Bladder Cancer Services

When bladder cancer is detected in its early stages, it is highly treatable; however, bladder cancer frequently recurs. For this reason, bladder cancer survivors treated at our Cancer Institute are monitored closely and screened frequently for several years after their initial diagnosis and treatment to prevent or minimize recurrence.

Our goal is to offer you immediate access to comprehensive testing to promote earlier detection, more accurate diagnoses and timely and effective treatment strategies.

Advanced Imaging and Diagnostic Tests for Bladder Cancer

At the Cancer Institute, we provide you with the latest technology to detect and diagnose bladder cancer. Imaging tests take pictures of the inside of your body to help our urologists, oncologists and pathologists detect cancer and determine treatment options with the greatest potential for success. These tests also provide your doctor with important information to determine if cancer has spread, if treatment is effective or if cancer has recurred after treatment.

Our bladder cancer care team may prescribe one or more of the following diagnostic tests:

• Biopsy: This test removes cells or tissue from the bladder so they can be viewed by a pathologist under a microscope to check for signs of cancer. A biopsy for bladder cancer is performed through cystoscopy.

• Blue Light Cystoscopy with Cysview®- We are one of a limited number of medical centers nationwide offering Blue Light Cystoscopy with Cysview®, a state-of-the art procedure that improves detection of certain bladder cancers.

• Computerized tomography (CT) scan: This procedure takes images of the inside of the body at different angles or slices. The pictures are generated by a computer linked to an X-ray machine. A dye may be injected into a vein or administered orally to make the organs or tissues show up more clearly during the procedure.
• Cystoscopy: This procedure is considered the "gold standard" for diagnosing bladder cancer. The test is usually performed in your urologist's office or an outpatient surgery center. During the test, a urologist inserts a slender, fiber-optic instrument into the urethra to look inside the bladder and urethra. A cystoscope has a light and a lens for viewing on a TV monitor. It also has a tool to remove tissue to check cells under a microscope for signs of cancer or other abnormalities. In addition to its use as a screening tool, bladder cancer survivors are screened with this test to prevent recurrence after undergoing treatment.
• Intravenous pyelogram (IVP): This test involves a series of X-rays of the kidneys, ureters and bladder to determine if cancer is present. A contrast dye is injected into a vein and moves through these organs to determine if there are blockages.
• Transurethral resection of bladder tumor (TURBT): This test is similar to a cystoscopy, except a larger tissue sample is removed for testing and it is generally performed at the hospital or in our outpatient surgical center.
• Urinalysis: This test examines the color of urine and its contents, such as sugar, protein and red and white blood cells.
• Urine cytology: This test examines urine samples under a microscope for abnormal or free-floating cancer cells. Bladder cancer recurrence is generally detected by this test.

• Blood in the urine (hematuria) is the most common symptom of bladder cancer. Someone experiencing this symptom may notice blood that looks bright red or has a tea-colored appearance. Other times, blood is not detected visually, but rather from a test using a microscope. Bleeding may start and stop with irregularity. It is important to note that infections, benign tumors, bladder stones or other problems can also cause blood in the urine.

Other symptoms of bladder cancer can include one or more of the following:

• Frequent urination
• Frequent urinary tract infections
• Pain during urination
• Pain in the abdomen
• Pain in the back
• Urgent urination

Consult with a Doylestown Health Urologic Cancer Specialist

Our urologists are available for consultation with you or anyone in your family experiencing the symptoms of bladder cancer. Our cancer care team encourages anyone with high risk factors for bladder cancer, especially cigarette smoking, to talk to your primary care provider about your screening options.

Smoking Tobacco

Cigarette smoking accounts for approximately 60 to 70 percent of bladder cancer cases in the United States. Bladder cancer frequently begins in the cells that line the inside of the bladder because harmful chemicals from smoking, called carcinogens, can damage the lining of the bladder. Our urologists and cancer specialists strongly encourage you to quit smoking to lower your risk for bladder and many other forms of cancer.

