Bladder Cancer
About this Cancer
The bladder is a hollow organ in the lower abdomen that stores urine. Cancer occurs when cells in the bladder begin to grow uncontrollably affecting the normal function of the organ, and, sometimes surrounding organs. When detected and treated early, bladder cancer can be cured the majority of the time.
Risk Factors
People with a history of smoking, a family history of bladder cancer, or who have had regular exposure to industrial chemical may be at increased risk for bladder cancer.
Diagnostic Tests
There are several different laboratory and clinical tests used to diagnose bladder cancer. They are all relatively simple and painless, though some do require the use of local anesthetics and, in some patients, can cause mild discomfort.
- Urinalysis - A small sample of urine is examined under the microscope to check for the presence of blood.
- Intravenous Pyelogram or IVP - Patients receive an injection of a liquid dye though a vein in their arm followed by several x-rays. The dye travels to the kidneys, ureters and bladder and allows the doctors see if there are any suspicious lumps or lesions. Some patients report feeling warm or tingly during this procedure.
- Cystoscopy - A thin, lighted tube is inserted through the urethra and into the bladder under local anesthesia to allow the doctor to visualize the bladder. If the doctor sees any suspicious areas, a sample of the tissue will be removed and examined under a microscope for cancer cells.
- Biopsy - A surgical procedure in which a piece of tissue is removed from the bladder and examined for the presence of cancer cells. It is the only definitive way to diagnose bladder cancer.
Cancer Symptoms
The most common symptoms of bladder cancer are:
- Blood in the urine
- Increased frequency of urination
- Pain or burning with urination
- Incomplete emptying of bladder
Current Treatments
There are a wide variety of methods used to treat bladder cancer, including surgery, radiation treatment and drug therapy. At Johns Hopkins, bladder cancer experts develop a personalized treatment plan for each patient based upon the specific characteristics of the tumor. Treatment may involve a single therapy or a combination of therapies.
Early or superficial bladder cancer - At this stage, the cancer is confined to the inside lining of the bladder. Cancerous cells can often be removed using surgical tools inserted through a cystoscope into the bladder. More than 70 percent of bladder cancers diagnosed are of this type.
Invasive bladder cancer - In these more advanced cases, cancer cells have spread from the lining of bladder into the muscle and possibly surrounding organs, and a radical cystectomy is usually needed. In this treatment, a surgeon removes the diseased bladder and possibly other surrounding organs, including the uterus, fallopian tubes, and ovaries in women, and the prostate and seminal vesicles in men. In the past, the only option for urine collection following surgery was an external bag called an ostomy. Now, because of a new procedure pioneered at Johns Hopkins, most patients are candidates for bladder reconstruction. Doctors use a portion of the large bowel, which they fashion into a new bladder. The new bladder is attached to the urethra allowing patients to urinate normally and eliminating the need for a urine collection pouch or ostomy. Today, most patients are candidates for this procedure. For patients where bladder reconstruction is not possible, doctors can make an internal storage pouch for the urine using a piece of small intestine. Patients are taught to use a small tube or catheter to drain the urine through a tiny, concealable opening in the abdomen. Both of these new techniques have significantly improved the quality of life for bladder cancer patients.
In addition to surgery, radiation therapy or chemotherapy may be recommended to kill cancer cells doctors were unable to remove during surgery or to safeguard against recurrence of the disease. Radiation therapy is a localized treatment that uses targeted beams of x-rays to destroy cancer cells in a specific part of the body. Chemotherapy refers to the use of anticancer drugs administered orally and/or intravenously and travel through the bloodstream to destroy cancer cells that have broken away from the original tumor. Cisplatin is the drug most commonly used in the treatment of bladder cancer.
Treatment Approaches
The collaboration of the many clinicians and researchers at Johns Hopkins has led to many advances in the understanding and treatment of bladder cancer.
- A combination approach, called bladder-sparing surgery, utilizes drug therapy and radiation therapy prior to surgery to shrink the tumor and possibly completely eliminate the cancer. This experimental technique may soon offer patients an effective alternative to removing the bladder and an improved quality of life.
- Scientists have begun to identify the genetic changes that contribute to the development of bladder cancer. Their work could very soon lead to new ways of treating the disease, or possibly even preventing it from ever occurring.
- Johns Hopkins researchers have developed a test using microsatellite analysis that appears to detect bladder cancer at an earlier stage. The test, which uses state-of-the-art molecular genetics technology, detects DNA abnormalities or mistakes specific to bladder cancer in cells found in the urine. Further clinical studies of the test are underway at Johns Hopkins.
