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Bladder Cancer: Basics of Diagnosis, Workup, Pathology, and Treatment

Dan Reznicek MD, a Urologist in Bellingham Washington, covers the basics of bladder cancer. Bladder cancer is common and is one of the top 5 cancers diagnosed every year in the US. In addition to this video, see resources available at www.nccn.org, www.bcan.org, and visit our website at www.pacificnorthwesturology.com. Basics: What is bladder cancer? How does bladder cancer happen? What are the symptoms? What is the workup? How is it treated? What is bladder cancer? Bladder cancer is a the development of a group of cells in the lining of the bladder that begin to grow and divide uncontrollably. They are in the urothelium of the bladder. What is the urothelium This layer prevents you from reabsorbing the salts in the urine and the waste products that have been excreted. It is also a barrier from bacteria and infection. The vast majority of bladder cancers in this country come from the lining of the urothelium and are known as urothelial carcinoma. Historically, it was also called transitional carcinoma. The other bladder cancers that will not be covered in this video are small cell carcinoma, adenocarcinoma, and squamous cell carcinoma. These are quite rare, and their outcomes and treatments are different from urothelial carcinoma. Risk factors include smoking, male sex, and exposures to certain chemicals used in the dye and textile industry. What are symptoms of bladder cancer? Most people are diagnosed with bladder cancer after seeing blood in the urine (also called hematuria). Sometimes your urine may look normal, but blood is seen on a urine test at your doctor’s office and that is called microscopic hematuria. See a doctor if you note blood in your urine. Usually there is no pain with bladder cancer in early stages. In some people, they can develop irritative voiding symptoms such as burning with urination, more frequent urination, difficulty urinating or a weak stream, and the sudden urge to urinate. These symptoms will seem like a urinary tract infection but no bacteria is seen on a culture. These symptoms are less common but can occur. If bladder cancer is caught late and spread to other areas of the body, patients may experience back pain, weight loss, tiredness, swelling, bone pain, and other symptoms. What is the workup? A medical history and perform a physical exam. Other tests that may be performed include urine tests with a culture, cancer markers, or microscopic exam. Imaging tests such as a CT scan, Ultrasound, or MRI may be recommended. A cystoscopy should be performed if bladder cancer is suspected or possible. How is it treated? Treatment depends on the stage of the cancer. TNM staging of bladder cancer is covered in the video. Cancers that are in the lining of the bladder alone are known as non-muscle invasive bladder cancer (NMIBC). These are treated with endoscopic removal (transurethral resection of a bladder tumor [TURBT]) and may require further local therapies with drugs instilled into the bladder. Some cancers involve the muscle of the bladder and require further treatment. Muscle invasive bladder cancer is treated with surgery, chemoradiation, or a combination of therapies. If left untreated, muscle invasive bladder cancer can be deadly and we highly recommend treatment. Metastatic cancer is less common and describes bladder cancer that has spread beyond the bladder and into other organs. 4% of cancers are diagnosed at this stage. At this point in time, metastatic bladder cancer is incurable, but new treatments are being discovered each year. Treatments at this stage are focused on slowing the cancer growth and lengthening survival.