The bladder is part of the urinary tract. Urine passes from the kidneys to the ureter and bladder and finally out the urethra. Bladder cancer is the presence of malignant cancer cells within the bladder and surrounding tissue.

Approximately 74,000 Americans will be diagnosed with bladder cancer in 2012, most over the age of 70 years old. Three times as many men will be diagnosed as women. While family history, chemical exposure, chronic irritation from long-term catheter drainage and chronic infections may play a role, smoking has been identified as a leading cause of bladder cancer.

Typical bladder cancer symptoms include blood in the urine, painful and/or frequent urination and pelvic pain. Because these symptoms are commonly associated with many different urinary conditions and ailments, it is very important to go to a doctor to be properly diagnosed.

Surgery, chemotherapy, radiation therapy and immunotherapy therapy — alone or in combination — can all be effective bladder cancer treatments. Your oncology team will make a recommendation based on the type, stage and location of your cancer.

Surgery

For early stage bladder cancer, transurethral resection (TUR) surgery may be performed through a resectoscope — a tube inserted into the bladder via the urethra. This avoids the need for an incision. When the cancer has spread beyond its original site into adjacent wall tissue, a cystectomy may be performed through an open incision. If only a portion of the bladder is removed, it is called a partial cystectomy. Removing the entire bladder is a radical cystectomy.

Chemotherapy

Chemotherapy may be an effective bladder cancer treatment against bladder cancer and may be recommended in combination with surgery and/or radiation therapy, especially for more advanced bladder cancers.

There are three different forms of chemotherapy. Neo-adjuvant or primary systemic chemotherapy is used before radiation or surgery to help shrink the tumor. Adjuvant chemotherapy is used after radiation therapy or surgery to destroy any remaining cancer cells. Systemic chemotherapy circulates the chemotherapy throughout the body via the bloodstream when the cancer is metastatic.

Immunotherapy or Biologic Therapy

Immunotherapy also called biologic therapy, uses certain drugs to boost your body’s own immune system so it can better fight the cancer. Intravesical therapy is directly delivered into the bladder through a catheter rather than by mouth or through intravenous injection. Bacillus Calmette-Guerin (BCG) therapy is the most effective intravesical immunotherapy for bladder cancer. The BCG vaccine was originally developed to protect against tuberculosis. It works by boosting the entire immune system rather than targeting only the tumor. In high doses, it can slow the growth of tumor cells and help the body to destroy the cancer.

Bladder Cancer Radiation Therapy

Radiation therapy uses high-powered x-rays to shrink tumors and destroy cancerous cells. There are two basic types of radiation therapy:  External Beam Radiation Therapy uses highly sophisticated, often robotically controlled systems to irradiate tumors from outside the body. Internal Radiation Therapy, also known as Brachytherapy, delivers radiation from a source implanted inside the body. Which one is best suited for your particular situation depends on the size, location and stage of the tumor or tumors.

3D-Conformal Radiation Therapy

3D-Conformal Radiation Therapy is one of the most common forms of external bladder cancer radiation therapy. It uses a device called a "multi-leaf collimator" to shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. This enables your Radiation Oncologist to prescribe a higher, more effective dosage amount while minimizing the risk of side effects.

Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. Typically, you will be scheduled for five sessions a week for six to seven weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.

High dose-rate (HDR) Brachytherapy

Occasionally, interstitial high dose-rate (HDR) Brachytherapy is used to treat bladder cancer. Radiation is delivered from inside the body through catheters that have been directly placed into the wall of the bladder where the tumor is located. During treatment, a computer-controlled machine sends tiny radioactive pellets down each catheter to deliver the prescribed dosage of radiation directly to the tumor. The overall treatment time at the tumor site is 10 to 20 minutes. Your bladder cancer treatment plan may require one session or multiple sessions. The catheters are then removed so that no radioactive material remains in the body. You are free to resume normal activity right after each treatment.