Bladder Cancer

The bladder is a hollow, muscular organ shaped like a balloon that sits in your pelvis. Kidneys filter wastes from the blood, which then combine with water to form urine, which travels down thin tubes called ureters to the bladder. The bladder stores urine and empties it through the urethra.

Bladder cancer forms in tissues of the bladder. Most bladder cancers are urothelial carcinomas, which begin in cells that normally make up the inner lining of the bladder. Less common types include squamous cell carcinoma and adenocarcinoma, which develop in the bladder as a result of chronic irritation and inflammation.

The UC Davis Cancer Center provides comprehensive, multidisciplinary care for patients with all stages of bladder cancer. Our patients receive all of their care from a team of top academic physicians.

cell To diagnose bladder cancer, the doctor must first rule out other possible causes of blood in the urine. A blood test will be ordered to make sure your kidneys are functioning properly. A CT scan of the abdomen and pelvis also will be ordered to look for other possible causes of bleeding. Finally, your doctor will look for abnormalities in the transitional cells that line a portion of the kidneys and the ureter, which carries urine to the bladder. If abnormalities are detected, your primary care doctor will refer you to one of our urological oncologists.

What to expect during your visit with the urological oncologist

Your specialist will conduct a physical exam, feeling the abdomen and pelvis for possible tumors, and will review various test results. You also will be given a local anesthetic and undergo a cystoscopy, a procedure in which the doctor uses a thin, flexible scope to look in your bladder. If an abnormality is seen in your bladder during the cystoscopy, arrangements will be made for a surgical appointment to confirm your diagnosis.

Confirmation

To confirm a cancer diagnosis, you will be taken into surgery and put under general anesthesia. A scope will be passed into your bladder and some bladder muscle will be removed. (Details of this procedure will be explained to you at your pre-operative visit). Next, a pathologist will examine the tissue to confirm if it is cancer, as well as determine the stage (how deep the tumor is in the bladder) and grade (how serious the malignancy).

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

The most common sign of bladder cancer is blood in the urine, a condition that is usually painless. Blood in the urine (hematuria) can either be seen by the patient or detected on routine analysis of the urine. In some women, bladder cancer is often accompanied by a urinary tract infection, which can cause urination frequency and feeling an urgent need to urinate without results. When these symptoms are present, a medical evaluation is needed to rule out bladder cancer.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

No one knows the exact causes of bladder cancer. Studies have shown that people who get bladder cancer are more likely to have the following risk factors:

a history of smoking
exposure to certain substances such as rubber, certain dyes and textiles, paint and hairdressing supplies
a diet high in fried meats and fat
being an older, male or white
having an infection caused by a certain parasite

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

About 75% of tumors removed from the bladder have not invaded the bladder muscle. If during the cystoscopy your tumor appears to be non-invasive, a medicine called Mitomycin C will be placed in your bladder to reduce chance of recurrence. The drug is left in for one hour then drained. Most patients return home after the procedure, and some will retain the catheter for a couple of days. Occasionally, patients are asked to stay overnight at the hospital.

Follow up

Your urologist will see you one to two weeks after surgery to review the grade and the stage of the tumor. Your treatment options will be based on these findings. In general, if the tumor is low grade/low stage, you will not have any more treatment. Because transitional cell carcinoma of the bladder has a 50 percent chance of returning after surgery, you will be asked to return to the clinic in three months for another cystoscopy.

If the tumor is high grade and low stage, you may be brought back for a follow-up cystoscopy in three months or you may have a medicine called BCG (Bacillus Calmette Guerin) placed in your bladder once a week for six weeks. Medical treatment is followed with another cystoscopy three months later. If the tumor has invaded the muscle, further therapy may be necessary and options include:

Bladder removal, called cystectomy. If you do choose to have a cystectomy, UC Davis surgeons can build a new bladder from your intestine (neobladder) or use a small portion of your bowel to carry urine to the outside, called an ileal conduit.
Chemotherapy followed by cystectomy.
Chemotherapy and radiation therapy.

If your tumor has spread outside the bladder you will be set up to see one of our specialists in hematology and oncology for chemotherapy.

Clinical Trials

UC Davis Comprehensive Cancer Center has a large clinical trials network, allowing our patients access to the newest drugs and therapies before they become widely available. During all stages of your treatment you should talk to your medical specialist about what clinical trials may be available for you.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center