Leading bladder cancer treatment in San Diego
Leading bladder cancer treatment in San Diego
Scripps MD Anderson Cancer Center is a leader in caring for people with bladder cancer. Our oncology specialists treat bladder cancer with advanced therapies designed to eliminate cancer and prevent recurrence, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery, and immunotherapy to harness the power of the body’s own immune system.
Our multidisciplinary, collaborative board of cancer specialists reviews every patient’s care plan to ensure you receive the best possible care from diagnosis to recovery.
About bladder cancer
Bladder cancer is a type of genitourinary cancer that starts in the bladder, a hollow, muscular organ where urine is stored until it leaves the body.
About 5% of all new cancers in the United States are bladder cancers. It’s the fourth most common cancer among men, affecting about 1 in 26 men during their lifetime. Women have a 1 in 88 chance of developing bladder cancer.
As with other genitourinary cancers — such as prostate, testicular and kidney cancer — when detected early, bladder cancer has a higher likelihood of successful treatment.
Types of bladder cancer
The bladder wall is made up of several layers, which are composed of different types of cells. Most cancers start in the inner lining of the wall. As cancer grows, it can spread through the layers of the wall and may spread beyond the bladder.
According to the American Cancer Society, bladder cancers may be described as invasive or non-invasive based on whether they have spread into the bladder wall:
- Non-invasive cancers are in the inner layer of cells (the transitional epithelium), but have not grown into the deeper layers.
- Invasive cancers have grown into deeper layers of the bladder wall. These cancers are more likely to spread and are harder to treat.
There are two subtypes of bladder cancer:
- Papillary carcinomas grow in slender, finger-like projections from the inner surface of the bladder toward the hollow center. Papillary tumors that grow toward the center of the bladder without growing into the deeper bladder layers are called non-invasive papillary cancers.
- Flat carcinomas do not grow toward the hollow part of the bladder. A flat tumor that is only in the inner layer of bladder cells is known as a non-invasive flat carcinoma or a flat carcinoma in situ (CIS).
A papillary or flat tumor that grows into deeper layers of the bladder is called an invasive urothelial (or transitional cell) carcinoma. Almost all bladder cancers are this type. Other types are very rare.
Squamous cell carcinoma
Squamous cell carcinomas make up less than 2% of bladder cancers in the U.S. This rare cancer type is usually invasive.
Adenocarcinomas represent about 1% of bladder cancers, and are nearly always invasive.
Small cell carcinoma
Small cell carcinomas, which start in neuroendocrine cells, make up less than 1% of bladder cancers. They typically grow quickly and are treated with chemotherapy.
Sarcomas are a rare bladder cancer type that start in the muscle cells.
Bladder cancer causes, risks and family history
All of the causes of bladder cancer are not known. But according to the American Cancer Society, researchers do know that some cases are related to gene mutations that occur during a person’s lifetime (rather than being inherited). Some of these mutations are related to exposure to cancer-causing substances, such as those in tobacco smoke or workplace chemicals. Other mutations have unknown causes.
Known bladder cancer risk factors include:
Smoking is the most important risk factor for bladder cancer. Smokers have about three times the risk of developing bladder cancer compared to non-smokers. This include cigarettes, pipes and cigars.
Exposure to workplace chemicals
Certain industrial chemicals called aromatic amines and other organic chemicals (especially those used in dyes, paint, rubber, textiles, dry cleaning and diesel fuel) have been linked to bladder cancer.
Men have up to four times the risk of bladder cancer as women.
Bladder cancer risk increases with age. About 9 in 10 people diagnosed with it are older than 55. It’s rare under age 40.
Arsenic in drinking water
The likelihood of having arsenic in drinking water depends on the source of the water. Most public water systems have standards for low arsenic content.
Personal history of bladder cancer
Bladder cancer has the highest recurrence rate of any cancer. About 50% to 80% of bladder cancers return after treatment.
Prior chemotherapy or radiation therapy
Previous treatment with the chemotherapy drug cyclophosphamide (Cytoxan), or previous radiation treatment to the pelvic area, can raise bladder cancer risk.
People who have family members with bladder cancer have an increased risk of the disease, possibly due to shared exposure to tobacco smoke or cancer-causing chemicals.
Inherited genetic syndromes
In rare cases, inherited mutations in certain genes may increase the risk of bladder cancer, including the retinoblastoma (RBI) gene, Cowden disease and Lynch syndrome.
Having any of these risk factors does not mean you will develop bladder cancer. But if you’re concerned about your risk, especially if you have a family history of bladder cancer or inherited gene mutations, talk with your doctor.
Bladder cancer prevention, screenings and early detection
There are no screening exams to detect the disease in people with an average risk. If you have a high risk of bladder cancer, your doctor may want to test for it, even if you have no symptoms.
