Bladder Cancer

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For people with bladder cancer — as well as cancers of the prostate, kidneys and testicles — the Swedish Cancer Institute's nationally recognized genitourinary cancer program offers the services of a renowned team of physicians, surgeons and other specialists.

All Swedish bladder-cancer patients benefit from a comprehensive approach to care that begins with state-of-the-art imaging techniques and features the latest treatments and a wide range of high-quality support services.

Overview

The inner layer of bladder wall is lined with cells called urothelial cells. Cancer arising from these cells makes up 90 percent of all bladder cancers – and are referred to as urothelial cell carcinomas. Inner layers of kidneys and ureters are also consisted of urothelial cells where cancer may arise.

Symptoms

The most common sign of bladder cancer is blood in the urine, with other signs including pain during urination, increased urgency and frequency of urination, and frequent bladder or urine infections.

Diagnosis

Diagnosis of bladder cancer is based on urine cytology, cystoscopy and biopsy. Urine cytology is a test examining a urine sample by microscope for the presence of cancer cells.

A cystoscopy is a procedure performed by urologists. By inserting a small tube with camera lens through the urethra, a urologist can examine the bladder and urethra for abnormal growth or a tumor. If found, the urologist will take a sample of the abnormal tissue (called biopsy) for testing. If suspicion of cancer is high, urologists will then perform a transurethral resection of bladder tumor (TURBT) in order to determine the cancer grade and stage. TURBT is also an important form of treatment of bladder cancer. 

The grade and stage of bladder cancer are important, and dictate choices of treatment. Grade refers to how abnormal the cancer cells appear under the microscope. Bladder tumors are classified as either low or high grade. Low-grade cancers can recur but rarely invade into deeper layers of bladder. High-grade cancers are more likely to recur and become invasive. 

Stage is based on how deep the cancer has penetrated into the tissues of the bladder, whether the cancer involves lymph nodes near the bladder, and whether the cancer has spread beyond the bladder to other organs. Imaging tests such as CT and MRI are used to detect abnormalities or masses along the urinary tract including the  kidneys, ureters and bladder, as well as enlarged lymph nodes and cancer spread (called metastasis) to other organs. PET/CT and bone scan may be considered in some patients if metastatic disease is suspected based on CT or MRI.  

Treatment

An individualized treatment plan may include a combination of the following:

  • Surgery
    • Transurethral resection of bladder tumor (TURBT). TURBT is a procedure by a urologist performed in an operation room. During the procedure, a urologist removes the tumor with an electric wire through a cystoscope. 
    • Cystectomy. Cystectomy is surgery to remove the bladder entirely or partially.
  • Radiation therapy. Radiation therapy kills cancer cells through X-rays. Radiation therapy can be combined with chemotherapy for enhanced efficacy. For some patients, a combination of radiation and chemotherapy can be considered if surgery is not feasible.
  • Chemotherapy. Chemotherapy kills cancer cells by disrupting their growth and damaging their DNA. Chemotherapy drugs are mostly given through a vein, and sometimes, directly into the bladder. To improve the chance of curing the cancer, chemotherapy may be given before cystectomy or concurrently with radiation therapy.
  • Immunotherapy. Immunotherapy enables the immune system to eliminate cancer cells. Some immunotherapy drugs, such as bacillus Calmette-Guerin (BCG), can be given into the bladder through a urinary catheter. Others such as immune checkpoint inhibitors are given intravenously.
  • Targeted therapy. Some bladder cancers carry a mutation in specific genes that make cancer cells susceptible to drugs targeting those mutations. For some bladder cancer patients with mutations in FGFR2 and FGFR3 genes, erdafitinib is a treatment option when chemotherapy is not effective.
  • Research. Researchers at the Swedish Cancer Institute participate in clinical trials and innovative therapy in all aspects of the treatment of bladder cancer. This includes surgery, radiation, systemic therapy and supportive care. Several clinical trials are available at Swedish for patients with bladder cancer, with more planned in the upcoming years.  

As of Summer 2021, the following clinical trials are available at Swedish Cancer Institute:

  1. A Phase III Randomized Adjuvant Study of Pembrolizumab in Muscle Invasive and Locally Advanced Urothelial Carcinoma (AMBASSADOR) Versus Observation.
  2. A Phase 1/2 Study of CPI-0209 Monotherapy and in Combination With Other Therapy in Patients With Advanced Tumors. 

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