Bladder Cancer

Overview

Bladder cancer results from the unchecked growth of cancerous cells in the urinary bladder. More than 79,000 new bladder cancer cases are diagnosed in the United States every year, with men accounting for nearly 75 percent of them. There are several types of bladder cancer, whose symptoms and treatments may vary.

At City of Hope, treatment begins with comprehensive screening and diagnostic tools, and centers on our unique “coordinated care pathway” in which our multidisciplinary teams combine the latest research findings with outstanding patient care.


Request a consultation

Our bladder cancer team is an integrated group of experts who will focus on providing you optimal care from the moment of diagnosis to active treatment to recovery and survivorship.

If you have been diagnosed with bladder cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information. 

They actually listened to what I wanted from the surgery; they were able to give me options that other hospitals were not able to give me." Christine Crews, bladder cancer survivor

Highlights of our bladder cancer program include:

  • Leadership and experience in bladder surgery, being one of the largest centers offering robotic cystectomies with novel urinary diversion options, such as Indiana pouches and neobladders.
  • Surgical expertise in minimally invasive operations
  • Specialization in urinary tract reconstruction and the treatment of erectile dysfunction, urinary incontinence and urologic retroperitoneal disease.
  • A “coordinated care pathway” that integrates experts from multiple specialties to focus on individual cases through the entire continuum of care and rehabilitation — expediting recovery, improving outcomes and enhancing the patient experience
  • A wide portfolio of drugs that can fight cancer better with fewer side effects
  • Ongoing research and clinical trials of promising new therapies, including immunity-based and stem cell therapies
  • Long-term survivorship and follow-up program focused on minimizing recurrence risk and improving quality of life
Located near Los Angeles, California, City of Hope has been named a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education.
 
As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based bladder cancer treatment guidelines for patients throughout the country.

 

 

NEWS & BREAKTHROUGHS

What is bladder cancer?

Bladder cancer is a disease in which cells in the urinary bladder start growing abnormally and uncontrollably.

  • About 90 percent of bladder cancers are transitional cell carcinomas (also known as urothelial carcinomas), which begins in the cells that line the inside of the bladder.
  • Rarer bladder cancers include squamous cell carcinomas (originating from flat-shaped cells), adenocarcinomas (from mucus-secreting gland cells), small cell carcinoma (from nerve-like neuroendocrine cells) and sarcomas (from the bladder’s muscle cells).

What are the types of bladder cancer?

  • Non-muscle-invasive bladder cancer (NMIBC)
    • These cancers are the most common and about 90 percent of bladder cancers are transitional cell carcinomas (also known as urothelial carcinomas), which begins in the cells that line the inside of the bladder.
  • Muscle-invasive bladder cancer is when the cancer has grown into deeper layers of the bladder wall. These are more likely to spread to other organs and are harder to treat. Rarer bladder cancers include:
    • squamous cell carcinomas: Accounting for about four percent of bladder cancers, this cancer forms in the squamous cells, thin, flat cells that appear in the bladder in response to long-term infection or irritation. Over time, they can become cancerous.
    • adenocarcinomas: This type develops from glandular cells that release mucus and other fluids, and is responsible for about two percent of all bladder cancers.
    • small cell carcinoma: Beginning in the nerve-like neuroendocrine cells, this cancer is extremely rare. It is highly aggressive and often diagnosed at advanced stages.
    • sarcoma: Another rare bladder cancer, sarcoma starts in the muscle cells of the bladder.

The choice of treatment and the long-term outcome for people who have bladder cancer depend on the stage and grade of the cancer.

  • The stage is determined by the cancer growth in the bladder wall and how far it has spread to nearby tissues and other organs, such as the lungs, the liver, or the bones.
  • The grade depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Tumor grade helps determine risk of recurrence and progression in bladder cancer.

What are the signs and symptoms of bladder cancer?

