The 2nd most common urologic cancer, bladder cancer affects over 82,000 Americans per year. About 25% of those diagnosed are female with around 75% diagnosed being male (American Cancer Society). At UF Health, we understand that a bladder cancer diagnosis can be life-altering and comes with many unknowns and questions. Our team of bladder cancer doctors include board-certified urologic surgeons, radiologists, medical oncologists, radiation oncologists and pathologists among others. Our multidisciplinary approach ensures that our patients get the best cancer care possible.

UF Health offers advanced urology and bladder cancer care

The UF Health Cancer Center received designation from the NCI because of the exceptional, multidisciplinary care the Cancer Center delivers to patients and the leading-edge clinical research conducted by its faculty. Our providers across the spectrum of cancer care work together to provide personalized care to our urologic cancer patients. Cases are presented at weekly tumor boards which are attended by physicians across multiple departments, so they can work together to develop the best treatment plan possible.

What is bladder cancer?

Bladder cancer is a type of cancer that is often referred to as urothelial carcinoma. Urothelial carcinoma starts in cells that line the inside of the bladder. This type of bladder cancer represents 90% of bladder cancer diagnoses. Other types of bladder cancer include squamous cell carcinoma, adenocarcinoma, sarcoma and small cell carcinoma. It is important to know the type of bladder cancer that you have, as this changes your treatment options.

Bladder cancer can generally be classified in two categories:

Non-muscle invasive bladder cancer: This is the earliest stage of bladder cancer and is also called non invasive bladder cancer. Around 70% of patients present with non-muscle invasive bladder cancer. This means that the cancer hasn’t spread into the deep muscle layer of the bladder wall. The overall five-year survival for patients with non-muscle invasive and localized bladder cancer is more than 92% with the right treatment plan. Treatment efforts for patients with non-muscle invasive cancer typically focus on preventing future recurrences and progression of the cancer.

Muscle invasive bladder cancer: Tumors that grow into the deep muscle layer and bladder wall are considered muscle invasive. These represent around 25% of new bladder cancer cases. For cancer that is confined to the bladder and treated with surgery, the five-year survival is 85%. The most common parts of the body where the disease spreads beyond the bladder include regional lymph nodes, bones, liver and lungs. Urothelial cells also can line the upper urinary tract, which contains tubes that attach and carry urine from the kidneys to the bladder. The survival rate decreases with more advanced stages of the disease.

What are the warning signs of bladder cancer?

Some of the early symptoms of bladder cancer are difficult to recognize. Common symptoms include:

• Hematuria, or blood in the urine. This may appear orange, pink or rarely, dark red.
• Change in bladder habits, thus includes increased frequency, incomplete emptying or urgency.
• Pain or burning sensation during urination

Blood in the urine is normally the first sign of bladder cancer. It may be apparent on a regular basis or disappear and reappear over the course of days or weeks. If you notice blood in urine, you should seek medical attention quickly, so an evaluation can be completed.

Bladder cancer testing

Diagnosing bladder cancer can happen in a number of ways. If a patient’s symptoms or lab results suggest bladder cancer, we will run further tests and procedures to make a diagnosis.

The evaluation likely will include the following:

• A urinalysis, or urine test
• CT scan or MRI scan
• A cystoscopy. A cystoscopy is performed by a urologist who places a small camera in the bladder through the urethra — the tube that carries urine out of the body — to check for abnormal areas. The test takes less than a minute and is done under local anesthesia. If abnormalities such as tumors or oddly appearing tissue are discovered during a cystoscopy, a biopsy or a sample of tissue may be taken at that time to determine if there is cancer present.

Further urine testing for cancer cells in the urine may be performed as indicated.

The next part of testing is to determine the stage and type of bladder cancer. Patients who are determined to have bladder tumors will undergo a biopsy and resection. This is known as transurethral resection of the bladder tumor, or TURBT. The goal of the TURBT is to remove as much, if not all of the bladder tumor. The TURBT will establish the diagnosis of bladder cancer and help to determine the stage of cancer.

Routine surveillance of the kidneys is also important following a diagnosis of bladder cancer. This is because urothelial carcinoma can appear in the lining of the ureters and kidneys. Surveillance of the kidneys will be completed with CT scans or MRIs.

Bladder cancer staging

Clinical staging for bladder cancer is completed by combining the results of the physical exam, TURBT and radiographic tests (CT scan or MRI).

The prognosis of bladder cancer is directly linked to the stage of the bladder cancer. Staging is a process that shows how far the cancer has spread. The treatment and outlook for bladder cancer will depend significantly on its stage.

Treating bladder cancer

Results from a bladder cancer diagnosis and staging evaluation help a urologist devise a treatment plan based on a number of factors. This includes the type of cancer, grade of cancer and stage of cancer.

Non-muscle invasive bladder cancer treatment options

Approximately 70% of new cases are diagnosed at stage 1, which are of non muscle-invasive bladder cancers.

The focus of treating stage 1 is preventing cancer recurrence and to avoid surgical removal of the bladder when possible.

