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Urothelial bladder cancer (UBC) is a cancer that starts in the cells that line the inside of your bladder. It is the most common form of bladder cancer and more than 19,000 women are diagnosed with UBC each year.
The good news? Bladder cancer has a 5-year survival rate of over 80% when detected early and can be treated in many ways.
HealthyWomen spoke to Dr. Claire de la Calle, a urologist specializing in bladder cancer at Fred Hutch Cancer Center, to learn more about UBC treatment.
What Types of Surgery Are Used to Treat UBC?
Bladder cancer is usually first diagnosed through an endoscopic procedure, in which we insert a small camera into the bladder through the urethra (the hole through which we urinate) and perform an internal biopsy. This surgery is called transurethral resection of a bladder tumor, or TURBT.
For some bladder cancers, this is the only step, so patients can be cured with this procedure. However, many bladder cancer patients will require several of these surgeries. If the cancer is more advanced, the patient may opt for bladder removal and the surgery is called a radical cystectomy.
Is the treatment different for a non-muscle invasive bladder cancer (CVSIM) If the tumor has not spread to the bladder muscle, this stops a muscle invasive bladder cancer (CVCIM) has it spread?
Yes, that’s a good point. It is always convenient to know whether the cancer has cellular invasion or not because the clinical processes are completely different. For non-muscle invasive bladder cancer, we can only offer treatments to try to help the patient maintain their bladder. However, in cancers with cellular invasion, the bladder often needs to be removed.
How does it work? intravesical therapy (Give medicine directly into the bladder) Does it work on UBC?
For low-risk patients with non-muscle invasive bladder cancer, treatment consists of an initial TURBT followed by a subsequent cystoscopy (basically inserting a small camera into the bladder in a clinic). It is a five-minute procedure that we carry out regularly to ensure that the cancer has not come back.
For moderate to high risk non-cellular invasive bladder cancers, we can offer several intravesical (ie “in the bladder”) therapies. We do this to kill any remaining cancer cells in the bladder after the initial TURBT to prevent the cancer from coming back and getting worse. So if the cancer comes back, these therapies could prevent it from progressing deeper into the bladder wall.
The most commonly used intravesical therapy is called BCG. BCG is actually a type of immunotherapy, meaning it sensitizes your immune system to attack cancer. It is a live, weakened (weakened) version of a bacteria used to make the tuberculosis vaccine.
When BCG is put into the bladder, it essentially makes the bladder believe there is an infection. This leads to a huge immune reaction, which ultimately triggers a reaction against the cancer. As a result, your immune system attacks bladder cancer cells.
BCG is one of the first immunotherapies in the history of medicine and it works really well. Unfortunately, there is currently a BCG shortage in the United States; we simply do not produce enough BCG for all bladder cancer patients. Therefore, in recent decades, urologists have had to find other methods of treating bladder cancer.
One of the things we’ve started doing is intravesical chemotherapy. This is the same chemotherapy that we have been administering to patients through the veins for many decades. When administered into the bladder, it may be helpful in reducing the recurrence and progression of non-muscle invasive bladder cancers.
Can you tell us about the new developments in UBC treatments?
Unfortunately, BCG sometimes doesn’t work. For patients with non-muscle invasive bladder cancer who do not respond well to BCG, we offer many other intravesical therapies. It is a very active research area.
Many studies are currently underway and the FDA will likely approve several drugs very soon. These include new options for intravesical chemotherapy.
Is there a high risk of UBC recurring after treatment?
Bladder cancer definitely happens all the time. For low-risk CVSIM, recurrence rates are between 30 and 40%. The rate is around 55% for medium-risk cases and between 60 and 70% for high-risk cases.
What are the disadvantages and side effects of the various treatment options?
Because bladder cancer tends to recur, returning to the operating room too frequently is a major problem. There is a risk of repeated anesthesia and scarring of the bladder may occur as each operation removes a small piece of the bladder. Blood in the urine and infections may also occur after surgery.
With intravesical therapies, the vast majority of patients experience symptoms such as urgent, increased frequency, and painful urination. Fortunately, we can help most patients who experience these side effects so they can continue their treatments.
What would you like more women to know about bladder cancer?
Unfortunately, women tend to have worse clinical outcomes than men, in part because they often do not receive a diagnosis until the cancer is at an advanced stage. Many women have blood in their urine and this is thought to be due to urinary tract infections (UTIs). They go to doctors who treat urinary tract infections over and over again until finally someone says, “Maybe it’s bladder cancer.”
This is why I wish more people (and healthcare professionals) knew that blood in urine is never normal. It may be due to a urinary tract infection, but after an infection is treated there should be no blood in the urine. If this is the case even in microscopic quantities, the patient should definitely see a urologist.
This educational resource was created with support from Merck.
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