By Dr. Vahan Kassabian and Dr. A. Dev Mally, Advanced Urology

Bladder Cancer Overview

BLADDER CANCER

Occurring most frequently in men, bladder cancer is among the most common types of cancer and affects nearly 70,000 U.S. adults annually. Of this group, 90 percent of this cancer occurs in adults over the age of 55. Survival rates for bladder cancer vary depending on the stage of the cancer at the time of diagnosis. While survival rates for later stage cancers that have spread into the lymphatic system are relatively low, there is good news — usually, the prognosis isn’t all too dire. The average five-year survival rate for bladder cancer is 77 percent.

What is Bladder Cancer?

Bladder cancer occurs when uncontrolled cell production in the bladder appears, producing cancer cells. As cancer cells begin to grow in the bladder, tumors may form. These cancer cells usually first appear in the inner bladder lining, the urothelium. It is here at this stage that it’s most manageable with treatment. As the cancer progress, growing through the layers of bladder tissue and beyond, treatment methods grow more complex.

Common Bladder Cancer Types

• Urothelial Carcinoma (UC) is the most common type of bladder cancer in the United States. The urothelium, or inside lining of the bladder starts in the kidney, ureter, bladder and urethra. UC can therefore occur anywhere that has this lining. If it is considered superficial, or it has not yet invaded into the muscle layer, it can be removed through cystoscopy. If it has invaded into the muscle layer of the bladder, then the best chance for a cure would involve removing the entire bladder. Besides the cancer stage, the other important fact to know about your cancer is the grade. Urothelial cancer can be low grade or high grade. Low grade UC often recurs (comes back) after treatment, but usually does not spread to the deep layer of the muscle or to other parts of the body. High grade Urothelial Carcinoma often recurs (comes back) and may eventually spread to the muscle layer and other parts of the bladder.

Less Common Bladder Cancer Types

These are less common bladder cancer types:

• Adenocarcinoma – This is a rare, invasive type of bladder cancer, similar in histology to colon cancer in the type of cells generated. Adenocarcinoma accounts for about one percent of cases.
• Small Cell Carcinoma – This is another rare (one percent of cases), fast-growing cancer that is usually treatable with chemotherapy, followed by surgery.
• Sarcoma – These rare cancers affect the muscles of the bladder organ.
• Squamous cell carcinoma – Rare in their occurrence, squamous cell carcinomas are usually aggressive.

Causes of Bladder Cancer and How to Prevent Bladder Cancer

There are certain causes and risk factors for bladder cancer that patients should consider. Avoid behaviors and environmental factors that increase the risk of cancer such as:

• Smoking & other tobacco use (7-fold increase risk of developing bladder cancer)
• Exposure to carcinogenic chemicals
• Exposure to radiation
• Parasitic infections, often in international travelers entering certain areas

• Increasing age
• Being male
• Being Caucasian
• Chronic bladder or urinary inflammation or cystitis

• Family history of bladder cancer
• Previous treatment for cancer, especially someone who has had radiation to treat prostate cancer.

Here are a few tips for bladder cancer prevention:

• Drink plenty of high-quality, clean water
• Eat lots of antioxidant-rich vegetables and fruits

• Cease smoking immediately
• Limit or eliminate all exposure to carcinogenic chemical compounds in the workplace or environment

Healthy Lifestyle Tips for Living With Bladder Cancer

If you’re living with bladder cancer, a supportive lifestyle is essential to managing and treating your condition. Don’t start any new bladder cancer medication, diet or exercise regimen without consulting your physician.

• Get enough rest — Your body is working hard!

• Manage fatigue — Getting tired is a fact of living with cancer. Order your priorities so that fatigue doesn’t hinder you from attaining your most important goals.
• Exercise regularly — You’ll actually have more energy by giving your body the gentle exercise it needs to function well. Visit one of the area’s beautiful parks like Stone Mountain or Sweetwater Creek State Park for a refreshing walk in nature or take a stroll down the Beltline.
• Drink plenty of water — Hydration is key to proper kidney and bladder functioning.
• Cease smoking now — Smoking increases the risk of cancer and makes recovery even more difficult.
• Get support — Don’t battle cancer alone. Whether it’s group therapy, friends or family, having a support system in person or online is an essential part of a healthy lifestyle.