TURBT is usually the first treatment for these cancers. TURBT is a procedure performed through a cystoscope where the tumor is resected without making a visible incision on the body. The entire removal of a bladder tumor can be accomplished through this operative cystoscope. Following a TURBT, drug therapy in which medications are put into the bladder to prevent disease recurrence and progression are often recommended. The biopsy specimen from the TURBT is sent to the pathologist who will evaluate the specimen for the presence, extent and aggressiveness of cancerous cells. Surveillance cystoscopy is required after diagnosis for bladder cancer. The timing of the surveillance cystoscopies are based upon the risk of the cancer coming back.

Intravesical drug therapy uses one of several types of medical therapies placed directly into the bladder through a urethral catheter in an attempt to minimize the risk of tumor recurrence and progression. About 50-68% of patients with superficial bladder cancer have a very good response to intravesical therapy. The most commonly used intra-vesical is Bacille Calmette-Guerin, or BCG, which is given once a week for six straight weeks. BCG is a weakened tuberculosis (TB) bacterium. Maintenance therapy (repeated therapy on a regular basis) with BCG or other drugs administered intermittently following initial diagnosis and treatment of superficial bladder tumor can further decrease the likelihood of recurrence.

Muscle invasive bladder cancer treatment options

Stage 2 is described as muscle-invasive bladder cancer meaning cancer has spread into the deep muscle layers of the bladder but not outside of the pelvis. Treatment for stage 2 and 3 bladder cancer is more aggressive and includes a combination of chemotherapy, radiation therapy and sometimes, bladder removal. Stage 4 bladder cancer is when the cancer has spread beyond the pelvis and is primarily treated with chemotherapy and immunotherapy. Treatment options for muscle invasive bladder cancer include:

Radical Cystectomy with urinary diversion – Radical cystectomy in both men in women includes removing the bladder, pelvic lymph nodes and creation of a new means to eliminate urine from the body. In men the prostate is also removed and in women fallopian tubes, ovaries and anterior portion of the vagina are also removed. The procedure to develop the new means to eliminate urine from the body is referred to as a urinary diversion. Several urinary diversion options are available. The type of urinary diversion performed is based on patient choice and medical conditions.

Chemotherapy – Chemotherapy is a systemic treatment, or a drug that is dispersed throughout the entire body. It is designed to kill cancer cells. Typically, it is administered through a vein. The chemotherapy may be administered before surgery, known as neoadjuvant therapy, after surgery known as adjuvant therapy or in the setting of advanced disease. On the other hand, in patients with non-invasive bladder cancer, chemotherapy may be infused into the bladder through the urethra, called intravesical chemotherapy, in hopes of reducing recurrence and progression of disease.

Radiation therapy with chemotherapy – Radiation uses high-energy X-rays to destroy cancer cells. The addition of systemic chemotherapy makes cancer cells more susceptible to the killing effects of radiation. Radiation therapy is also used to treat patients with stage 2 and 3 bladder cancer. This type of therapy can help patients avoid the need for radical cystectomy.

Should bladder cancer patients consider clinical trials?

Clinical trials can offer patients access to the latest advances in care, provide a chance to help others by establishing the best care for future patients, and will often provide closer monitoring.

What is bladder cancer removal surgery?

This involves removing the bladder and prostate in men and involves the bladder and sometimes the reproductive organs in females. Both genders have lymph nodes removed as well. We then create a urinary diversion.

Are there ways to prevent bladder cancer?

The leading cause of bladder cancer is smoking. Smokers are 4 to 7 times more likely to develop bladder cancer than non-smokers. Visit tobaccofree.ufl.edu for help.

Bladder cancer has also been known to be caused by environmental and occupational exposure. For example, some chemicals used in the rubber, leather, paint and dye industries can increase risk of bladder cancer.

Hereditary forms of bladder cancer are rare but should be considered when patients have multiple forms of cancer in their family.

Find a bladder cancer doctor near you

Located in Gainesville, Florida, and within one of the nation’s top research universities, the UF Health Cancer Center brings together numerous researchers and clinicians dedicated to the prevention, diagnosis and treatment of all cancers. Our nationally recognized multidisciplinary team of specialists meets weekly to carefully review patient information and develop the best possible treatment plan for each individual.

The multidisciplinary treatment team for genitourinary cancer includes physicians, nurses and staff who can provide extensive experience in many areas of prevention, diagnosis and treatment. Our patients benefit from numerous services and an integrated clinical experience including:

• Urologic oncology
• Medical oncology
• Radiation oncology
• Pathology
• Radiology
• Pharmacy
• Weekly GU tumor board
• Clinical trial enrollment
• Psychosocial support
• Genetic counseling
• Social workers
• Patient educators and resources
• Personal wellness and rehabilitation programs
• Nutrition counseling
• Spiritual guidance
• Palliative care
• Home care
• Prevention and screening
• Support groups

State-of-the-art technology and innovative therapy

Our renowned experts utilize the latest innovative technology to provide extensive treatment and therapy options, including:

• Robotic surgery
• Laparoscopic surgery
• Cryosurgical ablation
• Brachytherapy
• Proton therapy
• External beam radiotherapy
• Intensity modulated radiotherapy (IMRT)
• Intensity guided radiotherapy (IGRT)
• Cutting edge clinical trials