The bladder is a balloon-shaped organ in the pelvic area that stores urine. The ureter is a small tube that delivers urine from each kidney down to the bladder. The lining of these structures can develop cancer. The most common type of cancer in these locations is transitional cell carcinoma. Patients who develop this type of cancer can be much more likely to form new tumors of the same type in other locations of this urinary tract lining.
A diagnosis can be prompted by pain, increased urinary frequency, blood in the urine (visible or detected by urinalysis), or a coincidental finding on an x-ray such as a CT scan. Smoking is the greatest single risk factor for bladder cancer. Exposure to certain toxic chemicals and drugs may also increase the risk. The diagnosis can sometimes be made by a variety of x-ray tests. However, placing a telescope inside these structures is often necessary. Examination of the urine for cancer cells (urinary cytology), abnormal DNA (FISH test), or certain chemicals can be helpful.
Bladder cancer can often be treated by placing a telescope into the bladder and scraping the tumor from the lining of the bladder. However, when the tumor invades deep into the wall of the bladder, it is usually necessary to surgically remove the bladder (robotic cystectomy). If the tumor is isolated to a relatively small area away from the opening of the bladder, partial removal of the bladder (partial cystectomy) may be all that is required. Laparoscopic removal using small “button-hole” size incisions can reduce the operative risk and recovery time, particularly with partial removal.
Ureteral cancer usually requires removal of the entire ureter, kidney, and a small portion of the bladder where the ureter inserts (nephrouterectomy). Occasionally, when the tumor is isolated to the lower portion of the ureter, this lower segment can be removed and the remaining portion of the upper ureter can be re-routed to another location in the bladder (ureteral re-implantation). Both of these procedures can also be performed laparoscopically, but require a high level of expertise.
Q: What information should I bring to my first office visit with Scott D. Miller, MD? A: Please bring relevant x-ray films (or computer disks) and any pertinent laboratory, radiology, and pathology reports. Completing our patient information forms (available on our website) prior to your arrival will help inform Dr. Scott Miller regarding your medical history, medications and allergies.
Q: What are the risk factors for developing bladder or ureteral cancer? A: The most significant risk factors are age, smoking, and certain industrial exposures.
Q: What are the risk factors that raise the chance that my bladder or ureteral cancer has spread to other areas of the body? A: The most significant risk factors for having disease outside of the bladder or ureter are tumor size, stage, and grade. A small amount of disease outside of the bladder or ureter, whether close or distant, can be difficult to detect by any type of x-ray test.
Q: What is meant by the term “cancer stage”? A: “Cancer stage” refers to the extent and location of disease, regardless of aggressiveness.
Q: What is meant by the term “cancer grade”? A: “Cancer grade” refers to the aggressiveness of disease, regardless of extent and location. This determination is made by microscopic examination by the pathologist.
Q: What tests do I need prior to making a treatment choice? A: In order to make an informed decision, patients should undergo CT scan of the abdomen and pelvis, chest x-ray, and telescopic examination of the bladder (cystoscopy).
Q: What is a FISH test? A: A FISH test helps detect abnormal DNA in the urine from cancer cells that may have shed from the lining of the urinary tract.
Once diagnosed with transitional cell carcinoma of the bladder or ureter, long-term regular examination of the entire urinary tract is mandatory. Once this tumor occurs in one place, it is much more likely to occur in other parts of the urinary tract. In addition, a slow-growing disease process can suddenly become very aggressive. The keys to successful management include close physician observation, increased fluid intake, and smoking cessation.