• Eat a healthy, nutrient-dense diet — Your body needs high-quality fuel to heal and prosper. Antioxidant foods including a high ratio of fruits and vegetables work best.

How to Know When to See a Doctor in Atlanta for Bladder Cancer

Most patients are diagnosed with bladder cancer because of blood that is found in their urine, known as hematuria. The blood may be microscopic seen on a urine sample done at their doctor or it may be visible blood that you can see when you urinate. If you see blood in your urine, see a doctor immediately to determine the cause. Other symptoms and warning signs of bladder cancer include:

• Difficulty urinating or weak urine stream
• Feeling of urgency to urinate even when bladder isn’t full

• Painful or burning sensations when urinating

Other signs of advanced cancer may include:

• Weight loss
• Weakness and fatigue
• Loss of appetite

• Swelling feet
• Bone pain
• Inability to urinate
• Low back pain on one side

If you’ve experienced any of these symptoms, we urge you to schedule an appointment. If you’re feeling stress about a bladder cancer diagnosis, we are here for you. You may be looking for answers online, searching the web for “bladder cancer screening near me.” The earlier you can diagnose bladder cancer, the better your chances for a successful treatment outcome will be. Call us today at 404-341-5219to set an exam for bladder cancer screening.

What to Expect When Seeking Treatment for Bladder Cancer in Atlanta

Depending on your current level of health, the stage of your bladder cancer and your personal preferences, there are multiple treatments for bladder cancer.

Treatments for bladder cancer include:

• Surgery
  • TURBT also known as TransUrethral Resection of Bladder Tumor, remove the tumor through a cystoscope (for initial diagnosis and treatment)
  • Radical Cystectomy – remove the entire bladder if the cancer is more advanced and invades the deep muscle layer of the bladder wall.

• Intravesical therapy – chemotherapy or immunotherapy (BCG) placed in the bladder once a week for six weeks or immediately after surgery to remove cancer with a cystoscope
• Chemotherapy (IV medications given if your cancer is more advanced, usually prior to or after removal of bladder)
• Radiation therapy (using high-power energy beams like strong x-rays to destroy bladder cancer)

• Immunotherapy (using your own immune system to fight the cancer)

If you believe you have bladder cancer or have been diagnosed, it can be a difficult feeling to process.

You are not alone.

At Advanced Urology, our Atlanta medical team is dedicated to giving you the care, attention and support you need to combat bladder cancer. Call us today at 404-341-5219 to set an appointment and discuss your treatment options.

UROTHELIAL CANCER

Upper tract cancers refer to tumors in the ureter and the lining of the kidney collecting system. They originate from the same lining that is in the bladder. The major risk factors associated with them are environmental toxins, i.e. tobacco, and some genetic conditions. Specialized testing including imaging, blood work and minor procedures may be necessary to diagnose these. Upper tract cancers make up about 5-10% of all urothelial cancers. They can be either high grade or low grade. Depending on the size and location of the tumors, many treatment options may be available. These include fulguration (killing the tumor cells with laser or electrocautery), medications/chemotherapy, or removal. In some instances, organ-sparing treatments may also be possible. It is important that you investigate any blood in the urine for the presence of tumors all along the urinary tract.

CAUSES AND SYMPTOMS

Bladder cancer is a condition that affects the bladder. The bladder is part of the urinary system that comprises structures such as your kidneys, ureters and the urethra. The bladder stores urine after it is made in the kidneys and passed through the ureters.

When cells in the bladder grow uncontrollably, this leads to bladder cancer. Bladder cancer is caused by a combination of some known and unknown factors and can originate from various cell types in the bladder. Bladder cancer is one of the most common types of cancers in the United States affecting close to 70,000 adults each year.

The Common Symptoms of Bladder Cancer

While most patients with bladder cancer have no symptoms, there are some signs and symptoms that can point towards bladder cancer. The most common symptom associated with bladder cancer is blood in the urine (either microscopic or visible). While these alone cannot be used to determine a final bladder cancer diagnosis, they can be useful in helping you examine yourself regularly and catch any anomalies early. If you have any of the listed symptoms, make an appointment immediately for further screening.

