed laparoscopically. Laparoscopy allows the physician to make only a few small incisions into which he inserts rigid instruments used to visualize and excise the bladder, and certain adjacent structures.

There are two types of cystectomies:

  • Partial Cystectomy: If cancer has invaded the muscle layer of the bladder wall, but is not large and is confined to one region of the bladder, then it may be possible to treat the cancer by removing only part of the bladder. With this procedure, the portion of the bladder where there is cancer is removed, and the hole in the bladder wall is then closed.
  • Radical Cystectomy: If the cancerous tumor is larger in size or is in more than one region of the bladder, then the entire bladder may need to be removed. With a radical cystectomy, nearby lymph nodes may also be removed, along with the prostate (for men), and, for women, the ovaries, fallopian tubes, uterus and a small part of the vagina. This type of bladder cancer surgery is an extensive procedure, but may help ensure that all cancer cells are removed from the body and reduce the likelihood of the disease recurring.

Radical cystectomy requires a rerouting of the urine to the outside of the body or a substitute reservoir for the urine to pool, then be expelled from the body. The surgically constructed reservoir is formed from resected section of the small and/or large intestines and attached to the ureters. The urine is expelled through an opening in the abdomen.

Another method of rerouting the urine is done by attaching the newly formed bladder to the ureters and the urethra, allowing a more natural method of expelling the urine.

The symptoms associated with bladder cancer may be the result of less serious problems or infections. If any of these conditions last more than two weeks, the urologist can conduct tests to be sure that the patient receives the correct diagnosis as soon as possible.

  • Blood in the Urine: The first sign of bladder cancer is usually blood in the urine, also called hematuria. (see glossary) The color of the urine may change to a very pale yellow-red. More rarely, the urine may be dark red. Other times, the urine does not change color but blood is found during a routine medical check-up. Hematuria may be caused by other conditions, such as an infection, noncancerous lesion, kidney stones, bladder stones or a benign kidney disease. If blood is found in the urine, follow-up tests can help pinpoint the exact cause.
  • Changes in Urination: Frequent urination, pain during urination and a feeling of urination urgency even when the bladder is not full may be bladder cancer symptoms. It is important to recognize that these changes are more commonly a sign of a less serious condition, such as a benign tumor or an infection. An inability to urinate may be a sign of bladder cancer.
  • Lower Back Pain: Larger bladder cancers may cause lower back pain.