Hoag Bladder Cancer Program

What is bladder cancer?

Bladder cancer typically originates in the cells lining the inside of the bladder, and most often affects adults in older stages of life. It is usually diagnosed early, making it a highly treatable cancer. Bladder cancer is also likely to recur following treatment. Therefore survivors continue to receive follow-up testing for many years after diagnosis.

The most common type of bladder cancer in the United States is transitional cell carcinoma. Other less common types include squamous cell carcinoma and adenocarcinoma.

What are the symptoms?

The most common symptom of bladder cancer is hematuria or blood in the urine. Frequent, urgent or painful urination are other common symptoms.

What causes bladder cancer?

The causes of bladder cancer are unclear. It can be a due to a history of smoking, a parasitic infection, or chemical or radiation exposure.

If it runs in my family, am I more likely to get it?

It is rare for bladder cancer to run in families, but if at least one of your immediate relatives has a history of the condition, this may increase your risk of getting it. In addition, a family history of Lynch syndrome, or non-polyposis colorectal cancer, can increase your overall risk of cancer in your urinary system, colon, uterus, ovaries and other organs.

Hoag Family Cancer Institute offers a Hereditary Cancer Program to assess a person's family history and any associated risk for cancer. Learn more by calling 949-764-5764.

Are there other risk factors to be aware of?

Several factors may increase your risk of bladder cancer, including:

• Age: Your risk increases with age.
• Race: Individuals who are Caucasian have a greater risk.
• Gender: Men have an increased risk.
• Smoking: Smoking cigarettes, cigars or pipes increase your risk through the harmful chemicals that accumulate in your urine, thus causing damage to the lining of your bladder.
• Previous cancer treatment: Individuals who have received radiation treatment to the pelvis or taken an anti-cancer medication called cyclophosphamide have greater risk.
• Chemical exposure: Exposure to these chemicals increase your risk: arsenic and the chemicals used to manufacture dyes, rubber, leather, textiles and paint products.
• Medications taken: Individuals who have taken pioglitazone (a diabetes medication), or medications containing pioglitazone, for more than a year have an increased risk.
• Bladder inflammation: Repeated urinary inflammations or infections-which can happen with long-term catheter use-may increase your risk of squamous cell carcinoma.

Should I be screened for bladder cancer?

There is no routine screening for bladder cancer. However, individuals with symptoms such as hematuria or painful urination should undergo testing to evaluate for this condition.

How is bladder cancer diagnosed?

Your doctor may choose any combination of the following tests to diagnose bladder cancer:

Cystoscopy: During this procedure, a thin tube with a lens and fiber-optic lighting is inserted into the urethra. This enables the doctor to view the inside of your urethra and bladder. A local anesthetic is generally used to increase your comfort level.

Biopsy: Your doctor may collect bladder tissue sample during the cystoscopy. This tissue is then examined by a pathologist for presence of cancer.

Urine cytology: In this procedure, a urine sample is analyzed through a microscope to check for cancerous cells.

Imaging: Two forms of imaging used for bladder cancer are a computerized tomography (CT) scan and an intravenous pyelogram, which uses a dye to highlight your kidneys.

How aggressive is my cancer?

The aggressiveness or grade of bladder cancer is determined by the pathologist who examines the cancerous tissues under a microscope. This tissue can be obtained with biopsy or after surgical removal of the tumor. After you are diagnosed, your doctor may do some additional tests-including a CT scan, MRI, bone scan or chest X-ray-to find out the stage of the cancer.

The stages of bladder cancer include:

• Stage I: Cancer is in the inner lining of the bladder but hasn’t entered the bladder wall.
• Stage II: Cancer has entered the bladder wall and is still confined to the bladder.
• Stage III: Cancer cells have spread through the bladder wall to the surrounding tissue.
• Stage IV: Cancer cells may have spread to the lymph nodes and additional organs including your bones, lungs or liver.

What are my treatment options?

Biological Therapy

Also called immunotherapy, biological therapy is the use of certain drugs that signal your body’s immune system to fight cancerous cells. Your doctor will recommend the most appropriate course of treatment for you.

Chemotherapy

Chemotherapy treatment for bladder cancer often combines two or more drugs to destroy cancerous cells. It can be used prior to or after surgery.

When administered before surgery, chemotherapy is generally used to shrink the size of a tumor enabling a minimally invasive surgery. When administered after, chemotherapy is intended to kill any remaining cancer cells.

Radiation Therapy

Radiation therapy aims high-energy beams directly at the cancerous cells to eradicate the cancer.

Radiation is sometimes used following surgery to destroy any remaining cancerous cells or, in certain cases, can be combined with chemotherapy when surgery has been ruled out as an option.

