Robotic Bladder Surgery

Symptoms of Bladder Cancer

Blood in the Urine (hematuria)

Having blood in your urine is the most common symptom of bladder cancer. Sometimes you can see the blood in your urine, but most of the time you can’t. In many cases, it will need to be tested under a microscope by a pathologist to be sure. Having blood in your urine does not automatically mean you have bladder cancer. Things like a urinary tract infection or kidney stones can cause blood to appear in your urine. It’s even normal for some people to have a bit of blood in their urine.

Frequent or Painful Urination (dysuria)

Although less common, frequent or painful urination not due to a urinary tract infection can be a sign of bladder cancer. If you have these symptoms or concerns, contact us today for an appointment or to request more information.

Causes of Bladder Cancer

It’s not always clear to doctors what causes bladder cancer. However, there are several risk factors that may increase your chance of developing it:

Smoking

Smoking is responsible for half of all bladder cancers in the United States. When you smoke, some of the chemicals are expelled into your urine. Over time, this can damage the lining of your bladder. Bladder cancer is two to three times more likely to occur in smokers than non-smokers.

Chemicals

Think of your kidneys as a filtration system. They play a key part in removing harmful chemicals from your blood and body. This means that when you are exposed to chemicals that are linked to cancer (carcinogens), they can find their way to your bladder. These harmful chemicals then sit there for a few hours before you urinate. High levels of arsenic in drinking water is linked to higher rates of bladder cancer. Plus, chemicals used in the manufacture of dyes, paints, rubber, leather and textiles can increase your risk. Hairdressers, machinists, printers, painters and truck drivers may be at higher risk. Chemicals are responsible for about 23% of all bladder cancers.

Other Risk Factors

• Increasing Age - Although bladder cancer can occur at any age, it rarely appears in people younger than 40.
• Race and Sex - Caucasians have a greater risk than other races, and males about four times more than women.
• Bladder Infections - Having frequent bladder infections or ones that last a long time.
• Certain Medicines - Certain drugs used for treating other cancers, such as cyclophosphamide (Cytoxan®).
• Radiation Therapy – When used on the pelvic area, such as for prostate and cervical cancer.

Today, there is no recommended routine screening for the general public for bladder cancer. However, you may be referred to a urologist if your primary care doctor believes you have a problem. A urologist handles problems of the urinary and male reproductive systems.

The urologist will ask about your possible exposure to risk factors, such as smoking and chemicals. He or she will also discuss your health habits, family medical history and any past treatments. Those who had certain birth defects of the bladder, had bladder cancer before or were exposed to certain chemicals would be considered very high risk. This may result in more wide-ranging tests. The earlier bladder cancer it is found, the chance of it being successfully treated is higher.

After a thorough physical exam, one or more tests also may be prescribed:

Imaging Tests

If there is blood in your urine, a CT scan of your kidneys, ureters and bladder may be ordered. A contrast dye is injected into a vein to help create a better image for diagnosis. A CT scan is like a highly detailed x-ray, but taken from many angles. A computer then builds them into a single picture.

AdventHealth Celebration has an advanced imaging center that uses the latest medical scanning technology in a peaceful and relaxing “virtual beach” environment. This helps many patients overcome their anxiety and discomfort. Learn more here.

Urine Cytology

Your urine will be tested under a microscope (urine cytology) to look for cancer cells. There are several tests that can also look for tumor markers. These are commonly linked with cancer cells.

Cystoscopy

A soft, thin, flexible tube with a fiber optic lens is inserted through your urethra into your bladder. Sterile salt water is also injected through the scope to fill your bladder for better viewing. This is often done in the doctor’s office using local anesthesia on the area for comfort. Any tumors found in the urethra or bladder are unlikely to be removed during this procedure. You will likely need to return for surgery to remove them. This is known as TURBT surgery.

If cancer is found, it will then be staged. These are measurement systems based on the size (grade) and location (stage) of the tumor. There are two main systems used by many doctors. They tell all treating doctors the severity and location of the cancer. TURBT (transurethral resection of bladder tumor) will be used to get a tissue sample. This minimally invasive procedure is done through the urethra during cystoscopy. It can remove entire tumors that are clearly seen and take tissues samples (biopsy) from the bladder. A pathologist will look at how different the cells look from healthy cells, on a scale of 1 to 3. Generally, the higher the grade or stage given to a patient, the worse the prognosis. They also will look how far the tumor has grown through the bladder wall and whether it has grown into nearby tissue.

Bladder Cancer Grading Systems

TNM System

Stage	Tumor Location
Ta and Tis	Low-grade tumor appears on the bladder lining
T1	Tumor goes into the bladder lining
T2 (a and b)	Tumor goes into the muscle layer
T3 (a and b)	Tumor has spread outside the bladder and also may be in the ureter, vagina or prostate
T4 (a and b)	Tumor has spread (metastasized) to nearby lymph nodes or parts of the body farther away

1973 WHO (World Health Organization) System

Used to grade the aggressiveness of the urothelian neoplasm (bladder tumors).

Grade	Appearance
Urothelian Papillomas	Benign lesions
Grade 1	Well differentiated (less aggressive)
Grade 2	Moderately differentiated
Grade 3	Poorly differentiated (more aggressive)

More tests may be needed to determine the stage of the bladder cancer. These can include a CT scan, MRI (magnetic resonance imaging) scan, bone scan or chest x-ray.

Treatment options for your cancer will vary. Your doctor will consider the stage of the cancer, your health and your treatment preferences before recommending a course of action. Be sure to discuss all your concerns before deciding on which treatment is right for you.

