There are several types of bladder cancer, and treatment depends on where the cancer began and the stage of disease. In this video, Dr. Petros Grivas and Dr. Jonathan Wright discuss what people diagnosed with bladder cancer should know, including questions to ask their doctor, current treatment options, and the latest research in bladder cancer.
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Bladder Cancer – What to Know If You’ve Just Been Diagnosed
An illustration shows the location of the urinary bladder in the body. It is connected to the 2 kidneys by long tubes called ureters and another tube called the urethra leads out of the body from the bladder.
Voice-over: The bladder is a hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract also includes the kidneys, ureters, and urethra. Bladder cancer begins when healthy cells in the bladder lining—most commonly urothelial cells—change and grow out of control forming a mass called a tumor.
Jonathan Wright, MD, MS, FACS; Urologic Oncologist; Member, American Society of Clinical Oncology: Most people don't realize just how common bladder cancer is. It's the sixth most common cancer overall and it affects both men and women. What our bladder does is act as a storage container. It stores the urine that our kidneys make and then helps excrete it out, or it helps us urinate it out. And what cancer in the bladder is just an abnormal growth of cancer cells in the urinary bladder, where the urine is stored. The most common way that it presents is having blood in the urine, so one of the things we really try to make people realize is that if you see blood in your urine you need to tell your doctor.
Voice-over: There are 3 main types of bladder cancer.
3 Main Types of Bladder Cancer:
- Urothelial Carcinoma
- Squamous Cell Carcinoma
Voice-over: Urothelial carcinoma is the most common type of bladder cancer and squamous cell carcinoma and adenocarcinoma are less common types. Bladder cancer is also described as muscle invasive, non-muscle invasive, or non-invasive, depending on whether it has grown into or through the muscle of the bladder wall.
An illustration shows how the bladder wall is composed of several layers. The inside of the bladder is lined with a layer of cells called the urothelium. The lamina propria separates this layer from the bladder wall muscles (muscularis propria), which are surrounded by perivesical fat, and finally the peritoneum.
Petros Grivas, MD, PhD; Medical Oncologist; Member, American Society of Clinical Oncology: Every time there is a cancer diagnosis, there is so much anxiety and stress and we have to be respectful of that. And I think the patient themselves and the family should be encouraged to ask questions, and make sure they leave the visit with most, if not all their questions--ideally all their questions asked.
Voice-over: After being diagnosed with bladder cancer, it is important to learn as much as possible about your specific cancer and the treatment options available to you.
Dr. Grivas: I think an important question for the patient is, what is the current extent of the cancer? We call this stage, how much the cancer has spread or not in the organ of the bladder or in other parts of the body, lymph nodes, or other parts of the body.
And also what is the grade? Grade means, how do the cells, the cancer cells look under the microscope. This is relevant only in patients with localized early forms of bladder cancer.
Dr. Wrights: Another important thing for a patient to do, is get a second opinion. I think it's important for a patient and their family to hear from another physician as well to reinforce the initial recommendations, or to hear about additional treatment options that they might not have done before.
Voice-over: There are many different treatment options for bladder cancer depending on the stage and the extent of the cancer.
Dr. Wright: I think it's important for patients and their family to realize that no matter what stage the cancer is, we have treatment options for the patient. And it's our job to help the patient and the family navigate along those treatment options and figure out what's right for them. For those that are caught really early and are not very invasive we may end up just saying, let's just keep watching it. There are a lot of different treatment options for patients with bladder cancer.
For those that we catch really early, after we remove the tumor—typically done like patients having a colonoscopy, through a small telescope and then a pluck removal—we'll often just keep watching and doing looks into the bladder in the future to monitor for any recurrence.
Voice-over: When more treatment is needed doctors will consider several different options and recommend a specific plan for you.
Dr. Wright: For those that might be a little bit more invasive or a little bit more aggressive, we will often treat with a topical therapy essentially, delivering the treatment into the bladder on a weekly basis for typically around 6 weeks, and sometimes longer thereafter. We will always continue to monitor the bladder and look back in periodically, similar to how patients have skin exams to watch for recurrent skin cancer, or colonoscopies to watch for recurrent colon polyps or tumors. For those cancers that are more deeply invasive, and invade into the muscle of the bladder, at that point we need to talk about more extensive treatments, which may include chemotherapy given in your veins. It might include radiation to the bladder, and it might include surgical removal of the entire bladder and bladder reconstruction using your intestines to help drain your urine. And then for those patients that have bladder cancer that spread beyond the bladder, our primary treatment options include chemotherapy, and we do have some new exciting developments using immunotherapy, so immune-based therapies, and also some targeted therapies that are available and increasingly being used in bladder cancer.
Voice-over: When talking to your oncologist about treatment options, you may want to ask if there are any clinical trials that may be an option for you.
Dr. Grivas: I think every patient should ask, in my humble opinion, about clinical trials. This is very important because clinical trials are trying to achieve 2 different goals. Number 1, provide access to innovative and promising therapies to our patients, but they also are very important, are really really necessary to help us develop important data and information and knowledge that can keep moving the needle forward, and help us develop more therapies.
Voice-over: There are many new innovations in bladder cancer, including new therapies and a focus on earlier detection.
Dr. Wright: It's been exciting over the past 5 years or so, because we've seen increased funding and acknowledgement of the need for bladder cancer research, and that has led directly to development of new targeted and other therapies for bladder cancer. We're continuing to try to find new therapeutics and new combinations of therapeutics. We're also trying to figure out better ways to detect the cancer at an earlier stage through urine tests or through blood tests, and using mutations that are in the DNA, in our patient's DNA or in the tumor, that we might be able to target as well. So understanding the genetics and the genomics of bladder cancer is another hot area of research.
Dr. Grivas: Other examples of a very innovative research includes immunotherapy, and understanding the components of the immune system response, and how we can make it more robust against the cancer. And also how we can make it more selective, so the immune system can attack the cancer cells, and not as much the normal tissue in the body.
Voice-over: When facing bladder cancer, it is important to seek out support, and find reliable sources of information to help you better understand your diagnosis and navigate life with cancer.
Dr. Grivas: I think it's also important to make sure they ask for support. When I say support, I talk about social support, mental support, emotional support, because it's a lot, you know, going on right in in our minds during that stressful situation, and what resources the cancer center has in order to support the patient through this journey.
So I encourage our patients to look at Cancer.Net. Cancer.Net is a great resource. It has a very simplified framework of information regarding what the stage of bladder cancer is, what is the grade, what are the therapy options, what are the team members that the patient needs to talk to, what are other resources in terms of causes of bladder cancer, what are the potential implications in the life expectancy, as well as details about side effects from therapy. So I think it's a it's a great resource for the patients.
For more information, visit cancer.net/bladder.
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