Cancer of the Bladder

Bladder tumors are very common. It is more common in men than women. They are probably caused by smoking. Sometimes exposure to chemicals can also cause bladder tumors.

The most important sign of bladder tumors is blood in the urine. This may be grossly bloody urine, or blood detected in the urine in the doctor’s office.  This is called microscopic hematuria and is not visible by the naked eye.

When blood is detected in the urine it becomes necessary to do a CT scan, which is a diagnostic imaging test to check the body, specifically the ureters, the kidneys, and the bladder to see if there is a growth there. There are two kinds of CT scans, one with contrast dye and one without. If the patient has compromised kidney function, it is best to do one without dye. Also, in diabetic patients, a scan without dye would be better. After the CT scan, the patient needs to see a urologist so he can look inside the bladder to see if there is a tumor or not. The CT scan will not show the details of the bladder. If it is a large tumor, that may be seen by the CT scan, but if it a small tumor in the lining of the bladder, which is called mucosa, it may not show on the scan.

There are some urine tests that one can do to see if the patient has a tumor or not, most of these tests will show a tumor that is very aggressive, that can be seen by a CT. A cystoscopy, which is looking inside the bladder with a scope is crucial to detecting bladder cancer. Most of these cancers arise from the lining of the bladder, so they can be seen by a good cystoscope. In some cases they cannot be seen, in which case random biopsies may show the changes in the cancer. If during cystoscopy the doctor sees a tumor, then he may go ahead and scrape it and send it to the pathologist to see what kind of cancer it is. It is very rare to find benign cancers of the bladder, and some of these tumors may be very fast growing. The slower growing ones are usually contained in the lining of the bladder, and scraping it with a special tool and administering radiation and chemotherapy will usually take care of that. If the pathologist (the doctor who studies the cancerous cells on microscope slides) says that the tumor is involving the muscle, then just scraping it is not enough. These kind are normally very aggressive tumors, and something different needs to be done. Either the bladder needs to be removed or radiation and chemotherapy should be administered.   

There are two treatments to prevent the recurrence of bladder tumors. The first one is Mitomycin, and the other one is BCG. Mitomycin is an oncologic medication that is instilled in the bladder according to a certain program. BCG is another medication administered within the bladder, but it is actually used primarily as a vaccine for tuberculosis, so it can have all kinds of undesirable side effects. After removal of the bladder, it is important that the doctor does a follow up cystoscopy every three months, and then one every 6 months to ensure that the tumor has not come back. The doctor will then release the patient from his care after 5 years.