Urothelial bladder cancer (UBC) is cancer that starts in the cells that line the inside of your bladder. It’s the most common type of bladder cancer – and more than 19,000 women receive a UBC diagnosis every year.
The good news? Bladder cancer has a five-year survival rate of more than 80% when caught early – and there are many ways to treat it.
HealthyWomen spoke to Dr. Claire de la Calle, a urologist specializing in bladder cancer at Fred Hutch Cancer Center, to learn more about treating UBC.
What Types of Surgery Are Used to Treat UBC?
Typically, bladder cancer is first diagnosed through an endoscopic procedure, in which we insert a small camera into the bladder through the urethra (the hole through which we pee) 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. But many bladder cancer patients will need several of these surgeries. If the cancer is more advanced, the patient may elect to have the bladder removed, a procedure called a radical cystectomy.
Is treatment different for non-muscle invasive bladder cancer (NMIBC), when the tumor has not spread to the bladder muscles, and muscle invasive bladder cancer (MIBC), when it has?
Yes, that’s a great point. We really want to know if the cancer is non-muscle invasive or muscle invasive because the clinical pathways are completely different. For non-muscle invasive bladder cancer, we can offer treatments to try to help the patient maintain their bladder. However, with muscle-invasive bladder cancer, the bladder often needs to be removed.
How does intravesical therapy (introducing medication directly into the bladder) work for UBC?
For low-risk patients with non-muscle invasive bladder cancer, treatment initially consists of TURBT, followed by surveillance cystoscopies (basically inserting a small camera into the bladder in the clinic). It is a five-minute procedure that we perform regularly to ensure the cancer does not come back.
For non-muscle invasive bladder cancer ranging from moderate to high risk, we can offer several intravesical (i.e. “in the bladder”) therapies. We do this to try to kill any cancer cells remaining in the bladder after the initial TURBT, to prevent the cancer from coming back and to keep it from getting worse. So if the cancer comes back, these therapies can 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 primes your own immune system to attack the 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. It leads to a massive immune response, which ultimately leads to an anti-cancer response. So your own immune system attacks the bladder cancer cells.
BCG is one of the very first immunotherapies ever used in medicine, and it works really well. Unfortunately, there is currently a BCG shortage in the United States – we simply are not making enough BCG for all bladder cancer patients. Therefore, in recent years, urologists have had to find other ways to treat bladder cancer.
One of the things we’ve started doing is intravesical chemotherapy. It is the same chemotherapy that we have been administering to patients through their veins for many, many decades. When administered into the bladder, it may help reduce the recurrence and progression of non-muscle invasive bladder cancer.
Can you talk about some of the new advances in UBC treatment?
Unfortunately, BCG sometimes doesn’t work. For patients with non-muscle invasive bladder cancer that does not respond to BCG, we offer many other intravesical therapies. It is a very active area of research.
Many studies are currently underway and several drugs are likely to be approved by the FDA 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. In low-risk NMIBC, recurrence rates are 30–40%. For medium risk the rate is around 55%, for high risk it is 60-70%.
What are the disadvantages and side effects of the different treatment options?
Since bladder cancer tends to come back, having to go to the operating room often is a big deal. 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 can also occur after surgery.
With intravesical therapies, the vast majority of patients experience symptoms such as urgency, frequency, and pain during urination. Fortunately, we can support most patients with all of these side effects so they can continue treatments.
What do you wish more women knew about bladder cancer?
Unfortunately, women tend to have worse outcomes than men, and this is partly because they are often not diagnosed until the cancer has progressed. Many women have blood in their urine, which is probably due to a urinary tract infection (urinary tract infection). You see doctors trying over and over again to treat what they think is a urinary tract infection until finally someone says, “What if that could be bladder cancer?”
So I wish more people (and providers) knew that blood in the urine is never normal. It may be a urinary tract infection, but there should be no blood in the urine after the infection is treated. If this is the case – even if it is a microscopic amount – the patient should definitely see a urologist.
This educational resource was created with support from Merck.
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