Bladder Cancer

Bladder cancer is the fourth most common cancer in men and the eleventh most common cancer in women in the United States. Most bladder cancers start in the cells that line the inside of the bladder. Doctors call this type of cancer urothelial carcinoma.

Treatment depends largely on how deeply the cancer has grown into the bladder wall. Early-stage cancers that stay in the inner lining are usually removed with a thin scope passed through the urethra, without any incisions. This procedure is called transurethral resection of bladder tumor (TURBT). It is often followed by medicine placed directly into the bladder. Cancers that have grown into the muscle layer of the bladder, called muscle-invasive bladder cancer, need more intensive treatment.

For many years, the standard treatment for muscle-invasive bladder cancer was surgery to remove the entire bladder (radical cystectomy). Today, many patients have another option: bladder-preserving treatment. This approach combines surgery to remove only the tumor with chemotherapy and radiation therapy. It allows patients to keep their own bladder while still achieving excellent cancer control.

Symptoms of Bladder Cancer

• Blood in the urine (hematuria). This is the most common symptom. Urine may look pink, red, or cola-colored, or the blood may be visible only under a microscope.
• Changes in urination. You may need to urinate more often or more urgently, or feel burning when you urinate. These symptoms can happen when the tumor irritates the bladder.
• Pelvic pain. Pain in the pelvis or lower belly is more common when the cancer is advanced.
• Heavy bleeding. Large or advanced tumors can cause more significant bleeding.

These symptoms are often caused by conditions other than cancer, such as a urinary infection. Even so, they should always be checked by a doctor.

Causes and Risk Factors

• Smoking. This is the leading cause of bladder cancer.
• Chemical exposure at work. Certain chemicals used to make dyes, rubber, and paint can raise the risk.
• Long-term bladder irritation. This includes chronic inflammation or repeated bladder infections.
• Earlier radiation therapy to the pelvis.
• Certain chemotherapy drugs, such as cyclophosphamide.

How Radiation Therapy Treats Bladder Cancer

Modern radiation therapy uses detailed imaging to aim radiation precisely at the bladder. Most patients are treated with intensity-modulated radiation therapy (IMRT), which shapes the radiation beams to match the tumor while limiting the dose to nearby healthy organs. Radiation is usually given together with chemotherapy, which makes cancer cells more sensitive to radiation.

For some patients, such as those with small tumors or those being treated to relieve symptoms, we may use a shorter course with a higher dose each day. One example is stereotactic body radiation therapy (SBRT).

For muscle-invasive bladder cancer, the combination of tumor-removal surgery, chemotherapy, and radiation is called trimodality therapy. In well-chosen patients, it can clear all signs of cancer, with long-term survival similar to surgery to remove the bladder. Leading national and international guidelines, including those of the National Comprehensive Cancer Network (NCCN), now recognize bladder-preserving chemotherapy and radiation as a standard treatment option for suitable patients.

We also use radiation to treat:

• Cancer that has come back in the bladder lining after earlier tumor removal and treatments placed into the bladder.
• Early stage bladder cancer, when it has not responded to BCG (an immune treatment placed directly into the bladder).
• Symptoms of advanced cancer that has spread beyond the bladder, such as bleeding or pelvic pain.

Advanced Technology at ROC

• Daily image-guided treatment. The size and position of the bladder change from day to day as it fills and as the bowel moves. Before each treatment, we take a quick CT scan on the treatment machine (called a cone-beam CT) and adjust your position for that day. This makes sure the tumor receives the full dose while the nearby bowel and rectum are protected.
• Bladder filling program. We coach patients to empty their bladder and then partly refill it before each treatment. This keeps the bladder a consistent size and position, which helps reduce side effects.
• Stereotactic body radiation therapy (SBRT). When cancer has spread to a limited number of places, such as lymph nodes or bones, SBRT delivers high, highly precise doses of radiation in just 3 to 5 treatments. This shortens the overall treatment time and limits side effects.

What to Expect During Treatment at ROC

1. Simulation (planning scan). You will lie on a comfortable table while we take a CT scan, which may be combined with an MRI to show the tumor more clearly. We will make a custom cushion or body mold to help you lie in the same position for every treatment, and we will place a few small marks on your skin as reference points.
2. Treatment planning. Our radiation oncologists and medical physicists design a plan just for you. Most courses last 4 to 6 weeks, depending on the stage of the cancer, whether radiation is your main treatment or follows surgery, and your overall health. Shorter courses are used when the goal is to relieve symptoms.
3. Daily treatments. Each session takes about 10 to 15 minutes. Treatment is painless, and you will not feel anything as the machine moves around you. Before every session, we take an image to confirm you are in exactly the right position.
4. Chemotherapy during radiation. Your medical oncologist will plan chemotherapy to be given during your radiation treatments. It is typically given to make cancer cells more sensitive to radiation.
5. Supportive care. We will show you how to care for your bladder and manage the urge to urinate, and we can prescribe medicine to ease bladder irritation if needed.

Side Effects and Expected Results

Short-term side effects (during and shortly after treatment)

• Bladder irritation (radiation cystitis). You may need to urinate more often or more urgently, with mild burning. This is usually managed by drinking plenty of fluids, taking medicine for discomfort, and sometimes antibiotics.
• Tiredness (fatigue). This is usually mild to moderate and goes away within a few weeks after treatment ends.
• Skin changes. You may notice mild redness of the skin in the pelvic area.
• Loose stools or diarrhea. This can be managed with medicine and changes to your diet.

Long-term side effects (uncommon, affecting fewer than 5 in 100 patients)

• Small blood vessels in the bladder wall (telangiectasias). These rarely cause bleeding. If they do, the bleeding can usually be treated with a simple office procedure.
• Bladder shrinkage or narrowing of the urethra. Scarring can make the bladder smaller (bladder contracture) or narrow the tube that carries urine out of the body (urethral stricture). These problems are uncommon with modern IMRT.
• Bowel blockage (small bowel obstruction). This is rare. It may be treated by resting the bowel or, in some cases, with surgery.

Long-term results

For muscle-invasive bladder cancer treated with trimodality therapy, 5-year overall survival is approximately 50%, and most patients keep a bladder that works well.

Schedule a Consultation

Call 847-698-0600, ext. 112, to schedule a consultation with one of our radiation oncologists. We will work closely with your urologist and medical oncologist to create a treatment plan tailored to you.