There are several types of bladder tumors with varying histology and prognosis. Although some benign bladder masses exist, most bladder tumors are considered malignant (cancerous) until proven otherwise by biopsy.
Bladder tumors are often discovered at the time of cystoscopy during workup of blood in the urine (hematuria) or irritative symptoms. The most common cause of bladder cancer is a history of smoking, and tobacco use increases risk of bladder cancer 2 to 4 fold. Other risks associated with bladder cancer are chronic bladder inflammation, history of pelvic radiation, or chronic occupational exposures to chemical such as textile, aniline dyes or paint.
Bladder tumors are classified based on cell type, appearance, grade and level of invasion. “Papillary tumors” are the most common type of bladder tumor and have a cauliflower appearance, while “carcinoma in situ” lesions have a flat broad based appearance. Tumors can be solitary or multifocal and mixed histology of tumors is common.
Papillary Bladder Tumor
Carcinoma In Situ
Once a bladder tumor is discovered, the only way to confirm the type, grade and extent of invasion is to perform a transurethral resection of bladder tumor (TURBT). This is a procedure that is performed in the operating room under general or spinal anesthesia. The goal of surgery is to resect as much of the tumor as possible for pathologist to examine. Depending on the size and depth of tumor, this may be done in one or more procedures. Your surgeon will discuss with you the potential administration of intravesical Mitomycin C (MMC) immediately after surgery. MMC is a cytotoxic agent that inhibits DNA synthesis, and when administered immediately after TURBT has proven to decrease risk of tumor recurrence by 13% in non-muscle invasive bladder tumors. Your surgeon will determine if MMC administration is indicated and safe at the time of surgery. Depending on the extent of resection and appearance of urine, you may have a temporary foley catheter or may be asked to stay overnight for observation and bladder irrigation.
You will see your surgeon for follow up within 1-2 weeks of surgery to discuss your pathology results and further treatment options. Low grade tumors are followed with routine cystoscopy surveillance, while high grade tumors may require in-office intravesical bladder immunotherapy with BCG in conjunction with intermittent surveillance cystoscopy.
Tumors that have invaded the bladder muscle (muscle -invasive bladder cancer) have a high risk of progression and metastasis. Your surgeon will discuss with you the treatment options for MIBC which include neoadjuvant chemotherapy followed by removal of bladder (cystectomy) with urinary diversion. Alternative treatment option include triple therapy with TURBT, chemotherapy and radiation.
Bladder cancer is a serious condition that should not be taken lightly. Tumors detected at an early stage have more treatment options and better prognosis. Your surgeon will help you through the diagnosis and treatment process.