Bladder cancer signs and symptoms:

• Blood in the urine

• Your urine changes color, either to red or any other color other than the usual yellow hue

• An abnormally frequent urge to urinate even when you have not taken in lots of fluids
• You have a burning sensation when you urinate
• You have challenges urinating, even when you are pressed

These signs and symptoms are usually an indication of early-stage bladder cancer but cannot indicate what the bladder cancer prognosis will be. Bladder cancer symptoms in women are like those in men.

Besides these, there are further signs and symptoms that typically are an indication that the bladder cancer has spread.

Advanced bladder cancer signs and symptoms include:

• An inability to urinate even when you are pressed
• Lower back pain
• Involuntary loss of weight

• Low appetite
• Swollen feet
• Deep tissue and bone pain
• Lethargy and a general lack of energy throughout the day

It is important to note that while these signs and symptoms may point to bladder cancer, there are other conditions with similar signs and symptoms. Further screening is, therefore, necessary to get a final bladder cancer diagnosis. At this point, you’ve probably researched your symptoms online and concluded about your condition. Maybe you’ve entered queries like “where to get bladder cancer treatment near me” or “urological oncologist near me.” If this is you, Advanced Urology in Atlanta is here for you. Call Advanced Urology today at 404-341-5219 to learn more about treatment options and make an appointment.

What Causes Bladder Cancer?

These factors include:

• Smoking and use of other tobacco products (increase your risk of developing bladder cancer 7–Fold)

• Exposure to certain chemical compounds known to penetrate the skin and affect cells
• Exposure to radiation, either at work or when undergoing other cancer treatment
• Chronic irritation affecting the bladder
• Some types of parasitic infection (such as schistosomiasis)

Other risk factors associated with bladder cancer.

• Your race – If you are white then you have a naturally higher chance of getting bladder cancer than other races
• Your gender – Bladder cancer is more prevalent in men.
• Genetics – If you have first degree relatives (sibling, parent or child) with bladder cancer you may also be at a higher risk
• Lifestyle – The link between bladder cancer and smoking has been proven in multiple studies.

• Location and traveling – Some countries outside the United States have parasites known to cause chronic bladder inflammation

When to See a Doctor in Atlanta, GA for Bladder Cancer

Bladder cancer survival rate probabilities go up when there is early detection and diagnosis. If you catch bladder cancer early, the condition is usually very treatable with a favorable prognosis.

If you are interested in learning more, the Bladder Cancer Advocacy Network is a support network that promotes these ideals by providing information and support networks. Other cancer support and awareness networks also promote early testing and detection through the cancer ribbon awareness symbol.

DIAGNOSIS AND TESTING

Bladder cancer is one of the most common cancers in the United States affecting over 68,000 adults. Normally, it affects men more often than women especially if they’re older, but it can affect anyone at any age.

It isn’t clear precisely what causes bladder cancer, but we do understand how it develops over time.

When You Need to Be Tested for Bladder Cancer in Atlanta, GA

Bladder cancer develops as cells in your bladder mutate and aggressively multiply. Most patients with bladder cancer have no symptoms and are found incidentally due to blood found in their urine (may be microscopic or gross, meaning visible). If you have symptoms or if you have blood in your urine, we check 1. Urine sample for cancer cells 2. Imaging of your kidneys with either ultrasound or CT scan 3. Cystoscopy (place a small scope into the bladder through your urethra, the tube that you urinate through) to evaluate the bladder. All 3 of these tests are recommended for screening for bladder cancer per the American Urologic Association (AUA) guidelines.

Bladder cancer affects thousands of Americans and people worldwide. The usual symptoms of bladder cancer are:

• Blood in your urine giving it a red or rusty color.
• Pain in your pelvis
• Fatigue or tiredness

• Extreme unexplainable weight loss
• Intermittent fever
• Painful urination

If you’re experiencing any of these symptoms contact your doctor or urologist immediately.

Risk Factors for Bladder Cancer

Doctors don’t know what exactly causes bladder cancer, but they have pinpointed several risks that can make you more prone to bladder cancer.