Bladder cancer cannot be completely prevented, but taking steps to reduce the risk factors that are within your control may help with bladder cancer prevention.
The following protective factors may help prevent bladder cancer:
- Avoid tobacco
- Limit exposure to workplace chemicals known to cause cancer
- Drink plenty of water
Bladder cancer symptoms, diagnosis and stages
As with most cancers, the earlier bladder cancer is found, the greater the likelihood of treatment being successful. In its early stages, bladder cancer may cause blood in the urine or other urinary symptoms, but it generally does not cause pain. Learn more about bladder cancer symptoms, diagnostic testing and stages below.
Bladder cancer symptoms
Bladder cancer can often be detected early. One of the first signs is blood in the urine. Early symptoms of bladder cancer include:
- Blood in the urine that may come and go
- Urinating more often than usual
- Pain or burning sensation while urinating
- Feeling as if you need to go right away, even when the bladder is not full (urgency)
- Having difficulty urinating or having a weak urine stream
Keep in mind that many of these symptoms are very likely to be caused by non-cancerous conditions, such as a urinary tract infection (UTI), overactive bladder or an enlarged prostate. But let your doctor know if you’re experiencing anything unusual, so that you can find and treat any potential problems.
As bladder cancer advances, symptoms may include:
- Being unable to urinate
- Lower back pain on one side
- Loss of appetite
- Unintended weight loss
- Swelling in the feet
If you have any of these symptoms, call your doctor to determine the cause and next steps.
If you have bladder cancer symptoms or you have a very high risk of bladder cancer, your doctor may recommend testing. Scripps MD Anderson physicians use advanced imaging and lab tests to diagnose bladder cancer. These may include:
The simple urine test can detect blood and other substances in the urine. Blood in the urine is usually the first symptom of bladder cancer, but it can be caused by other non-cancerous conditions.
This test examines a urine sample for signs of abnormal cells that may indicate cancer. Cytology alone cannot confirm a cancer diagnosis.
A urine cystoscopy is the most common test to check for bladder cancer. The physician inserts a thin tube with a camera on the end (cystoscope) through the urethra and into the bladder to examine the walls of the bladder for abnormal growths. Cystoscopy also may be used to remove a tissue sample from the bladder for a biopsy and to remove early stage tumors on the surface of the bladder wall.
Intravenous pyelogram (IVP)
During IVP, the physician injects an iodine-based dye into a vein, and then takes a series of X-ray images to look for any abnormal growths.
During a biopsy, the doctor removes a small tissue sample from the bladder to be examined under a microscope.
Computed tomography (CT) scan
A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.
Magnetic resonance imaging (MRI)
MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.
Positron emission tomography (PET) scan
A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.
Bladder cancer stages
Bladder cancer stages describe how far cancer has (or has not) spread beyond its original starting point in the bladder. Staging guides Scripps oncologists in developing a bladder cancer prognosis and treatment plan.
Abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread to other areas. Stage 0 bladder cancer has two substages:
- Stage 0a (also called papillary carcinoma) may look like tiny mushrooms growing on the lining of the bladder.
- Stage 0is (also called carcinoma in situ) is a flat tumor on the lining of the bladder.
Stage I bladder cancer has spread to the layer of tissue under the inner lining of the bladder.
Stage II bladder cancer has spread to the muscle wall of the bladder.
Stage III bladder cancer has spread from the bladder to the layer of tissue surrounding it, and may have spread to the reproductive organs.
Stage IV bladder cancer has spread from the bladder to the wall of the abdomen or pelvis, and may have spread to one or more lymph nodes or to other parts of the body.
Understanding your diagnosis
A bladder cancer diagnosis can turn your world upside down. It’s completely normal to feel anxious, scared, depressed or overwhelmed. Learning all you can about your diagnosis and your options can help you make informed, confident decisions about the next steps to take.
Questions and considerations
Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:
- Should I get a second opinion?
- How do I find a specialist?
- What is my cancer treatment plan?
- Will I have to miss work/school?
- What are the side effects of bladder cancer treatment?
- How successful is my treatment likely to be?
- What costs will be covered by insurance?
- Which costs will I be responsible for?
Your Scripps team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community cancer resources that provide education, information and helpful resources — often at no cost.
Learn more about the many cancer patient resources available to you and your loved ones via Scripps.
Treatment and clinical trials
When you’ve been diagnosed with bladder cancer, you want a team of expert cancer specialists on your side. Scripps MD Anderson's multidisciplinary oncology teams fight bladder cancer using the latest evidence-based treatments and therapies. Surgery is part of nearly every bladder cancer treatment plan, and whenever possible, Scripps surgeons will use advanced minimally invasive surgical techniques to minimize your discomfort, hospital stay and recovery time.
