Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.
There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):
•Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
•Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
•Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.
Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.
Listen in as Kevin Chan, MD discusses Bladder Cancer, it's treatments and diagnoses.
Selected Podcast
Bladder Cancer: New Advances and the Latest Treatments
Featured Speaker:
Kevin Chan, MD
Urologist Kevin Chan, M.D., focuses on treating erectile dysfunction, urinary incontinence, urinary tract reconstruction, and urologic retroperitoneal disease. Additionally, Dr. Chan treats all aspects of general urology, including benign prostatic hyperplasia and kidney stones. In addition to his clinical work, Dr. Chan has been active in clinical research. His areas of research include improving surgical techniques in urinary reconstruction after bladder removal in the setting robotic surgery, improving surgical techniques for the management of male incontinence, and the development of novel diagnostic techniques to improve the detection and progression of prostate cancer. Transcription:
Bladder Cancer: New Advances and the Latest Treatments
Melanie Cole (Host): As a patient at City of Hope, you have a highly experienced and dedicated team to treat you and help you cope with a bladder cancer diagnosis. Specialists at City of Hope are internationally recognized experts in the treatment of bladder cancer. My guest today is City of Hope urologist, Dr. Kevin Chan. Welcome to the show, Dr. Chan. Tell us, how common is bladder cancer?
Dr. Kevin Chan (Guest): Bladder cancer is … I would call it not uncommon. Amongst cancers, it’s the fourth most common new cancer diagnosed in the United States.
Melanie: Who is at risk?
Dr. Chan: Men have a three-to-one predisposition, meaning about one in 25 men will get diagnosed with bladder cancer and one in 90 women. The main risk factor for bladder cancer is actually smoking.
Melanie: Well, that would seem to be the main risk factor for so many cancers. Tell us a little bit about bladder cancer. Would you have any symptoms if this was starting to grow?
Dr. Chan: The most common presenting symptom for bladder cancer is blood in the urine. Anybody with blood in the urine necessitates a workup with a CT scan and a scope inside the bladder analogous to a colonoscopy, but this is for the bladder. The other ways bladder cancer can present is microscopic blood in the urine. If your primary doctor did a urinalysis, or sometimes some people have irritative urinary symptoms like frequency and urgency, but those are much rarer. The most common is blood in the urine.
Melanie: Is this something, Dr. Chan, that when we get our annual physicals and we pee in a cup, that gets screened for?
Dr. Chan: To some extent, yes. Most people do the urinalysis under a routine physical exam. Many times, people will detect blood and they’ll attribute it to a urinary tract infection. They’ll get treated and there’ll be some delay in the diagnosis. That even happens with blood that you can see in the urine. Many will get diagnosed with a urinary tract infection. They get treated with antibiotics and then they get persistent blood in the urine, and that’s when they often go to a urologist. A urinalysis ideally is a good screening tool for bladder cancer, but it doesn’t always kind of work out that way.
Melanie: Then you diagnose bladder cancer. It would be a very scary diagnosis, I would assume. What are some of the treatments? What’s your first line of defense that you do?
Dr. Chan: Right. The most important things you need to know when you get diagnosed with bladder cancer are grade of the cancer and stage. Grade tells you how aggressive it is. It’s high grade and low grade, essentially. Stage tells you at what particular point in time have you caught this. Have you caught it very early, where it’s confined to a very superficial part of the bladder? Have you caught it late, where it’s located on the bladder? If you have a low-grade cancer, it’s typically early stage. Those patients can be managed simply with cystoscopy and resection, meaning going in with the scope in the bladder and just shaving out the tumor. Then we would just simply monitor them with periodic scopes for the next five years periodically. If you have more advanced bladder cancer that’s gone kind of into the muscle wall of the bladder but still confined to the bladder and not spread beyond it, that’s when we’re talking about having a much larger operation such as bladder removal and having to do some type of reconstruction to make a new bladder.
Melanie: What happens with bladder removal, Dr. Chan? You mentioned reconstruction. It’s such an important organ. What does that mean?