• Older age – As with most cancers, the older you are the more at risk you are for cancer.
• Smoking – Smokers are at an increased risk for bladder cancer and there is a large benefit to stop tobacco products. Patients with a prior smoking history will always be at higher risk of developing bladder cancer, though smoking cessation is still strongly encouraged to further decrease your risk.
• Family history – Some genes prone to bladder cancer are inherited.

• Exposed to dangerous substances – People who work with dangerous chemicals or radiation are susceptible to bladder cancer.
• Prolonged exposure to bladder irritants – People who abuse alcohol have an increased risk of bladder cancer.

What to Expect When Getting Tested for Bladder Cancer

If you suspect you have bladder cancer or if you’re suffering from any of the symptoms listed above, it’s important to schedule an appointment with your doctor or urologist immediately. At this point, you’ve probably researched your symptoms online and come to a conclusion about your condition. Maybe you’ve entered queries like “where to get bladder cancer treatment near me” or “urological oncologist near me.” If this is you, Advanced Urology in Atlanta is here for you. Call Advanced Urology today at 404-341-5219 to learn more about treatment options and make an appointment.

If your doctor suspects bladder cancer, a series of test will be performed for an accurate diagnosis. These procedures are all relatively quick, non-invasive and accurate in diagnosing bladder cancer.

• Urine testing – Signs and symptoms of bladder cancer may be found in your urine. The doctor or nurse will take a small sample for quick test results.
• Image testing – A ultrasound or CT scan or MRI will give the doctor a visual image of the kidney and bladder. An inside look will allow the doctor or specialist examine the bladder for lesions or anything else that may be causing your symptoms.
• Cystoscopy – Place a small scope into the bladder via the tube that urine comes out of. If there is a suspicious area or bladder cancer seen, the tissue is removed through the scope without making any incisions on the abdomen. The sample is tested for bladder cancer.

TREATMENTS AND SURGERY

Bladder cancer is fatal in advanced stages, though very treatable in early stages. There are several types of treatment, but the majority of bladder cancer is treated with surgery. The doctor will remove the bladder tumor or the entire bladder itself depending on the severity of the tumor.

If the tumor is small and does not invade the deep layers of the wall, then it is treated through a scope and possibly with immunotherapy. Most of these patients do not need to have their entire bladder removed.

How to Know if Bladder Cancer Surgery is Right for You

In most cases, just the bladder tumor is removed without removing the entire bladder. This can be done with a small scope and does not require any incisions on the abdomen. Surgery to remove the entire bladder is considered a major surgery and is recommended as standard of care if the tumor is advanced and has invaded into the deep layer of the bladder wall. For these patients, removing the bladder entirely is the best way to ensure the cancer doesn’t spread to other organs or affects other bodily functions.

If you suspect you’re suffering from bladder cancer or if you’ve recently been diagnosed with bladder cancer, you should see one of our cancer specialists at Advanced Urology. At this point, you’ve probably researched your symptoms online and come to a conclusion about your condition. Maybe you’ve entered queries like “where to get bladder cancer treatment near me” or “urological oncologist near me.” If this is you, Advanced Urology is here for you. Call Advanced Urology in Atlanta today at 404-341-5219 to learn more about treatment options and make an appointment.

Some other factors to consider regarding any surgery are:

• Age – The older you are the more risks there are to surgery.

• Immune system – If your immune system is easily compromised from a separate condition or disease, you’re at more of a risk for infection from surgery.
• Aversion to surgery – If your religion or culture is against surgical procedures, other, less effective, options are available.

Your doctor or specialist will take all those factors into account before recommending surgery after looking over your tests and screening results.

The Types of Surgery for Bladder Cancer in Atlanta

Treatment depends on the size of the tumor, and the overall health of the patient. The goal is to remove the tumor and maintain the overall health of the bladder but in some cases, the entire bladder will be removed.

Fortunately, if the bladder is removed, there are bladder alternatives that can reroute the urine. The types of surgical treatment are:

• Transurethral resection of bladder tumor – This procedure removes bladder cancer confined inside of the bladder. With a wire loop inserted into the bladder, the doctor connects it to an electrical current which burns the cancerous cells off. This is done entire with a small scope and does not require any incisions.
• Cystectomy – This surgery removes the bladder either partially or entirely depending on the size/ location/grade/ stage of the tumor. After the entire bladder has been removed, there are 3 options for storage of urine in a patient without a bladder.

