Department of Medical Oncology
Jean Hoffman-Censits, MD
Wm. Kevin Kelly, DO
Jianqing Lin, MD
Atrayee Basu Mallick, MD
Avnish Bhatia, MD
Michael J. Ramirez, MD
Lewis J. Rose, MD, FACP
Andrew E. Chapman, DO, FACP
For further information contact:
Thomas Jefferson University Hospital
Each year in the United States, more than 52,000 men and 18,000 women are diagnosed with bladder cancer. Most are over 70 years old. Risk factors include smoking, chemicals in the workplace, personal history of bladder cancer, certain cancer treatments (e.g. cyclophosphamide, radiation therapy), arsenic, or a family history of bladder cancer.
Bladder cancer forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are (TCC) transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.
Stage 0: The cancer cells are found only on the surface of the inner lining of the bladder. The doctor may call this carcinoma in situ.
Stage I: The tumor has grown deeper into the inner lining of the bladder, but it hasn’t invaded the muscle layer of the bladder.
Stage II: The tumor has invaded the muscle layer of the bladder.
Stage III: The tumor has grown through the muscle layer to reach tissues near the bladder, such as the prostate, uterus, or vagina.
Stage IV: The tumor has invaded the wall of the pelvis or abdomen, but cancer is not found in any lymph nodes. Or, the cancer cells have spread to at least one lymph node or to parts of the body far away from the bladder, such as the liver, lungs, or bones.
For early-stage cancer of the bladder that is confined to the bladder wall, Jefferson physicians commonly perform transurethral resection of the bladder tumor (TURBT), which can also be employed as a diagnostic tool. This procedure is usually followed by intravesical therapy with mitomycin C or Bacille Calmette-Guérin (BCG). The latter is the therapy of choice for the more aggressive cancer of the bladder lining.
In the case of muscle-invasive bladder cancer, usually neoadjuvant chemotherapy is followed by a partial or total cystectomy, which may be performed laparoscopically or with robotic instrumentation; radiation therapy may also be prescribed before or after a cystectomy. Elderly patients or patients who are not candidates for surgery may receive only chemotherapy and/or radiation.
Reference: National Cancer Institute.