Most common bladder cancer symptoms are linked with urination changes, including:

  • Blood in the urine
  • Pain or burning sensation during urination
  • Weak urine flow
  • Urgency to urinate, even with bladder is not full
  • Increased urination frequency

Bladder cancer may also cause more generalized symptoms, such as:

  • Pain in the lower back or pelvic area
  • Fatigue
  • Swelling in the feet
  • Loss of appetite and unexplained weight loss

Although these symptoms can be caused by other conditions, you should check with a doctor – preferably a urologist – so they can make a definitive diagnosis.

What increases your risk of bladder cancer?

Factors that can elevate risk of bladder cancer include:

  • Smoking: Smoking causes approximately half of all bladder cancer cases and smokers are three times more likely to get bladder cancer compared to nonsmokers.
  • Age: Approximately 90 percent of cases are diagnosed in people older than 55.
  • Gender: Bladder cancer is more common in men.
  • Chronic bladder infections or irritations, including prolonged use of urinary catheters
  • Workplace chemical exposures: Chemicals called aromatic amines, which are used in the dye industry, can cause bladder cancer. As such, people work in printing, painting, textiles and hairdressing industries may have a higher bladder cancer risk.
  • Prior treatment with radiation therapy in the pelvic area or with chemotherapy
  • Genetic mutations: Having certain changes in the genes that are linked to bladder cancer.

Sources: National Cancer Institute and American Cancer Society

Learn more about bladder cancer

Bladder cancer cells

Though the rate of new bladder cancer diagnoses in men and women have been dropping slightly in recent years, it’s still important to arm yourself with the facts. And so, in honor of Bladder Cancer Awareness Month, here’s everything you need to know about the disease.


 

 

How is bladder cancer detected and diagnosed?

Once you notice symptoms, or as part of a routine examination, your doctor may use the following tests to look for bladder cancer:

  • Physical exam
  • Internal exam: The doctor inserts gloved, lubricated fingers into the vagina or rectum to feel for lumps in the bladder.
  • Urine lab test: A sample of your urine is taken and examined for cancerous or precancerous cells or biomarkers indicating bladder cancer.
  • Biopsy: Surgical removal of suspicious tissues for further examination
  • Cystoscopy: A thin, flexible tube (cystoscope) equipped with a lens and light source is inserted into the urethra and guided into the bladder. The bladder is then filled with fluid and examined for abnormalities. If suspicious tissues are seen, it may be biopsied for further examination. Localized, spinal or general anesthesia may be administered prior to this procedure.
  • Fluorescence cystoscopy: Also known as blue light cystoscopy, this enhanced form of cystoscopy uses a light-activated drug. The drug is taken up by cancer cells and glows when a blue light is shone upon it, allowing for easier detection of cancerous areas.

What is Blue-Light Cystoscopy with Cysview?

Blue-Light Cystoscopy with Cysview is an advanced approach for the detection and diagnosis of bladder cancer. Our team is using this enhanced imaging technique to precisely identify and remove cancerous lesions on the bladder.

Used as an adjunct to white-light cystoscopy, Blue-Light Cystoscopy with Cysview is the only Food and Drug Administration-approved technology that:

  • Detects more Ta/T1 bladder cancer lesions than does white-light cystoscopy alone
  • Leads to improved tumor resection, since every tumor detected is resected in the same TURB (transurethral resection of the bladder)
  • Allows for better patient management decisions

If cancer is found, additional tests are performed to determine the type and stage of disease.

These diagnostic tests include:

  • Intravenous pyelogram (IVP): Also called intravenous urogram (IVU), this procedure first injects a special dye into the vein. The dye then coats the interior lining of the urinary tract and an X-ray is taken to see if there are any tumors in the bladder, kidneys or ureters.
  • Retrograde pyelogram: For patients who cannot tolerate an IVP, this test injects the dye using a urinary catheter.
  • Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images at different angles to form a computer-generated image, which determines tumor size, location and number. CT scans may also be used to guide a biopsy.
  • Ultrasound: High energy sound waves are used to create images of the bladder, and it may be also be used to guide a biopsy.
  • Magnetic resonance imaging (MRI) urogram: This procedure images the bladder, ureters and kidneys using a powerful magnet, radio waves and a computer. A biopsy may be taken at the same time if the images show any abnormalities.
  • Lymph node biopsy: Removal and examination of lymph nodes in the pelvic region to see if the cancer has spread
  • Bone scan: A procedure using a small amount of radioactive material to determine if bladder cancer cells have spread to the bones
  • Genomic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations, which can be used to determine better treatments.

