Bladder cancer occurs when cells in the bladder grow uncontrollably. The main reversible risk factor for bladder cancer is cigarette smoking. Quitting cigarette smoking at any time can reduce a person’s risk of developing bladder cancer. The most common presenting feature of bladder cancer is hematuria, blood in the urine. This hematuria can be gross-visible to the naked eye or microscopic. Very often, the hematuria will be painless. Regardless of whether it is gross or microscopic, the presence of hematuria should prompt a referral to a urologist for evaluation. A key factor in determining the treatment and the prognosis of a patient’s bladder cancer is whether the cancer has invaded the muscle layer of the bladder wall. When it has not, the condition is called non-muscle-invasive bladder cancer (NMIBC).
NMIBC is an early stage of bladder cancer, where the tumor is confined to the inner lining of the bladder. NMIBC is distinct from muscle-invasive bladder cancer, which is a more advanced form of bladder cancer where the cancer has spread into the bladder's muscular wall and potentially beyond. NMIBC is further classified based on the specific layer of the bladder lining with which the cancer is involved: Ta (tumor in the innermost layer or lining of the bladder), T1 (cancer in the connective tissue beneath the lining), and carcinoma in situ (CIS, a high-risk, flat, high-grade cancer).
Diagnosing NMIBC typically involves a combination of cystoscopy (bladder visualization with a camera), urine cytology (microscopic examination of urine cells), biopsy and imaging tests (CT scans) to assess for potential spread. As mentioned above, these diagnostic tests are typically performed in response to a patient presenting to their medical provider with hematuria.
The primary goal of NMIBC treatment is to remove the cancer and prevent recurrence and progression. Treatment options include transurethral resection of the bladder tumor to remove the tumor from the bladder lining and intravesical therapy, which involves delivering medications directly into the bladder. These medications include chemotherapy to kill remaining cancer cells and immunotherapy to stimulate the immune system to attack cancer cells. If none of these treatments work and the bladder cancer continues to return and/or grow deeper into the layers of the bladder, a patient may need to undergo a radical cystectomy (bladder removal) with urinary diversion — an effective anti-cancer surgery, but not without its risks and potential complications. The specific treatment approach depends on the stage, grade, and risk of recurrence. Regular surveillance with cystoscopy and urine tests is crucial after treatment to monitor for any recurrence.
Until recently, the treatment for NMIBC had not changed for decades, and many patients underwent a radical cystectomy due to the lack of alternate, novel therapeutic options. Fortunately, in the past 5 years, there have been multiple new treatment options for NMIBC that have been approved by the Food and Drug Administration because of meaningful clinical trial results in treating patients with treatment-resistant NMIBC. Most of these treatments are given intravesically and are very well tolerated. Because of their success in the treatment-resistant setting, these novel therapies are now being evaluated in the first-line setting to determine if these new treatments are better at ‘curing’ the NMIBC from the time of the initial diagnosis and treatment than the current standard of care. While much work still needs to be done, it is a promising time for patients with NMIBC in that there are now many options for them, where not too long ago, there were few, and many patients needed to have their bladders removed.
Learn about bladder cancer treatment at Northside Hospital Cancer Institute.