Hoag offers a robust Radiation Oncology Program, utilizing multiple treatment options to accurately administer radiation therapy. Providing treatment in both Newport Beach and Irvine, Hoag's Radiation Oncology team consists of highly specialized radiation oncologists, physicists, dosimetrists, radiation therapists, radiation oncology nurses and many support team members, such as speech and swallowing therapists and oncology deititians.

Surgery

The first-line surgical treatment for bladder cancer is the trans-urethral resection of bladder tumor (TURBT). This involves the placement of endoscopic instruments into the bladder via the urethra. The tumor is then removed from the wall of the bladder and is examined by the pathologist to confirm the presence of cancer and also depth of penetration and grade of cancer.

Segmental cystectomy, or partial cystectomy, is performed only in limited circumstances in which the cancer is confined to a single area of the bladder.

Radical cystectomy is a surgery in which the entire bladder is removed, as well as adjacent lymph nodes. In men with invasive bladder cancer, the prostate and seminal vesicles are also removed. In women, the uterus, ovaries and part of the vagina are removed.

At Hoag, radical cystectomy is performed using robotic surgery, which allows for greater precision and potentially quicker recovery.

Following a radical cystectomy, the surgeon will create a new method for the patient to expel urine. Multiple options exist, and the decision is based on what is best for the particular patient-both physically and preferentially.

The surgeon can create a tube, or urinary conduit, with a piece of the intestine that runs from the ureters to the exterior of the body. The urine then empties into a urostomy bag worn on the abdomen.

Another option is for the surgeon to create a small reservoir inside the body-called a cutaneous continent urinary diversion-to contain urine. The urine is drained from the reservoir via a hole in the abdomen a few times per day through a catheter.

In certain cases, the surgeon can create a reservoir that functions more like the bladder out of part of the intestine, which is called a neobladder. Attached to the urethra inside the body, this allows the patient to urinate normally.

How can I get a second opinion?

A bladder cancer diagnosis can be scary and overwhelming. It is important that you have all of the information you need and an expert medical team to assist you in this journey.

If you would like a second opinion, Hoag can assist in connecting you with the proper resources. Contact Us 949-7-CANCER (949-722-6237) to learn more.

How do I take part in follow-up studies?

Hoag participates in a number of ongoing research studies. To find out if there are currently any bladder cancer-related studies and if you qualify, call 949-764-4430.

What side effects can I expect following treatment?

Radical cystectomy brings with it the risk of bleeding and infection.

Following surgery, men may experience erectile dysfunction due to the loss of the prostate and seminal vesicles. In some cases, surgeons may be able to avoid this by sparing the necessary nerves.

Women may experience premature menopause and infertility.

What happens following surgery?

Bladder cancer survivors can face a number of health concerns, but one of the biggest is recurrence or a second cancer. Survivors may actually have a higher risk of developing a second bladder cancer or another type of cancer. There is increased risk of the following:

• A second bladder cancer
• Acute myeloid leukemia (AML)
• Kidney or renal/ureter cancer
• Cancer of the larynx
• Lung cancer
• Pancreatic cancer
• Prostate cancer
• Vaginal cancer

It is important to have regular check-ups with your doctor. Be sure to inform your doctor of any new symptoms or concerns, as they could be an indication of recurrence or a second cancer.

Your individual exam schedule will depend on the initial extent and stage of your cancer, the treatment received, among other factors. Your first doctor visit after surgery is generally scheduled 2-3 weeks after you leave the hospital.

Is there anything I can do to prevent recurrence or a second cancer?

The following steps can help lower your risk and maintain your heath:

• Avoid tobacco products. (Smoking increases the risk of second cancers as well as other cancers.)
• Remain physically active.
• Get to and maintain a healthy weight.
• Eat healthy foods, emphasizing vegetables and fruits.
• Limit alcohol to no more than one drink daily for women or two drinks daily for men.

What if my cancer comes back?

If your cancer does come back, treatment options will depend on the treatments you have had previously and the location of the cancer. Options may include chemotherapy, immunotherapy, intravesical therapy, radiation therapy, surgery, or a combination of the above.

What if the cancer has spread or continues to grow?

For stage IV bladder cancers that have either reached the pelvic or abdominal wall or spread to adjacent lymph nodes or other parts of the body, surgery usually cannot remove all of the cancer.

For stage IV cancers that have spread, the first course of treatment is usually chemotherapy, sometimes followed by radiation therapy. For those that have not spread but continue to grow, chemotherapy is generally the first option. Then, depending on the outcome, a cystectomy may be possible if the cancer has lessened in size.

If standard treatments are no longer controlling the cancer, patients often consider participating in clinical trials for alternative treatment options. To see if any clinical trials are offered at Hoag, call 949-764-4430.