Based on the results of these tests, the bladder cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs. Bladder cancer is also evaluated by “grades” based on how much it resembles normal bladder cells and how aggressive it grows.

Stages of bladder cancer

After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body. There are three ways that cancer spreads in the body: into nearby tissue, into the lymph vessels to other parts of the body and into blood vessels to other parts of the body.

The following stages are used to describe the location and extent of bladder cancer:

  • Stage 0 (papillary carcinoma and carcinoma in situ): In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may later become cancer and spread into nearby normal tissue.
  • Stage I: Cancer has formed and spread to the layer of connective tissue next to the inner lining of the bladder.
  • Stage II: Cancer has spread to the layers of muscle tissue of the bladder.
  • Stage III: Cancer has spread from the bladder to the layer of fat surrounding it and may have spread to the reproductive organs (prostate, seminal vesicles, uterus or vagina).
  • Stage IV: Cancer has spread from the bladder to the wall of the abdomen or pelvis, one or more lymph nodes and/or other parts of the body, such as the lungs, liver or bones.
     

What are the current screening guidelines for bladder cancer?

There are currently no screening guidelines for bladder cancer, since no screenings have been shown to lower risk of dying from bladder cancer for people of average risk. However, your physician may recommend screening if you are at a high risk of developing bladder cancer, due to:

  • Specific genetic mutations
  • Birth defects
  • Workplace chemical exposure

Bladder cancer treatment options

With bladder cancer, the majority of patients that I see can be cured; the challenge is to get patients the same quality of life that they had before surgery.”  Kevin Chan, M.D., head of reconstructive urology at City of Hope

City of Hope offers the latest advances in bladder cancer care. It begins with our comprehensive screening and diagnostic tools, and centers on our unique “coordinated care pathway” in which our multidisciplinary teams combine the latest research findings with outstanding patient care.

Surgery

Surgery is a common treatment option for most bladder cancer patients, particularly those with early-stage, localized cancer. Different procedures may be chosen based on the individual patient’s diagnosis. City of Hope surgeons are among the most experienced in the country and have excellent success rates using a range of advanced technologies.

We specialize in:

  • Minimally invasive robotic cystectomies with advanced urinary diversion techniques.
  • Urinary tract reconstruction and the treatment of erectile dysfunction, urinary incontinence and urologic retroperitoneal disease.

Surgical procedures

The most effective surgical procedures depend on a cancer’s stage, including how large it is, and whether it has spread to other tissues.

Treatments include:

  • Local excision - This surgery (sometimes called a polypectomy) is used to remove precancerous polyps and very small cancers.
  • Transurethral resection - This minimally invasive surgical procedure, performed through the urethra, is most useful for removing those cancers that have not advanced beyond the lining of the bladder. In most low-grade, low-stage tumors, resection is all that is required. This procedure uses a thin, flexible tube (cystoscope) that is inserted into the urethra and guided into the bladder. After cancerous tissue is identified, tools inserted through the tube can surgically remove it or burn it off using an electric current.
  • Segmental or partial cystectomy - In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor often chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area. Because only part of the bladder is removed, the patient may urinate normally after recovery.
  • Radical cystectomy - For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor may also choose this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed. Because the entire bladder is removed, the surgeon will also need to perform a reconstructive procedure to divert urine flow.
  • Urinary diversion - Many patients today who require the removal of the entire bladder are candidates for continent urinary diversion, a type of surgery that involves complete pelvic reconstruction that allows patients to recover normal urinary function.