Additional Risk Factors

• Chemical exposure: Chemical exposure is the second most common risk factor for bladder cancer. Chemicals and other industrial substances in the workplace, such as arsenic, pesticides and the manufacturing of dyes, rubber, leather, textiles and paint, may contribute to bladder cancer.
• Chemotherapy: Some chemotherapy drugs, such as cyclophosphamide and ifosfamide, may increase your risk of developing bladder cancer.
• Radiation therapy: Radiation therapy in the pelvic area for cervical, prostate or rectal cancer may contribute to the development of bladder cancer.
• Cystitis or chronic urinary infections or inflammations: Repeat urinary infections or inflammation may increase an individual's risk for squamous cell bladder cancer.
• Demographics: People over age 65 are diagnosed more frequently with bladder cancer. The disease is rare in people under age 40. Men develop bladder cancer more frequently than women. Caucasians develop the disease more than people of other races.
• Bladder birth defect: While birth defects of the bladder are rare, this condition may be linked to bladder cancer.
• Personal or family history: In most cases, bladder cancer does not run in families; however, if one or more of your close relatives has a history of the disease, you may be at risk. Anyone with a family history of Lynch Syndrome or hereditary nonpolyposis colorectal cancer (HNPCC) may be at risk for cancer in the urinary system, colon, uterus, ovaries or other organs.

If you are concerned about your risk for bladder cancer, talk to your primary care provider about your screening options.

In general, bladder cancer is considered non-muscle invasive or muscle-invasive:

Non-muscle invasive bladder cancer: The majority of bladder cancers, or 75 percent, are non-muscle invasive. These bladder cancers are highly treatable, have not spread and are in the early stages of the disease. Non-muscle invasive bladder cancer is generally managed through minimally invasive surgical techniques or surgery in combination with chemotherapy or other infusion and therapeutic options.

Treatment Options for Non-Muscle Invasive Bladder Cancer

• Surgical- Transurethral resection of bladder tumor (TURBT) is the primary surgical approach for treating non-muscle invasive bladder cancers.
• Infusion Therapies- Chemotherapy and Immunotherapy
• Radiation Therapy- Penn Radiation Oncology Doylestown is an outpatient radiation treatment program located in The Pavilion at Doylestown Hospital, on the hospital's main campus. As a Penn Radiation Oncology satellite location, we are equipped with the most advanced technology
• Neoadjuvant Therapy- Given before the main type of treatment to increase the likelihood of successful response or to shrink the tumor
• Adjuvant Therapy- Given after the main type of treatment to lower the risk that cancer will return, or to increase the likelihood of cure

Muscle-invasive bladder cancer: Approximately 25 percent of bladder cancers are muscle-invasive, meaning the cancer has spread beyond the bladder walls to muscles, lymph nodes or other organs. This type of bladder cancer usually requires advanced surgery. If you have this form of bladder cancer, you may need your bladder partially removed or entirely removed, followed by reconstructive surgery, to create a urinary diversion. Our goal is to identify the treatment option with the highest likelihood of success, taking into account your quality of life and avoiding damage to other organs.

Treatment Options for Muscle-Invasive Bladder Cancer

• Partial cystectomy:  An option for a small percentage of people when cancer has invaded the muscle but is small and confined to one place in the bladder.
• Radical cystectomy: A major surgery that removes the entire bladder and surrounding lymph nodes. In addition, the prostate and seminal vesicles are removed in men and the uterus, ovaries, fallopian tubes and part of the vagina are removed in women.
• Urinary diversion: After radical cystectomy, our surgical team creates a new route for urine to exit the body. All options are available to you at Doylestown Health and include:
  • Ileal conduit
  • Cutaneous continent urinary diversion
• Continent neobladder: Urine is routed back into the urethra to create a urinary reservoir made of part of the intestine. A neobladder is sewn into the urethra and lets you urinate normally.

While the prognosis or chance of control or cure for non-muscle invasive bladder cancer is positive, bladder cancer frequently recurs. Non-muscle invasive bladder cancers require regular checkups, surveillance and follow up screening for several years to prevent recurrence. The primary tests used for surveillance are cystoscopy, cytology, bladder biopsy and urine-DNA tests. Our urologists generally recommend cystoscopy screening at different time periods during the months and years after the initial diagnosis and treatment.

Patients with aggressive cancers may undergo more frequent screening for bladder cancer recurrence. Surgery for muscle-invasive and more aggressive forms of bladder cancer usually requires removal of lymph nodes to detect their involvement with cancer. This helps doctors to decide if further treatment is needed after surgery, such as chemotherapy. It also impacts the chances of bladder cancer recurrence.