Frank Talk About Bladder Cancer

Bladder cancer is a serious disease, but with optimal care most people with the disease can live a normal life. Optimal care requires cooperation and coordination between patient and doctor. My philosophy is to encourage patients to participate fully in their care. I will review the options for treatment and make recommendations- sometimes very strong recommendations if I believe your life may depend on it- but the final choice is yours. I will continue to care for you even if you choose a suboptimal treatment as long as we understand that you are responsible for your choices.

The course and the treatment of bladder cancer is highly variable. Low grade tumors (those that have cells that look nearly normal under the microscope) generally do not invade (grow into the wall of the bladder) or spread. They are treated by surgical removal using a scope inserted through the urethra (transurethral resection of bladder tumor, TURBT). Low grade tumors often come back. Medicine can be put in the bladder to reduce the chance of tumor recurrence, but sometimes they just keep coming. While the risk of dying from low grade bladder cancer is very, very low, these tumors can become more aggressive, spread to the upper urinary tract, invade, and even metastasize (spread to other organs). Because the risk of tumor recurrence is life long, we recommend life long follow up.

High grade tumors, those that have cells that look very abnormal under the microscope, begin in the lining of the bladder but are at increased risk of invading and spreading. High grade bladder cancer is a life-threatening disease. I recommend TURBT followed by BCG (Bacillus Calmette-Guerin) immunotherapy for most patients with high grade bladder cancer that has not yet invaded the muscle wall of the bladder. If tumors do not respond to this treatment, or if the tumor invades the bladder wall, complete removal of the bladder (radical cystectomy) is generally recommended. This is major surgery and requires diversion of the urine to the abdominal wall or creation of a bladder from bowel. Even with this major surgery, cure is not assured. Chemotherapy can be used with cystectomy or radiation therapy to increase the chance of cure. Careful follow up is needed, especially if the bladder is not removed, because there is a risk of disease occuring in the urethra, upper urinary tracts, or elsewhere.

About 60 percent of bladder cancer is thought to be due to tobacco, which causes many types of cancer. But even if you don't smoke, you have an increased risk (about 30 percent) of having or developing another malignancy. It is therefore imortant to keep up your routine screening and examinations with your family physician, including periodic chest xrays, mammograms for women, and colonoscopy.

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Created: 3/15/2005 | Updated: 2/8/2006