What are types of urinary diversions?

Many patients today who require the removal of the entire bladder are candidates for continent urinary diversion, a type of surgery that involves complete pelvic reconstruction that allows patients to recover normal urinary function.

Depending on the disease, patient’s health, desired outcomes and quality-of-life goals, the surgeon may opt for one of several urinary diversion procedures following a radical cystectomy. Urinary diversions can be done intracorporeally or extracorporeally.

The most common ones include:

  • Ileal Conduit: The ureters (tubes that drain urine from the kidneys) are connected to a small segment of the ileum (small intestine). The end of the ileum conduit is brought out into the skin through an abdominal opening called a stoma. The stoma is covered by an external bag which collects urine as it drains from the conduit.
  • Indiana Pouch: This procedure creates an internal reservoir using the ileum and colon (large intestine), with a small part of the ileum brought to the skin as a stoma. The ureters empty into this pouch and the patient will regularly empty the pouch by passing a small, thin catheter through the stoma and into the pouch.
  • Neobladder: Some patients may be eligible for a neobladder procedure, which creates a pouch from the small intestine that is connected directly to the urethra. While this procedure allows patients to pass urine through the urethra, it may take a while to regain urinary control and patients may have to self-catheterize to drain urine from the neobladder.

City of Hope also has an extensive recovery and follow-up program for postcystectomy patients, aimed at helping them:

  • Regain urinary control
  • Minimize risk of complications
  • Address emotional, social and lifestyle issues related to the cancer or treatments

Specialists in this program include nurses, rehabilitation therapists, occupational therapists, clinical social workers, psychologists, psychiatrists, dieticians and other supportive care medicine experts.

Learn more about bladder cancer surgery

bladder cancer

Bladder cancer is a stubborn disease. Malignant cells in the bladder frequently grow back or pop up elsewhere, even if they're removed in their earliest stages. But the City of Hope surgeons and scientists working to eradicate bladder cancer are equally stubborn.


 

Mary Soto

Mary Soto was looking forward to her trip to Maui, where she would celebrate her 60th birthday with her daughter. But a visit with a urologist revealed that Soto had a sizable tumor in her bladder. A biopsy performed a few weeks later confirmed her fears – she had bladder cancer. Read her inspiring story.


 

 

Drug therapy

Drug therapy may be given to patients to fight bladder cancer cells throughout the body by killing them or stopping their growth and spread. These drugs include:

  • Chemotherapy, which targets all rapidly dividing cells, including bladder cancer cells
  • Immunotherapy, which stimulates the patient’s immune system to attack cancer cells

Drugs may also be prescribed to treat conditions related to bladder cancer or its treatments, such as low blood cell counts, nausea or pain.

In addition to oral and intravenous delivery, bladder cancer patients may also receive anti-cancer drugs intravesically. In intravesical therapy, a catheter is guided through the urethra and into the bladder, allowing for direct drug administration. By directly delivering and confining the drugs within the bladder, its effectiveness may be increased and side effects can be limited.

The drug or drug combination used depends on the type and stage of bladder cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight bladder cancer while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.

Radiation therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may delivered externally using focused beams of energy, or internally by placing a radiation-emitting substance placed in or near the tumor site.

Depending on the cancer, the patient’s health and desired outcomes, radiation therapy may be offered on its own or in conjunction with surgery and drug therapy. This includes:

  • Postsurgical treatment for surgeries that did not remove the whole bladder
  • Primary treatment for early-stage bladder cancer patients who can’t have surgery
  • Initial treatment for advanced bladder cancer, along with cancer-fighting drugs
  • Treatment to relieve symptoms associated with bladder cancer.

City of Hope offers a wide variety of leading-edge radiation therapy options to treat bladder cancer. These include image-guided external radiation systems (such as TomoTherapy or TrueBeam) that combine detailed imaging and radiation delivery technologies, allowing our care team to “sculpt” radiation beams to the tumor site while avoiding nearby healthy tissue. This maximizes radiation’s cancer fighting ability while minimizing exposure to the bladder, rectum and other nearby organs.