• • Ileal Conduit: Using your intestine to route the urine out into a pouch (urostomy bag) you wear on your abdomen.

• • Neobladder: Create a new bladder with the intestines. There would be no bag on the outside. You would urinate almost like you would now, though your new bladder is made using your own intestine. You still may need to use a catheter to empty your bladder if the new bladder does not empty on its own. Also, you will likely need a pad or diaper at night because most patients leak at night.
  • Continent urinary reservoir: Using a section of your intestine to create a small pouch (reservoir) to hold urine, located inside your body. You drain urine from the reservoir through an opening in your abdomen using a catheter a few times each day and night.

MEDICATIONS AND SUPPLEMENTS

Bladder Cancer is one of the most common cancers in the United States. It’s not entirely known why but many doctors believe it has to do with lifestyle and eating habits. In some cases, it’s even genetic.

Usually, surgery is the first suggested treatment. The goal is to remove the tumor in the bladder through the urethra to designate the stage and grade of the cancer.

Treatments & Medications for Bladder Cancer

Some possible alternatives to surgery are biological therapy, targeted therapy, chemotherapy and radiation therapy. Although not as effective as surgery, these treatments have been successful in treating bladder cancer. At this point, you’ve probably researched your symptoms online and concluded about your condition.

Maybe you’ve entered queries like “where to get bladder cancer treatment near me” or “urological oncologist near me.” If this is you, Advanced Urology in Atlanta is here for you. Call Advanced Urology today at 404-341-5219 to learn more about treatment options and make an appointment.

Supplements or Natural Products for Bladder Cancer

For bladder cancer, like any cancer, there is no natural alternative to conventional medicine although there are natural remedies that can help with your treatment plan and keep your body healthy enough to fight the cancer. Herbal supplements and vitamins haven’t been proven to affect recovery but there is data that show an increase in bladder health. The most common are:

• Vitamin D – A vitamin D deficiency has been known to be a symptom of bladder cancer. Taking a vitamin D supplement will help overall health as well.
• Korean Ginseng – An ancient cherished root, Korean Ginseng has been attributed to good health and longevity. There have been some tests that have shown that men who take Korean Ginseng have experienced better results in bladder health and less risk of bladder cancer.
• Echinacea – A special herb attributed to supporting the immune system. As your bladder cancer is treated, your immune system will be compromised. This herb will keep your immunity strong and you healthy.

What to Do When Alternative Methods Don’t Work

If you feel that your treatment or medication hasn’t been effective in fighting your bladder cancer, contact your doctor or specialist immediately. More than likely, the tumor will need to be removed through bladder cancer surgery but you may require further treatment if the cancer has spread.

Nonsurgical Treatments for Bladder Cancer in Atlanta, GA

Surgery is standard of care for treatment of bladder cancer. For cancer that has not invaded the deep muscle layer, the cancer is treated cystoscopically (through a small scope that goes through the tube that urine comes from) and sometimes also use BCG (immunotherapy given through a catheter in the office). If the cancer has gone through the deep layer of the bladder wall, then the gold standard is to remove the entire bladder. Some people may choose to treat their bladder cancer with less invasive medical methods, especially in the elderly with multiple medical problems. While not as effective as surgery, these are still good options for the right candidate. They employ a combination of cystoscopy to remove as much of the tumor through the scope, chemotherapy, and radiation.

• Radiation Therapy – Using high-powered energy beams like x-ray, doctors have been successful in targeting and treating bladder cancer.
• Chemotherapy – Cancer fighting drugs are entered through the body either intravenously (through the veins), or directly into the bladder through a tube inserted into the urethra. Usually, this method is used in conjunction with others including surgery to ensure the cancer is clear of the body.
• Biological Therapy – Also known as immunotherapy, uses your own immune system to fight the cancer on its own. This can be used when the cancer has spread to other organs or after having failed BCG intravesical therapy for superficial disease.

These procedures have various advantages for people who are prone to illness, have an aversion to surgery or if the tumor is relatively small.