Dr. Chan: The bladder, interestingly, doesn’t seem to do a lot, but it actually does more than you think, and trying to substitute it can be somewhat difficult. The main function of the bladder is to store urine at a very low pressure so it doesn’t put any problems on the kidneys. You can hold urine until you decide that you want to urinate. Then it has the ability to propel urine out. When we remove the bladder, we substitute intestine for that. We can use up to two feet of intestine to make a whole new bladder into a kind of a spherical shape. We hook the kidneys back in and hook it right back to the urethra, which is kind of the original plumbing to urinate. The good of it is that it does store urine at a low pressure. As you can imagine, it doesn’t have all the benefits of a native bladder, such as sensation, and it doesn’t really have the ability to push urine out. It’s not exactly the same, but in general, it can be pretty darn close to the same. That’s a very involved surgery. There are other types of reconstruction out there, so people that are not candidates for that neobladder that I just talked about, there’s catheterizable pouches, which is where we make a pouch out of colon. We hook the kidneys in. And this pouch is all inside the abdomen. When patients urinate, they simply pass a little catheter through a little opening in the skin that looks like a belly button. They drain their bladder and pull the catheter out and put a little Band-Aid over that opening and go about their business. There’s a very high quality of life with this. There’s no bag or external appliance. That’s a second option for patients. That’s considered a continent pouch because it doesn’t require a bag. A third option for reconstruction is an ileal conduit. That’s the common one many people know about. It’s a urostomy. This is the one that has that external bag similar to a colostomy for bowel content. This urostomy has a kind of a larger opening at the skin, and you put in the piece of bag over that. It drains urine. You empty the bag about every four hours. You change the bag about every three days. That’s probably the simplest, most straightforward reconstruction. Each reconstruction has its pros and cons. Different patients are probably appropriate for different types of reconstruction.
Melanie: When does radiation therapy and chemotherapy come in with bladder cancer?
Dr. Chan: In general, I’d say that radiation rarely has a role in bladder cancer. We use it in some salvage settings, and it on occasion can be used as primary therapy for people that are not surgical candidates. When I say not surgical candidates, perhaps they have a lot of other health problems that make surgery much more risky than the cancer itself, and it’s kind of a plan B for patients that are not super healthy but need to get treated for their bladder cancer. Chemotherapy is vital with bladder cancer. It has a number of roles. We have mentioned those superficial bladder cancers are the ones that are early stage. If they are high grade, we can actually put chemotherapy into the bladder and potentially decrease the risk of recurrence for more advanced bladder cancers like muscle-invasive bladder cancers that we talked about. There is some data and evidence that shows that if we give chemotherapy before surgery, we can improve survival rates by about five percent.
Melanie: Tell us a little bit about the survival rates for bladder cancer, Dr. Chan.
Dr. Chan: Again, this is variable based on the grade and stage of the bladder cancer. If it’s a low-grade cancer, which is typically early stage, the cure rates are well over 90 percent. That means something that most likely you won’t have to worry about in the future. If you have an early stage high-grade cancer, again, with bladder removal with a high grade, early stage cancer, their cure rates are still in the 90 percent range with bladder removal. If you have muscle-invasive cancer, which is a T2 bladder cancer, it’s a little more advanced. With bladder removal, the cure rates are in the 60 to 70 percent range. With chemotherapy beforehand, it could raise that another about five percent. Then when you get the more advanced cancers that have gone outside the bladder, then the survival rates do drop significantly.
Melanie: In just the last minute, Dr. Chan, tell us a little bit about what’s on the horizon, and give hope to the patients with bladder cancer and why they should come to City of Hope for their care.
Dr. Chan: There’s a lot of exciting developments for bladder cancer. If we just go by stage, early stage cancers, there’s new agents being tried for those superficial or earlier stage high-grade cancers that can just go into the bladder. Again, another opportunity to spare your bladder. With a full invasive bladder cancer, as you can see, we’ve already made one step, which is giving chemotherapy before surgery. That’s already improved survival rates. But the other aspect of that is the surgery. At City of Hope, our kind of passion or expertise is in not only doing the meticulous cancer surgery of removal of the bladder and the lymph nodes but also reconstruction. Our big thing is that most of the patients will survive their bladder cancer. We want to make sure that they have similar quality of life that they had before the surgery. My big area of research is surgical techniques in robotic cystectomy or robotic bladder removal and making neobladders and Indiana pouches that was the catheterizable pouch that I had mentioned, basically improving quality of life for patients that have to have their bladder removed. In addition, our expertise in robotic surgery has the potential ability not only to have less blood loss with this kind of surgery. It allows us to be a little more precise. And my general feeling on this is that it will allow improved nerve sparing techniques. That means that patients that get neobladders may ultimately have better urinary control. That also means that historically, men that would have their bladder removed also have their prostate removed and would typically have erectile dysfunction. That was just a given. With improved nerve sparing that can be done robotically, our feeling is that we can improve even that aspect of the surgery. And we’ve gotten good results from erectile function standpoint doing that robotically as well.
