Bladder Cancer Symptoms and What You Need to Know About Treatment

Bladder cancer was in the national news this week when the University of Colorado head football coach Deion Sanders announced that he had been diagnosed and treated for an aggressive form of the disease. He says he is now “cancer free” and urged people to pay attention to bladder cancer symptoms and keep up with regular doctor’s appointments.

Janet Kukreja, MD, director of urological oncology at University of Colorado Cancer Center, performed the bladder cancer surgery that cured Sanders. Kukreja has a strong connection to the University of Rochester Medical Center—she did her residency in urology and received a master’s degree in public health at UR.

Pioneering research and clinical care in bladder cancer have made the UR Department of Urology and the Wilmot Cancer Institute top sites for medical trainees but also for patients seeking the best treatment for bladder cancer. We asked William Tabayoyong, MD/PhD, who specializes in urologic oncology at UR Medicine, what people should know about bladder cancer.

What are the 5 warning signs of bladder cancer?

The most common warning sign of bladder cancer is visible blood in the urine. Sometimes, urine examined under a microscope detects blood that a person cannot see.

Individuals with bladder cancer also have increased urinary frequency and urgency.

It is important to understand that these signs/symptoms are not limited to bladder cancer but can indicate a urinary tract infection (UTI) and/or kidney stones.

Bladder cancer diagnosis: How is the disease diagnosed? Are there any new advances in early detection?

Most cases are diagnosed when a person goes to a urologist due to blood in the urine. Unfortunately, there are no satisfactory screening lab tests or imaging studies that have been effective for early detection of bladder cancer.

• Evaluation includes urinalysis, CT scans of the abdomen and pelvis, and direct visualization of the inside of the bladder with a camera (cystoscopy).

• If doctors identify a bladder mass during this evaluation, patients are then taken to the operating room for a transurethral resection of the bladder tumor (TURBT), which is a surgical biopsy of the entire mass from the inside of the bladder.

• The surgical team sends the resected bladder tumor tissue to pathology experts for diagnosis and staging.

Is bladder cancer curable?

Treatment depends on the stage of the disease at diagnosis.

• For early-stage bladder cancer (stage Ta or T1), which has not invaded the muscle surrounding the bladder, the standard of care is surgical removal of the tumor from the bladder. Following this, physicians infuse either chemotherapy or immunotherapy into the bladder to prevent cancer from progressing or returning.

• For muscle-invasive bladder cancer (stages T2-T4), the standard of care is chemotherapy followed by complete surgical removal of the bladder, removal of lymph nodes in the pelvis, and creation of a new way for urine to leave the body. For patients who are too frail to undergo surgery or who do not want to have their bladder removed, an alternate treatment can be removal of the tumor followed by chemotherapy and radiation—though this may not be as effective as removal of the entire bladder and lymph nodes.

• For bladder cancer that has spread to other parts of the body, the newest and best treatment for bladder cancer is a combination of two drugs: pembrolizumab plus enfortumab vedotin. Within the past year, this drug combo has replaced traditional chemotherapy as first-line treatment for patients with metastatic disease.

Can bladder cancer spread?

Yes, bladder cancer can spread directly from the bladder and invade surrounding organs such as the prostate and seminal vesicles in males, or the vagina or uterus in females.

• When bladder cancer metastasizes from the bladder, it usually spreads first in small deposits to the lymph nodes in the pelvis.

• Other sites where bladder cancer can spread are the lungs, liver, bones, and in rare but aggressive cases, the brain.

What causes bladder cancer?

Certain genetic mutations increase the risk of developing bladder cancer, but having these mutations does not always mean that a person will get the disease.

Most cases of bladder cancer are not hereditary. Smoking is a leading environmental factor that increases the risk of bladder cancer, as well as exposure to certain chemicals, including arsenic in drinking water and dyes used in some industries.

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