Bladder cancer usually originates in the bladder lining, which consists of a layer of surface cells (transitional epithelial cells), smooth muscle and a fibrous layer. Tumors are categorized as low-stage (superficial) or high-stage (muscle invasive).
People don’t usually undergo routine screenings for bladder cancer in the way one would be regularly screened for other cancers such as colon and breast. This kind of cancer is usually discovered in a patient who is experiencing specific bladder cancer symptoms, including:
- The appearance of blood in the urine, a condition called hematuria
- Pain during urination
- Changes in urination frequency (more often than usual) and urgency (an immediate need to go, even when the bladder isn’t full)
Be aware that what appear to be signs of bladder cancer could be due to conditions other than cancer, so it’s best to see a doctor right away.
At Northwell Health, the goal is to diagnose and treat bladder cancer while allowing patients to maintain their normal life activities.
Highlights of bladder cancer treatments and services include:
- A focus on treating the bladder cancer while preserving normal life functions
- Aggressive and innovative bladder cancer treatments, such as immunotherapy and chemotherapy
- Therapies to boost the immune system, reduce pain and improve quality of life
- Minimally invasive procedures, including laparoscopic and robotic surgery, that grant patients quicker recovery, less pain and scarring, and a sooner return to a normal diet
- Advanced reconstruction techniques
- Bladder preservation with chemotherapy and radiation therapy
Multidisciplinary Bladder Cancer Treatment
Within the first several days of a visit, the physicians conduct a complete array of tests and develop a personalized bladder cancer treatment program.
Each bladder cancer diagnosis is unique, so the physician team meets regularly to discuss the individual treatment approach for each specific situation. Weekly teleconferences allow physicians to share ideas and best practices for delivering highly specific and fully explored collaborative patient care. Each phase of a patient’s treatment is reviewed, to ensure that treatment milestones are reached
The first step to diagnosing any cancer, including bladder cancer, is usually a physical:
- A doctor will check overall physical health while considering the patient’s medical history, bladder cancer risk factors and any related medical or precancerous conditions
- A doctor might be able to detect symptoms of bladder cancer, such as lumps in the bladder wall or pelvis
A number of procedures and tests are used to deliver an accurate bladder cancer diagnosis.
- Cystoscopy - In order to look inside the bladder, a specialist will perform a cystoscopy. A thin tube called a cystoscope is inserted into the bladder through the urethra. The cystoscope contains a light and a lens in order to view the area. This procedure is usually performed in the office with local anesthesia.
- Biopsy - If any tissue appears to be showing signs of bladder cancer, a sample needs to be removed and examined further. This process, called a biopsy, is crucial for an accurate bladder cancer diagnosis. This procedure is done under general anesthesia during which a small tool is inserted through the cystoscope and a sample is extracted. In some cases, the entire tumor can be removed.
- Urine tests - In some cases, examining a urine sample can help determine symptoms of bladder cancer:
- Urine cytology uses a microscope to discover whether bladder cancer or precancerous cells are present.
- A urine culture tests urine color and components to determine whether symptoms are due to infection instead of bladder cancer.
- Urine tumor marker tests measure the amount of cancerous substances that may be present in urine.
Once a bladder cancer diagnosis has been confirmed, the doctor will conduct an imaging test to determine whether, and how much, the bladder cancer has spread to other parts of the body. This process, called staging, is necessary in order to conduct an appropriate treatment plan.
Staging may require one or more of the following imaging tests:
- Computed tomography (CT) scan - A CT scan is an X-ray procedure that records several detailed pictures from different angles. The pictures are made by a computer linked to an X-ray machine. This is generally done with an intravenous injection of dye to evaluate the kidneys and urinary system.
- Magnetic resonance imaging (MRI) - An MRI, which uses a magnetic field and radio waves to create detailed images of areas inside the body, is another method to determine whether the cancer has spread.
- Bone scan - A bone scan is used to determine whether the bladder cancer has spread to cells in the bone.
- Ultrasound - Ultrasound uses high-frequency sound waves to measure activity inside the organs.
The diagnosis will result in determining one of the two main stages of bladder cancer:
- Superficial bladder cancer (non-muscle invasive bladder cancer) means the cancer affects only the bladder lining, and hasn’t penetrated into the deeper layers of the bladder wall.
- Muscle-invasive bladder cancer means the cancer has invaded the deeper bladder layers. This requires a more aggressive treatment.