Our approach to treating bladder cancer
Your Scripps MD Anderson cancer care team includes professionals from every area of oncology, including urologists, surgeons, radiation oncologists, medical oncologists and nurses who specialize in cancer care. Should you need reconstructive surgery after your bladder cancer treatment, count on our surgeons for the expertise that has brought comfort and confidence to many patients.
In addition, your nurse navigator will help coordinate your care and ensure you have support and guidance throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.
Bladder cancer treatment options at Scripps MD Anderson
Your Scripps MD Anderson cancer care team will customize your treatment plan based on several factors, including:
- The stage of your cancer
- Whether your cancer has spread
- Your age and overall health
Treatment for bladder cancer typically involves surgery. Other treatments, such as radiation and chemotherapy, may be given before or after surgery.
Bladder cancer surgery
Depending on the bladder cancer stage, surgery may be the first treatment option. Surgical treatments for bladder cancer include:
- Transurethral resection (TUR) is the most common treatment for early stage bladder cancer. It removes tumors from the surface of the bladder wall using a resectoscope, which is a thin instrument with a wire loop on the end. The resectoscope is inserted into the bladder through the urethra. After the tumor is removed, remaining cancer cells may be destroyed with high-energy electricity or a laser.
- Cystectomy is used for more advanced bladder cancers. It involves the removal of part or all of the bladder. Depending on how far the cancer has spread, lymph nodes near the bladder also may be removed, as well as the prostate in men, and the uterus, ovaries and fallopian tubes in women. This procedure can also be performed with robot-assisted surgery though the Scripps Minimally Invasive Robotic Surgery Program.
- Bladder reconstruction surgery is an option when bladder cancer requires surgical removal of the bladder. It involves surgical procedures known as urinary diversions, which allow the body to store and eliminate urine through a different path, such as through the colon or through an opening in the abdomen into an external bag.
Radiation therapy may be part of a bladder cancer treatment plan before surgery to shrink the tumor, or after surgery to eliminate remaining cancer cells. Scripps provides the most advanced radiation treatments for bladder cancer, including:
- Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy. IMRT allows the radiation oncologist to specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.
- 3-D conformal radiation therapy allows the radiation oncologist to visualize a patient’s anatomy in 3-D. It uses specialized software to match radiation doses to the size and shape of a tumor while minimizing exposure to nearby healthy tissues and organs.
The treatment plan may include chemotherapy if bladder cancer has spread to the lymph nodes and other parts of the body. It may be used in combination with surgery and radiation therapy.
Also called biologic therapy, immunotherapy is designed to use the body’s own immune system to fight cancer. In the case of bladder cancer, the bacterial organism bacillus Calmette-Guérin (BCG) may be administered directly into the bladder through a catheter. BCG is the most effective biologic treatment to prevent bladder cancer from returning.
Bladder cancer clinical trials
Some cancer treatment plans may involve clinical trials. Talk with your physician about whether a bladder cancer clinical trial is right for you.
For a list of clinical trial that are currently enrolling patients, see our current list of clinical trials.
Your custom cancer treatment plan
Your Scripps MD Anderson cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.
Your bladder cancer treatment plan generally includes:
- Family and medical history
- A summary of your cancer diagnosis and staging information
- Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
- Plans for surgery, radiation, chemotherapy and/or other treatments
- Potential side effects of treatments
- Contact information for your cancer care team members
Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.
Your cancer care team
Your bladder cancer care team includes health and medical professionals from a wide range of specialties. Scripps MD Anderson will customize your team to ensure you have the expertise and support you need.
Your team may include:
- Surgeons and surgical oncologists
- Radiation oncologists
- Medical oncologists
- Registered nurses
- Nurse navigators
- Oncology social workers
Visit your cancer care team for more on Scripps MD Anderson's multidisciplinary approach to treatment.
Bladder cancer treatment locations
Scripps diagnoses and treats bladder cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
Learn more about our gamut of cancer care locations in Southern California and the services offered at each.
We are now offering Video Visits for some specialty care appointments. If you are interested in scheduling a Video Visit, contact the provider’s office directly. The doctor’s office will work with you to determine if this is the right type of visit for you.
Support groups, services and resources
Scripps offers a comprehensive lineup of support groups, support services and resources to help you along every step of your cancer journey.
Bladder cancer support groups, workshops and events
In addition to the bladder cancer support group listed below, we also host a handful of free workshops and health and wellness events on a number of topics such as:
- Expressive writing
For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps MD Anderson offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
Patient education is an integral part of understanding and coping with your cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:
- Bookmark the Scripps glossary of cancer terms for easy referencing.
- Download the appointment form and list of medications form on our resources page.
- Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site.
Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.