Bladder cancer is the second most common urologic malignancy after prostate cancer. It is the only cancer, other than lung cancer, directly linked to smoking, making smoking cessation an integral part of bladder cancer treatment. While it more commonly presents in the fifth and sixth decades, bladder cancer can present in younger patients, especially those who smoke, as well as those patients exposed to certain environmental toxins such as textile dyes and tars. The most common presenting symptom or sign is blood in the urine.
Fortunately most bladder cancers discovered (70 percent) are superficial and can be managed with local transurethral removal. Most bladder cancers carry the risk of recurrence (80 percent) and some have the potential to invade (20 percent). To reduce the risk of tumor recurrence, patients are offered sequential therapy within their bladder and are monitored closely. Patients with invasive tumor or cancers that have characteristics of invasion are counseled for bladder removal (radical cystectomy) with an option for chemotherapy agents, and treatment cycles have improved survival while at the same time reducing side effects. Sometimes patients will be offered bladder preservation based on their age and other medical conditions which involve individualized treatment of chemotherapy and radiation.
Installation of either chemotherapy (mitomycin, valrubicin) or biological agent (BBG) into the bladder weekly for six weeks is successful in reducing tumor recurrence in most patients. Often maintenance installations are continued for up to two years if no recurrences are found. Based on the grade and stage of the tumor, patient’s follow-up will be individualized and include regular cystoscopy, urine cytology and imaging.
Involves removal of the bladder and prostate in men and the uterus, ovaries anterior vagina and bladder in women. The type of urinary diversion is based on tumor characteristics and patient preference, strongly dependent upon patients’ ability to care for their urinary diversion. The most common urinary diversion is an incontinent urinary stoma (bag on the side). Suitable patients are offered continent diversions that have wither catheterizable stomas or are reattached to their own urethra. Sexual function can be preserved in appropriate patients. Overall treatment success requires an experienced, skilled team uniquely available at the Hollis Cancer Center.