Diagnosis and Treatment of Bladder Cancer
A diagnosis of bladder cancer begins with a medical history and physical examination. A urine sample observed under a microscope can illuminate the appearance of abnormal bladder cells and also rule out the possibility of an infection. The lining of the bladder can be evaluated by the use of a cystoscope, a flexible viewing instrument inserted through the urethra. If abnormal bladder cells are detected, a biopsy will be performed and/or the tumor removed by a procedure known as a transurethral resection of bladder tumor (TURBT). TURBT is accomplished using a resectoscope, a flexible viewing instrument with a wire loop on the end to remove the tumor. Additional testing may be done to identify the location of a suspected tumor or to check for the spread of cancer (metastasis). These may include magnetic resonance imaging (MRI), computed tomography (CT or CAT scan), intravenous pyelogram (IVP), and chest X-ray.
Bladder Cancer Stages and Grades
The tissue that is removed during a biopsy is assigned a "stage" and "grade." Staging reflects where the tumor is located and is defined as "superficial" (also referred to as "noninvasive") or "invasive." The grade of a tumor refers to how fast it is growing and how likely it is to spread (grade 1 and 2 are referred to as "low", grade 3 as "high"). With this information, a treatment plan will be developed to prevent or delay progression to more advanced cancer if possible, while maintaining an optimal quality of life for the patient.
Superficial tumors are limited to the bladder lining and classified as stages T1, Ta or Tis/CIS (carcinoma in situ, a non invasive, high grade cancer). An invasive tumor is one that grows into the layers of the wall of the bladder (stage T2) and can lead to metastasis. Invasive tumors that have progressed beyond the muscle layer into the surrounding fat layer and reproductive organs are classified as stage 3. Tumors that have metastasized to organs such as the prostate, uterus, pelvic wall and bones are classified as stage 4 and considered incurable.
Bladder Cancer Treatment
At Mount Sinai, we work closely with you to develop a treatment plan customized to your needs that takes into consideration: your age, medical history, and overall health; the type, location, grade and stage of your cancer; your expectations for the course of the disease; your preferences and tolerance for certain procedures.
Low grade, superficial bladder cancers are generally manageable and not fatal. These tumors can be removed using a resectoscope (a narrow, lighted tube with a cutting instrument). However, superficial tumors can recur frequently, especially in stage TIS and T1 bladder cancer. Because there is such a high rate of reoccurrence, these patients will be monitored closely by a urologist (through periodic cytoscopies and urinalyses). If the rate of reoccurrence is determined to be excessively high, intravesical chemotherapy (the use of a catheter to deliver medicine directly into the bladder to destroy existing tumors or prevent new ones from developing) may be recommended. For low grade tumors, the recommended medication is often a chemotherapeutic agent, such as mitomycin. High grade tumors are more commonly treated with BCH (Bacillus Calmette-Guerin), an immunotherapeutic vaccine.
Radical cystectomy (removal of the bladder) is the standard approach to the management of patients with muscle invasive bladder cancer. In men, the prostate is removed along with the bladder; in women, the urethra, uterus, fallopian tubes, ovaries, and anterior vaginal wall are removed. In some cases cancer can be removed while preserving healthy tissue and bladder function using nerve-sparing surgery and a combined modality approach. This includes a partial cystectomy, TURBT, chemotherapy and/or radiation. Cystectomies and partial cystectomies can be performed via minimally invasive laparoscopic procedures.
We perform advanced reconstructive procedures following radical cystectomies such as continent diversions to create new bladders (neobladders) from sections of the small intestine.
Approximately 25 percent of patients are diagnosed initially with metastatic bladder cancer (cancer that has spread). Chemotherapy is prescribed most commonly following surgery for high grade tumors or for those that have spread. For some, chemotherapy is administered prior to surgery to shrink a tumor for more effective results. For other patients, chemotherapeutic agents may be delivered directly to the bladder during surgery. Our physicians have the advanced training and experience to ensure the precise timing and dosing of these medications.
Radiation therapy sometimes administered following surgery to destroy remaining cancer cells. The Division of Interventional Radiology at Mount Sinai Health System was established as one of the nation’s first clinical sites for image-guided therapy and is on the cutting edge of all new interventional radiology techniques and technology.
We Can Help
If you or a loved one have been recently diagnosed with bladder cancer or are experiencing symptoms of bladder cancer (blood in your urine, painful urination, lower back pain, swelling of the lower legs), please call us to arrange a consultation with Dr. Hall or one of his colleagues at 212-241-4812.
Department of Urology
5 East 98th Street, 6th Floor
New York, New York 10029
Robotic Kidney Surgery
425 West 59th Street
New York, New York 10019