Removing the Tumor

For cancer that is limited to the inner layers of the bladder, TURBT (transurethral resection of bladder tumor) surgery is usually used. There is no cutting of the abdomen and general or spinal anesthesia is used. This minimally invasive procedure is done through the urethra during cystoscopy. A small wire loop is passed through a resectoscope (a rigid type of cystoscope), into the bladder. Then, an electric current is applied to burn away the cancer cells. Some procedures use a laser instead. TURBT can also remove entire tumors that are clearly seen. Other tissues samples from the bladder may also be taken.

Intravesical Immunotherapy/Chemotherapy

Special drugs can be put directly into your bladder (intravesical). These signal your immune system to help fight the cancer cells. It is usually used after TURBT surgery to help kill any remaining cancer cells. The drug is inserted through a catheter (a thin tube inserted through your urethra into the bladder). The catheter is removed and you hold the drug in your bladder for 1 to 2 hours before urinating it out. Generally, you receive weekly treatments.

Removing Part of the Bladder

Although rare, sometimes removing a small section of your bladder that contains cancer cells may be the best course of action. This is called a partial cystectomy. It is best used when the cancer has moved into the muscle wall of the bladder, but is not large and is only in one place. And, by removing this tissue and closing the hole, it will not harm bladder function. On the plus side, the patient keeps his or her bladder and doesn’t need reconstructive surgery. However, the bladder will now hold less urine and you will have to urinate more often. This usually gets better over time. A main concern is the cancer can return in another part of the bladder wall.

Removing the Entire Bladder

When the cancer invades into the deeper, muscle layer of the bladder, a radical cystectomy may be recommended. This surgery removes the whole bladder and nearby lymph nodes, along with part of the urethra and surrounding tissue. Women may also need to have their uterus removed. This means they will no longer be able to get pregnant. If part of the vagina is also removed, intercourse may become more difficult. Men also have their prostate removed as part of the surgery. This means they will no longer be able to father a child. Erectile dysfunction is one of the most common secondary effects from the surgery. Another way to collect urine from the kidneys then will be created by the surgeon. This step is called urinary diversion. Two options are currently used for urinary diversion after cystectomy:

• Abdominal diversion, such as ileal conduit. This redirects your urine into a collection bag (urostomy) outside your body.
• Urethral diversion to create a “neobladder” in the same place where your bladder was located. The procedure includes various forms of gastrointestinal pouches attached to the urethra to collect your urine.

Compassionate Care

We are focused on delivering state-of-the-art care in a supportive and caring environment. It’s at the center of everything we do at the Global Robotics Institute and AdventHealth Celebration. Our team of over 50 top medical professionals works in close partnership with cancer and internal medicine experts. This helps us determine the best treatment options for your bladder cancer. Each person’s case and needs is different. And your treatment may or may not include surgery. But if it does, its good to know it will be performed by some of the top surgeons and medical support staffs in the world.

Chemotherapy

Chemotherapy (chemo) uses powerful drugs to kill cancer cells. It can be used after surgery to kill any remaining cancer cells. It may also be used before surgery to reduce the size of tumors to make them easier to remove. Two or more drugs are usually used in chemo for bladder cancer. They are generally given in cycles with rest periods in between. They can be done as an outpatient procedure at a hospital, doctor’s office or at home. Rarely will you need to stay in the hospital for treatment. When the cancer has spread to the bladder muscle or other tissues, the drugs are usually given to you through a vein (intravenously). Although chemo kills fast-growing cancer cells, it can also harm normal cells that divide rapidly. Those in the bone marrow, lining of the mouth and intestines, and hair follicles also divide rapidly. Side effects can vary, mainly by the type and dose of the chemo drugs used

Common Side Effects:

• Loss of appetite
• Nausea and vomiting
• Hair loss
• Mouth sores
• Diarrhea or constipation
• Increased risk of infections
• Bleeding or bruising
• Fatigue

These usually go away after treatment is finished. Plus, there are ways we can help you minimize side effects.

Less Common Side Effects (usually in hands and feet):

• Burning sensation
• Tingling and numbness
• Sensitivity to hot and cold
• Weakness

Be sure to let your doctor know of any side effects you have. Some can be treated with drugs. For others, your chemo drugs and treatment may need to be changed or stopped altogether to keep them from getting worse.

Radiation Therapy

Although rarely used for bladder cancer, this treatment uses high-energy beams to target and kill the bladder cancer cells. This radiation is similar to that used for x-rays, but at much higher levels. It is usually used after surgery to kill remaining cancer cells. In rare cases, it is used with chemotherapy when surgery is not an option. Radiation therapy is painless and done in a hospital or clinic. A large machine moves around your body to direct exact bursts of radiation into the bladder area of your abdomen. You will likely go five days a week for several weeks for treatment sessions. Each session lasts about 30 minutes.

Common side effects:

• Nausea and vomiting
• Diarrhea
• Fatigue during the therapy period

Be sure to let your doctor and support team know of any side effects you have. They can help you treat or control these side effects.

AdventHealth Cancer Institute

Our team works closely with the internationally recognized and respected AdventHealth Cancer Institute. In fact, the premier treatment center treats more cancer patients than any health care center in the state. With AdventHealth Cancer Institute, you’ll have access to some of the most experienced and knowledgeable cancer experts in the world. Learn more.

Patient Follow-Up

Our team is fully committed to your care after treatment or surgery to help ensure the best possible outcomes. Bladder cancer frequently reoccurs, so we will want to keep a close eye on you. We will likely recommend being examined three or four times a year. These may include cystectomies and other tests. However, they will lessen over time to about once per year if everything continues to check out okay. One of the best things you can do is maintain a healthy eating plan and exercise regularly.