Melanie: Thank you so much, Dr. Chan. For more information on bladder cancer, you can go to cityofhope.org. That’s cityofhope.org. You’re listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening.
Bladder Cancer: New Advances and the Latest Treatments
Melanie Cole (Host): As a patient at City of Hope, you have a highly experienced and dedicated team to treat you and help you cope with a bladder cancer diagnosis. Specialists at City of Hope are internationally recognized experts in the treatment of bladder cancer. My guest today is City of Hope urologist, Dr. Kevin Chan. Welcome to the show, Dr. Chan. Tell us, how common is bladder cancer?
Dr. Kevin Chan (Guest): Bladder cancer is … I would call it not uncommon. Amongst cancers, it’s the fourth most common new cancer diagnosed in the United States.
Melanie: Who is at risk?
Dr. Chan: Men have a three-to-one predisposition, meaning about one in 25 men will get diagnosed with bladder cancer and one in 90 women. The main risk factor for bladder cancer is actually smoking.
Melanie: Well, that would seem to be the main risk factor for so many cancers. Tell us a little bit about bladder cancer. Would you have any symptoms if this was starting to grow?
Dr. Chan: The most common presenting symptom for bladder cancer is blood in the urine. Anybody with blood in the urine necessitates a workup with a CT scan and a scope inside the bladder analogous to a colonoscopy, but this is for the bladder. The other ways bladder cancer can present is microscopic blood in the urine. If your primary doctor did a urinalysis, or sometimes some people have irritative urinary symptoms like frequency and urgency, but those are much rarer. The most common is blood in the urine.
Melanie: Is this something, Dr. Chan, that when we get our annual physicals and we pee in a cup, that gets screened for?
Dr. Chan: To some extent, yes. Most people do the urinalysis under a routine physical exam. Many times, people will detect blood and they’ll attribute it to a urinary tract infection. They’ll get treated and there’ll be some delay in the diagnosis. That even happens with blood that you can see in the urine. Many will get diagnosed with a urinary tract infection. They get treated with antibiotics and then they get persistent blood in the urine, and that’s when they often go to a urologist. A urinalysis ideally is a good screening tool for bladder cancer, but it doesn’t always kind of work out that way.
Melanie: Then you diagnose bladder cancer. It would be a very scary diagnosis, I would assume. What are some of the treatments? What’s your first line of defense that you do?
Dr. Chan: Right. The most important things you need to know when you get diagnosed with bladder cancer are grade of the cancer and stage. Grade tells you how aggressive it is. It’s high grade and low grade, essentially. Stage tells you at what particular point in time have you caught this. Have you caught it very early, where it’s confined to a very superficial part of the bladder? Have you caught it late, where it’s located on the bladder? If you have a low-grade cancer, it’s typically early stage. Those patients can be managed simply with cystoscopy and resection, meaning going in with the scope in the bladder and just shaving out the tumor. Then we would just simply monitor them with periodic scopes for the next five years periodically. If you have more advanced bladder cancer that’s gone kind of into the muscle wall of the bladder but still confined to the bladder and not spread beyond it, that’s when we’re talking about having a much larger operation such as bladder removal and having to do some type of reconstruction to make a new bladder.
Melanie: What happens with bladder removal, Dr. Chan? You mentioned reconstruction. It’s such an important organ. What does that mean?
