INFORMATION ON DIAGNOSIS AND TREATMENT

Cancer of the urinary bladder is one of the most common cancers.  The most common type of bladder cancer in the United States and western Europe is urothelial carcinoma, also known as transitional cell carcinoma (TCC).  Risk factors include cigarette smoking, exposure to chemicals, and family history.  Signs and symptoms may include hematuria (blood in the urine), pain, or urination difficulties.

To work up and diagnose bladder cancer, multiple tests are usually done, and multiple doctors may be involved including a urologist.  Tests include urine tests (urinalysis, urine cytoloogy to look for cancer cells); imaging exams like IVP (intravenous pyelogram) or CT scan; and cystoscopy, a procedure performed by urology to examine the lining of the urethra and bladder.

A biopsy is needed to make a diagnosis of bladder cancer.  With the help of biopsy and imaging exams, grading and staging of bladder cancer can be done.  The staging of bladder cancer goes from stage I (localized and superficial) to stage II/III (more invasive) to stage IV (advanced and metastatic).  It is very important to evaluate for muscle invasion on pathology specimens.
For superficial bladder cancers, initial treatment usually includes TURBT (transurethral resection of bladder tumor).  Sometimes urologists also recommend intravesical chemotherapy or BCG; “intravesical” means that the treatment is applied directly to the inside of the bladder, usually through a bladder catheter.  Follow-up after superficial bladder cancers include repeat cystoscopy and urine cytology.

The standard treatment for muscle-invasive bladder cancer generally includes surgical removal of the bladder and nearby organs (called radical cystectomy).  For generally healthy patients, neoadjuvant (before surgery) chemotherapy is often considered and has been proven to improve patient outcomes.  Bladder preservation (not performing surgery) is sometimes considered in elderly patients or patients with many medical problems, and therefore in these patients partial resection, chemotherapy, and/or radiation therapy are considered.  For muscle-invasive bladder cancer patients who receive upfront surgery, chemotherapy after surgery (termed adjuvant) is oftentimes considered.
Bladder cancer very frequently requires the input from urologists, medical oncologists, and sometimes radiation oncologists.  In addition, clinical trials play a large role in the treatment of these patients.

Websites:
www.uptodate.com
http://www.cancer.gov/cancertopics/types/bladder
http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-types/bladder-cancer/index.html
http://www.mayoclinic.com/health/bladder-cancer/DS00177