Learn more about bladder cancer treatments

bladder cancer, in stages

In years past, Bladder Cancer Awareness Month has been a sobering reminder of a disease with few treatment options. For patients with metastatic disease (disease that has spread from the bladder to distant organs), average survival is typically just over one year.


 

 

 

Bladder cancer experts

City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat bladder cancer, coupled with our enduring belief in providing unparalleled compassionate care from the moment of diagnosis to active treatment to recovery and survivorship.

Urologic Oncologists

Kevin G. Chan, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Laura Crocitto, M.D., M.H.A.

Clinical Specialties

  • Urologic Oncology
  • Urology
Donald Hannoun, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Clayton S. Lau, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Jonathan N. Warner, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
  • Reconstructive Urology
Kristina Wittig, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Jonathan Lim Yamzon, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Bertram Yuh, M.D., M.S.H.C.P.M., M.I.S.M.

Clinical Specialties

  • Urologic Oncology
  • Urology
Ali Zhumkhawala, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology

Medical Oncologists

Sumanta Kumar Pal, M.D.

Clinical Specialties

  • Medical Oncology
Przemyslaw W. Twardowski, M.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncologist

Sagus Sampath, M.D.

Clinical Specialties

  • Radiation Oncology

Bladder cancer research and clinical trials

At City of Hope, bladder cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies with fewer side effects, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Some of our current research projects include:

  • Surgical and reconstruction techniques that can improve clinical and quality-of-life outcomes
  • Enhancing urinary diversion follow-up protocols to expedite recovery and minimize complication risk
  • Studying a class of drugs called PD-1 inhibitors, which shuts down the cancer’s ability to evade the immune system, and their effectiveness against bladder cancers
  • Gene therapies that can overcome bladder cancer’s resistance mechanisms, making it more sensitive to other treatments
  • Using neural stem cells, which gravitate toward bladder cancer cells, to deliver gold nanorods to tumor sites; when an infrared light is shone on those rods, the gold particles heat up and destroy the surrounding cancer cells with intense heat
  • Evaluating targeted therapies that can selectively attack bladder cancer cells, increasing its effectiveness while reducing side effects
  • Looking into administering drugs prior to bladder cancer surgery, which may be able to shrink tumors enough to avoid a more invasive procedure
  • Molecular profiling that guide physicians toward better treatments or avoid unnecessary therapies
  • Studying the bladder tumor’s microenvironment to determine how likely it is to metastasize, and determining which patients would require more aggressive treatments

Learn more about bladder cancer research

Breakthroughs - bladder cancer 2016 - 256x256

Shorter hospital stays and reduced readmission rates – those are the goals for bladder cancer patients at City of Hope in 2016. Uniquely coordinated care will make that possible.


 

 
 

Living with bladder cancer

I can be normal and live a normal life,” Sheldon Querido, bladder cancer survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your bladder cancer treatment.

We can help with all of the following concerns, and more:

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).

Hopeful.org

Hopeful.org is an online community, a space for everyone who has been touched by cancer to make connections, share their stories, offer support and seek advice.

It features new stories weekly on everything from recipes to news about immunotherapy and other groundbreaking treatments. No one should have to go through cancer alone, and Hopeful ensures that every person will have a supportive community to lean on.

To connect with fellow bladder cancer fighters, caregivers and supporters alike, join our Community of the Hopeful today.

 

Christine Crews Success Story Image
Christine, bladder cancer survivor

Just a little over a month after bladder cancer surgery, Christine was back at the gym teaching fitness classes and settling back into her presurgery life.

Success Story - Mary Soto
Mary Soto, bladder cancer survivor

Mary Soto was looking forward to her birthday trip with her daughter. But the problem that she had been dealing with on and off for the past few months - blood in her urine - returned full force.

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