Bladder Cancer
Cancer does not occur without genetic change . . .
Due to the high incidence and prevalence of bladder cancer throughout the world, there has never been a greater need for an absolute diagnosis. This is especially the case for previously diagnosed patients who require on-going monitoring to ensure that disease recurrence is detected as early and as accurately as possible. Early detection of bladder cancer recurrence is the key to increased survival.
What is bladder cancer?
Bladder cancer is an uncontrolled tumorous growth in the tissue that lines the bladder. It is the fourth most common cancer in men and the eighth most common in women.
What types of bladder cancer are there?
Simply described, there are three types of bladder cancer:
- Noninvasive cancer — Abnormal cell growths in the bladder lining that have not yet spread into the layers of tissue that surround the bladder lining.
- Invasive cancer — Cancer that has spread from the bladder lining into the other layers of bladder tissue that surround it.
- Metastatic cancer — Cancer that has spread from the bladder to other organs and sometimes to distant parts of the body.
How is bladder cancer treated?
Treatment is a two-part process.
- Part one is diagnosis, which includes identification of the cancer, followed by determination of its stage (invasiveness of the cancer into other tissue layers) and grade (aggressiveness of the cancer cells).
- Part two is treatment. Depending on stage and grade, the cancer may be treated with surgery (removal of the cancer), immunotherapy, chemotherapy, or radiation.
The most common form of therapy after surgery to remove bladder cancer is Bacillus Calmette-Guérin (BCG) immunotherapy. BCG treatment causes an immunoreactive response — your body thinks it is fighting an infection and the bladder lining can become inflamed. This response can result in an inhibition of cancer cell growth. After the initial course of BCG treatment, the patient is monitored on a routine basis (as determined by the physician) to check for recurrence of the cancer.
Why is monitoring so important?
The chance that bladder cancer will return is about 50 percent. The earlier bladder cancer is detected, the more likely you will benefit from therapy (to prevent or reduce tumor growth) or surgery (to remove the cancer again). In fact, when bladder cancer is detected and treated at an earlier stage and grade, there is a very high chance of eliminating the cancer or keeping it under control. This leads to a better quality of life.
How does my Urologist monitor my bladder cancer?
The primary way to monitor for bladder cancer is by cystoscopy. Cystoscopy is a medical procedure in which a cystoscope (a narrow tube and lens) is inserted into the bladder via the urethra. Local anesthetic or general anesthesia is typically administered during this procedure. The Urologist uses the cystoscope to look at the inside of the bladder for signs of cancer. If an area looks suspicious, the Urologist can collect a small sample (a biopsy) of the tissue and send it to a histology testing lab that studies the tissue to determine whether cancer cells are present.
To assist in the diagnosis, one of the following laboratory tests may also be performed on a sample of your urine:
- "Urine Cytology" test. This microscopic test looks for abnormal-appearing cells (potential bladder cancer cells) that were shed from the bladder lining into the urine.
- "Biomarker" test. These tests look for specific molecules or chemicals in the urine that are produced by cancer cells.
- "Genetic Abnormality" test. This test looks for cancer-associated genetic changes in cells collected from voided urine.
Why does the cystoscopy exam alone not always reveal when a tumor is present?
Even with the physician's skill with a cystoscope, results are not always conclusive. There are two particular situations that make it important to perform other tests to check for recurrence of bladder cancer.
- Certain kinds of non-invasive bladder cancer — called "carcinoma in situ" — lie flat against the bladder wall, making it difficult to see.
- BCG immunotherapy, as mentioned, can cause inflammation of the bladder lining. When this happens, the presence of cancer cells is sometimes masked.
