Bladder Cancer Diagnosis and Treatment

How We Diagnose and Treat Bladder Cancer

Diagnosis

When you see BIDMC's bladder cancer experts, you will start with a set of tests to thoroughly identify your condition and develop a treatment plan that works best for you. Some of these tests include:

• Urine tests: Your urine will be tested for tumor cells.
• Cystoscopy: A hollow tube (cystoscope) equipped with a lens will be inserted into your urethra (channel that carries urine out of the bladder) and slowly advanced into your bladder. This allows your doctor to examine the lining of your bladder and urethra.
• Biopsy: A small amount of tissue will be removed and examined under a microscope.
• CT scan: A CT (computerized tomography) scan creates a 3-dimensional picture from different angles which provides a clear image of abnormalities.
• MRI: MRIs (magnetic resonance imaging) use magnetic fields, not x-rays, to produce detailed images of the body, include the pelvic region area, which is made up of soft tissue.
• Ultrasound: Ultrasounds use sound waves to create a picture of the internal organs.

Treatment

Our Genitourinary Cancer team offers a full range of treatment options for bladder cancer, including innovative treatments that you can't find elsewhere in New England. One example of this is robotic-assisted surgery (for those patients with advanced cancer) where the entire bladder is removed and surgeons create a "urostomy" by attaching the kidneys to a small piece of intestine which is brought to the skin. Our surgeons also can create a "new" bladder inside the body. This means some select patients with advanced bladder cancer don't need an ileostomy bag (which sits outside the body) to collect urine.

Our treatment options include:

• Surgery, to remove cancerous tissue
• Chemotherapy in the bladder (intravesical chemotherapy), to treat tumors that are confined to the lining of the bladder but have a high risk of recurrence or progression to a higher stage
• Chemotherapy for the whole body (systemic chemotherapy), to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment in cases where surgery isn't an option
• Reconstruction, to create a new way for urine to exit the body after bladder removal
• Radiation Therapy, to destroy cancer cells, often as a primary treatment in cases where surgery isn't an option or isn't desired
• Immunotherapy, to trigger the body's immune system to fight cancer cells, either in the bladder or throughout the body

Surgery for Bladder Cancer

Transurethral resection of bladder tumor (TURBT)

A transurethral resection of bladder tumor (TURBT), or a transurethral resection (TUR), is often used to find out if someone has bladder cancer and, if so, whether the cancer has spread into the muscle. It is also the most common treatment for early-stage bladder cancers. Sometimes, a second, more extensive TURBT is done to better ensure that all the cancer has been removed.

Cystectomy

When bladder cancer is invasive or intravesical treatments do not work, all or part of your bladder may need to be removed in an operation called a cystectomy. In many cases, you would get chemotherapy first.  

Partial cystectomy

If the cancer has invaded the muscle layer of the bladder wall but is not very large and is only in one place, it can sometimes be removed along with part of the bladder wall without taking out the whole bladder. The hole in the bladder wall is then closed with stitches. Nearby lymph nodes are also removed and tested to see if the cancer has spread. Only a small portion of people with invasive bladder cancer can have this surgery. The main advantage of this surgery is that the person keeps their bladder and doesn't need reconstructive surgery. But the remaining bladder may not hold as much urine, and the bladder cancer can come back in another part of the bladder wall. At BIDMC this surgery is often performed robotically.

Radical cystectomy

If the cancer is larger or is in more than one part of the bladder, you will need a radical cystectomy. It removes the entire bladder and nearby lymph nodes. In men, the prostate and seminal vesicles are also removed. In women, the ovaries, fallopian tubes, the uterus, cervix, and a small part of the vagina are removed too. Most of the time, a surgeon performs a cystectomy through a traditional "open" incision in the abdomen. However, the vast majority of patients having this surgery at BIDMC since 2009 have been eligible for minimally invasive, or robotic surgery.

Radical cystectomy with intracorporeal urinary diversion

Some patients may be eligible for this procedure. Surgeons create a "neobladder" (new bladder) by taking a piece of the small intestine and forming a new reservoir for urine. The result is that you can urinate naturally rather than needing an ileostomy bag on the outside of your body. BIDMC is the only center in New England offering this procedure with the assistance of a surgical robot. The benefits to using the robot include faster healing and less blood loss during the procedure.

Chemotherapy for Bladder Cancer

If chemotherapy is part of your treatment plan, there are different ways for it to be delivered, depending on your type of cancer.

Intravesical chemotherapy is inserted directly into the bladder and is used for bladder cancer that's only in the lining of the bladder.

Systemic chemotherapy is given in pill form or injected into a vein or muscle. This allows the drugs to go into the bloodstream and travel throughout the body. It can affect cancer cells anywhere in the body.

Systemic chemotherapy can be used :

• Before surgery to try to shrink a tumor so that it's easier to remove and to help lower the chance the cancer will come back.
• After surgery (or sometimes after radiation therapy), to kill cancer cells that may remain after other treatments. This can lower the chance that the cancer will come back later.
• In people getting radiation therapy, to help the radiation work better.
• As the main treatment for bladder cancers that have spread to distant parts of the body.

Radiation Therapy for Bladder Cancer

Radiation therapy uses high-energy radiation to kill cancer cells.

It can be used:

• As part of the treatment for some early-stage bladder cancers , after surgery that doesn't remove the whole bladder (such as TURBT)
• As the main treatment for people with earlier-stage cancers
• To try to avoid cystectomy (surgery to take out the bladder)
• As part of treatment for advanced bladder cancer
• To help prevent or treat symptoms caused by advanced bladder cancer

Radiation therapy is often given along with chemotherapy to help the radiation work better.

Immunotherapy for Bladder Cancer

Immunotherapy is the use of medicine to help a person’s immune system recognize and destroy cancer cells.