Dr. Chan: The bladder, interestingly, doesn’t seem to do a lot, but it actually does more than you think, and trying to substitute it can be somewhat difficult. The main function of the bladder is to store urine at a very low pressure so it doesn’t put any problems on the kidneys. You can hold urine until you decide that you want to urinate. Then it has the ability to propel urine out. When we remove the bladder, we substitute intestine for that. We can use up to two feet of intestine to make a whole new bladder into a kind of a spherical shape. We hook the kidneys back in and hook it right back to the urethra, which is kind of the original plumbing to urinate. The good of it is that it does store urine at a low pressure. As you can imagine, it doesn’t have all the benefits of a native bladder, such as sensation, and it doesn’t really have the ability to push urine out. It’s not exactly the same, but in general, it can be pretty darn close to the same. That’s a very involved surgery. There are other types of reconstruction out there, so people that are not candidates for that neobladder that I just talked about, there’s catheterizable pouches, which is where we make a pouch out of colon. We hook the kidneys in. And this pouch is all inside the abdomen. When patients urinate, they simply pass a little catheter through a little opening in the skin that looks like a belly button. They drain their bladder and pull the catheter out and put a little Band-Aid over that opening and go about their business. There’s a very high quality of life with this. There’s no bag or external appliance. That’s a second option for patients. That’s considered a continent pouch because it doesn’t require a bag. A third option for reconstruction is an ileal conduit. That’s the common one many people know about. It’s a urostomy. This is the one that has that external bag similar to a colostomy for bowel content. This urostomy has a kind of a larger opening at the skin, and you put in the piece of bag over that. It drains urine. You empty the bag about every four hours. You change the bag about every three days. That’s probably the simplest, most straightforward reconstruction. Each reconstruction has its pros and cons. Different patients are probably appropriate for different types of reconstruction.
Melanie: When does radiation therapy and chemotherapy come in with bladder cancer?
Dr. Chan: In general, I’d say that radiation rarely has a role in bladder cancer. We use it in some salvage settings, and it on occasion can be used as primary therapy for people that are not surgical candidates. When I say not surgical candidates, perhaps they have a lot of other health problems that make surgery much more risky than the cancer itself, and it’s kind of a plan B for patients that are not super healthy but need to get treated for their bladder cancer. Chemotherapy is vital with bladder cancer. It has a number of roles. We have mentioned those superficial bladder cancers are the ones that are early stage. If they are high grade, we can actually put chemotherapy into the bladder and potentially decrease the risk of recurrence for more advanced bladder cancers like muscle-invasive bladder cancers that we talked about. There is some data and evidence that shows that if we give chemotherapy before surgery, we can improve survival rates by about five percent.
Melanie: Tell us a little bit about the survival rates for bladder cancer, Dr. Chan.
Dr. Chan: Again, this is variable based on the grade and stage of the bladder cancer. If it’s a low-grade cancer, which is typically early stage, the cure rates are well over 90 percent. That means something that most likely you won’t have to worry about in the future. If you have an early stage high-grade cancer, again, with bladder removal with a high grade, early stage cancer, their cure rates are still in the 90 percent range with bladder removal. If you have muscle-invasive cancer, which is a T2 bladder cancer, it’s a little more advanced. With bladder removal, the cure rates are in the 60 to 70 percent range. With chemotherapy beforehand, it could raise that another about five percent. Then when you get the more advanced cancers that have gone outside the bladder, then the survival rates do drop significantly.
Melanie: In just the last minute, Dr. Chan, tell us a little bit about what’s on the horizon, and give hope to the patients with bladder cancer and why they should come to City of Hope for their care.
Dr. Chan: There’s a lot of exciting developments for bladder cancer. If we just go by stage, early stage cancers, there’s new agents being tried for those superficial or earlier stage high-grade cancers that can just go into the bladder. Again, another opportunity to spare your bladder. With a full invasive bladder cancer, as you can see, we’ve already made one step, which is giving chemotherapy before surgery. That’s already improved survival rates. But the other aspect of that is the surgery. At City of Hope, our kind of passion or expertise is in not only doing the meticulous cancer surgery of removal of the bladder and the lymph nodes but also reconstruction. Our big thing is that most of the patients will survive their bladder cancer. We want to make sure that they have similar quality of life that they had before the surgery. My big area of research is surgical techniques in robotic cystectomy or robotic bladder removal and making neobladders and Indiana pouches that was the catheterizable pouch that I had mentioned, basically improving quality of life for patients that have to have their bladder removed. In addition, our expertise in robotic surgery has the potential ability not only to have less blood loss with this kind of surgery. It allows us to be a little more precise. And my general feeling on this is that it will allow improved nerve sparing techniques. That means that patients that get neobladders may ultimately have better urinary control. That also means that historically, men that would have their bladder removed also have their prostate removed and would typically have erectile dysfunction. That was just a given. With improved nerve sparing that can be done robotically, our feeling is that we can improve even that aspect of the surgery. And we’ve gotten good results from erectile function standpoint doing that robotically as well.
Melanie: Thank you so much, Dr. Chan. For more information on bladder cancer, you can go to cityofhope.org. That’s cityofhope.org. You’re listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening.