Q&A Topic: Bladder Cancer
Warren Bromberg, MD, FACS
Q. What are the key features of bladder cancer?
A. The pouch-like bladder stores urine produced by the kidneys until it’s time to urinate. Because urine contains waste products eliminated by the body, its inner lining has a special layer of transitional cells that prevent reabsorption of toxins back into the body. Bladder cancer, the fifth most common cancer in the US, is the abnormal, uncontrolled growth of cells that most often develops in that lining, possibly due to its exposure to toxins during the time urine is stored in the bladder.
Bladder cancer can take the form of a tumor or grow like a flat carpet on the bladder’s surface. While most bladder cancers are of the less aggressive type, it tends to develop in many spots within the bladder, and may recur after treatment. If undetected, the cancer can grow through both the bladder’s lining and wall and spread to other parts of the body. About 85 percent of bladder cancers remain confined to the bladder but some are aggressive and can be lethal.
Q. What are the risk factors for bladder cancer?
A. Risk factor number one is cigarette smoking. Toxic substances in the smoke enter the lungs, pass into the blood, and end up in the urine. Other risk factors are irritants that cause chronic inflammation of the bladder, such as urinary tract infections, indwelling urinary catheters and untreated bladder stones.
Q. What are the signs and symptoms of bladder cancer?
A. The key sign is either visible or microscopic blood in the urine. Bladder polyps or tumors that grow on the bladder wall are fragile and can bleed. A symptom may be increased urinary frequency or a burning sensation due to the cancer causing an irritation of the sensitive lining of the bladder. When bladder cancer is advanced, a large amount of visible blood may show in the urine, along with pain, and blockage of the urinary stream.
Q: How is bladder cancer diagnosed?
A. There is no screening. That’s why, as part of every routine physical, you should have a simple urinalysis to look for blood in the urine. Even a single painless episode of blood in the urine means you need to have it evaluated. A urologist will usually order an imaging study such as a CAT scan, then obtain visual proof of bladder cancer by looking into the bladder with a cystoscope, a small telescope inserted through the urethra. Ultimately, the growth is removed with a special scope under anesthesia for pathologic confirmation and treatment.
Q. What are my treatment options?
A. If the cancer is discovered early, it is readily removed with a cystoscope. The majority of people have treatable, early-stage cancer, but because it can recur, the patient must periodically come back to the office for cystoscopy, or a look into the bladder. Special medications can be repeatedly instilled into the bladder to activate the immune system and help block recurrences. These immunotherapies reduce recurrence by about 70 percent. If an invasive tumor has penetrated the bladder’s muscular wall, the bladder may need to be removed and the urinary tract reconstructed. Systemic chemotherapy or radiation may also be needed.
The best way to prevent bladder cancer is to immediately stop smoking; even inhaling secondhand smoke can hurt you. Northern Westchester Hospital provides high-level, cutting-edge treatment of bladder cancer at all stages, coordinated care and advanced radiological facilities. We have extensive experience performing minimally-invasive laparoscopic and robotic surgical approaches to speed recovery.
Learn More About Dr. Bromberg
Co-Director, Institute for Robotic & Minimally Invasive Surgery
Northern Westchester Hospital
Northern Westchester Hospital is a proud member of Northwell Health.