Your bladder is a hollow organ that stores your urine. The bladder fills through 2 tubes from the kidneys (the ureters), and urine exits through 1 (the urethra). Cancer can arise anywhere along the urinary tract, but most often, it's in the bladder.

We sort bladder cancers into invasive and non-invasive. Early cancer that's only in the bladder lining is non-invasive. Over time, the cancer grows into deeper structures of the bladder, becoming invasive. As it grows into the muscle of the bladder, it can damage the bladder’s structure. Eventually, it can also spread to other parts of the body.

Bladder cancer is more common in men than women. There are many reasons why the gender gap is so large, and may partly be due to differences in smoking rates and occupational exposures among men and women.

Tobacco contains cancer-causing chemicals (carcinogens). These toxins exit the body in our urine. The cells lining the urinary tract grow fast, which makes them more sensitive to carcinogens, causing genetic changes. Over time, these changes develop into cancer.

Modern treatments have steadily improved bladder cancer survival. It should be comforting to know that surviving this type of cancer is almost 5 times more likely than not compared to historical rates, with the use of modern approaches.

At Carilion, our cancer team are experts at diagnosing and treating all types of bladder and urinary tract cancers. 

Types include:

• Urothelial carcinoma: These cancers start in the cells lining the urinary tract—the “urothelium.”  Whether the cancer starts in the upper ureter, the bladder or the urethra, we care for them in the same way.
• Squamous cell carcinoma: Starts in the flat cells that line the bladder. They make up about 5% of bladder cancers.
• Adenocarcinoma: Starts in gland-forming cells. They account for 1 – 2% of bladder cancers.
• Small cell carcinoma: Starts in nerve-like cells and accounts for less than 1% of bladder cancers.
• Sarcoma: Starts in muscle cells of the bladder’s connective tissue. This type of bladder cancer is very rare.

Fortunately, most bladder cancers identified early are non-invasive. In this case, a Carilion urologist will direct your treatment. Your urologist can make the diagnosis, do cancer surgery and, when indicated, treat your bladder with medicine.

For invasive bladder cancer, your care team may include cancer medicine experts and sometimes radiation therapy experts in addition to your urologist. For these more aggressive cancers, your care plan may include a combination of chemotherapy and/or immunotherapy followed by a major abdominal surgery to remove your bladder and lymph nodes.

We’ll also aggressively treat bladder cancer that has spread to other areas of the body. In the last decade, a host of new treatments have significantly improved outcomes.

Cancer surgery

For bladder cancers that haven’t spread, our urologists can often remove tumors using endoscopy—a thin tube with a camera and small instruments—for a minimally invasive procedure. If the cancer is more advanced, removing the bladder and nearby lymph nodes may be the safest option.

Whenever possible, our surgeons use minimally invasive techniques to use smaller cuts to reach and remove your cancer. This includes laparoscopic tools and robotic surgery. During the surgery, we may also use imaging tools to help us pinpoint the tumor for removal.

Surgery for bladder cancer includes:

• Cystoscopy: Through a flexible scope, we can visualize the urethra, bladder, and ureters. We can typically do this procedure in your urologist’s office.
• Transurethral resection of bladder tumor: This is the most common way we treat non-invasive bladder cancer. The surgeons remove cancer from the bladder’s inner lining and some surrounding muscle tissue.
• Cystectomy: Surgery to remove part or all of your bladder and nearby lymph nodes. We use this if you have bladder cancer that has spread to the muscle wall or are at high risk for it.

If we remove your bladder, you'll need reconstructive surgery to create another way to store and pass urine. Our urologic surgeons may use an urostomy procedure, which reroutes your urine into a pouch outside the body. We may also create a neobladder or new bladder from a piece of the intestine that lets you pass urine like before. 

All of these options have pros and cons, and your urologist will guide you through each choice to find the approach that works best for you.

Cancer medicines

The bladder is unique in that we can directly treat the lining of the bladder with medicine through the urethra. This is called intravesical therapy. We give these through a tube placed through your urethra into your bladder called a catheter.

These cancer medicines are often used for non-invasive bladder cancer. You’ll often get these cancer medicine treatments from your urologist.

For advanced or high-risk cancers, you may need cancer medicines that can travel through the body to eliminate bladder cancer cells. These medicines can also stop cancer from progressing. You’ll often get these cancer medicines through a medical oncologist before considering bladder removal surgery.

Types of cancer medicines include:

• Non-targeted therapy: Medicines like chemotherapy kill rapidly growing cells. Not everyone with bladder cancer needs chemotherapy. Your cancer may respond well to other medicines. 
• Immunotherapy: Medicines that boost your immune system to fight cancer. A unique treatment for bladder cancer is an immunotherapy called Bacillus Calmette-Guérin. We administer this vaccine into the bladder to help the body's immune system attack cancer cells. 
• Targeted therapy: Some cancer cells have an “Achilles’ heel” that we can use to kill the cancer cells and leave healthy cells relatively untouched. If your cancer has these targets, we may be able to use targeted therapies.

Radiation therapy

Radiation therapy is another possible option for invasive bladder cancer in certain patients. We use high-energy rays to target and kill cancer cells.

For bladder cancer, external beam radiation is the most common type of radiation therapy. We use a machine outside your body to deliver a beam focused on your tumor and nearby lymph nodes.

Radiation therapy is often combined with chemotherapy and a TURBT. We call this trimodality therapy—a combination of 3 different treatments (surgery, chemotherapy, and radiation therapy). 

Trimodality therapy may be an option for certain patients who meet specific criteria. Your urologist and radiation oncologist will talk with you in detail to see if it’s right for you.

Clinical trials

Clinical trials are often available for treatment of advanced or metastatic bladder cancer. They compare a new cancer medicine or protocol to the current best therapy. Your care team may ask you to consider a trial when studying a new and exciting way to treat cancer.

These studies are voluntary; you'll talk to your care team before enrolling. A trial can be a first treatment option or an option if your treatment stops working.

Long-term management

Even after successful treatment, bladder cancers can come back. If your urologist removed one small cancer, it may not be the only one. So, constant surveillance is part of the cure. At Carilion, close follow-up of your urinary health is part of every cancer care plan.

Depending on your risk of bladder cancer coming back, you may need more intravesical therapy. How often you need it and for how long depends on your risk. Your treatment schedule may last several weeks or several years. 

It’s important to know most non-invasive bladder cancers can be treated and managed successfully, but they often require long-term follow-up and monitoring with your urologist.