Urinary Bladder Cancer

Bladder cancer is a significant urological malignancy that requires timely diagnosis and a well-structured treatment approach to achieve optimal outcomes. Our role is to provide patients with evidence-based, individualized treatment plans that ensure the best possible prognosis while preserving quality of life.

This guide aims to help patients and caregivers understand the nature of bladder cancer, its symptoms, diagnostic pathways, and modern treatment options.

Kidney cancer, also known as renal cell carcinoma (RCC), occurs when abnormal cells grow in the kidneys and form a tumor. The kidneys help filter waste and maintain the body’s fluid balance, making them vital for good health.

Bladder cancer arises when abnormal cells grow in the urothelial lining of the bladder. It is broadly classified into:

1. Non-Muscle Invasive Bladder Cancer (NMIBC)

• Confined to the inner lining of the bladder (Ta, T1, CIS).
• High recurrence rates but manageable with endoscopic resection and intravesical therapy.

2. Muscle-Invasive Bladder Cancer (MIBC)

• The tumor extends into the muscle layer of the bladder (T2 and beyond).
• Requires aggressive treatment, including radical surgery, chemotherapy, and radiotherapy.

3. Metastatic Bladder Cancer

• Cancer spreads beyond the bladder to lymph nodes and distant organs.
• Managed with systemic therapies, including chemotherapy, immunotherapy, and targeted treatments.

Bladder cancer is often detected early due to visible blood in urine (haematuria), but some cases may present with more subtle signs:

• Blood in urine (gross or microscopic haematuria) – Most common early symptom.
• Frequent urination – A feeling of urgency or needing to urinate often.
• Pain during urination (dysuria) – Discomfort or burning sensation while urinating.
• Pelvic or lower back pain – Seen in more advanced cases.

An accurate diagnosis is essential for tailoring an effective treatment plan. Common diagnostic steps include:

1. Cystoscopy

• A thin, flexible camera is inserted into the bladder via the urethra to inspect for abnormalities.
• Narrow Band Imaging (NBI) or Photodynamic Diagnosis (PDD) may enhance detection of small or flat tumors.

2. Urine Cytology & Molecular Biomarkers

• Urine cytology detects cancerous cells in voided urine.
• Advanced biomarkers (NMP22, UroVysion FISH, CxBladder) may aid in diagnosis and surveillance.

3. Imaging Studies

• CT Urogram – Preferred imaging for detecting bladder and upper tract tumors.
• Multiparametric MRI – Useful for local staging in muscle-invasive disease.
• PET-CT – Recommended for assessing metastatic spread.

4. Biopsy & Histopathology

• A transurethral resection of bladder tumor (TURBT) is performed to confirm diagnosis and assess tumor grade and stage.

Bladder cancer treatment is individualized based on tumor stage, grade, and patient factors.

1. Non-Muscle Invasive Bladder Cancer (NMIBC)

📌 Transurethral Resection of Bladder Tumor (TURBT):

• Standard first-line treatment for NMIBC.
• Complete resection of the tumor is performed endoscopically.

📌 Intravesical Therapy (BCG / Chemotherapy):

• BCG immunotherapy is the gold standard for high-risk NMIBC.
• Intravesical chemotherapy (Mitomycin C, Gemcitabine) may be used for intermediate-risk disease.

📌 Surveillance:

• Patients require regular cystoscopic follow-up due to the high recurrence risk.

2. Muscle Invasive Bladder Cancer (MIBC)

📌 Radical Cystectomy with Pelvic Lymph Node Dissection (PLND):

• Standard of care for localized MIBC.
• Can be performed via open, laparoscopic, or robotic-assisted surgery.

📌 Bladder Preservation (Trimodal Therapy - TMT):

• A select option combining TURBT, chemotherapy, and radiotherapy for carefully chosen patients.

📌 Neoadjuvant Chemotherapy (NAC):

• Platinum-based chemotherapy (MVAC / Gemcitabine-Cisplatin) is recommended prior to surgery to improve survival outcomes.

3. Metastatic Bladder Cancer (mBC)

📌 Systemic Chemotherapy:

• Gemcitabine + Cisplatin remains the first-line standard for fit patients.

📌 Immunotherapy:

• Checkpoint inhibitors (Atezolizumab, Pembrolizumab, Avelumab) for platinum-refractory or maintenance therapy.

📌 Targeted Therapy:

• FGFR inhibitors (Erdafitinib) for patients with FGFR3 mutations.
• Antibody-drug conjugates (Enfortumab Vedotin, Sacituzumab Govitecan) in chemo-refractory disease.

Bladder cancer treatment is not a one-size-fits-all approach. Each patient has a unique diagnosis, health status, and personal concerns that must be considered when planning treatment. A Uro-Oncologist leads a multidisciplinary team to ensure that every patient receives the best possible care, tailored to their specific needs.