Bladder Cancer

UT Southwestern Medical Center’s experts are uniquely involved in developing better strategies using multiple modalities to detect and treat bladder cancer. These modalities include enhanced diagnostic tools, new surgical techniques, and the latest immunotherapies.  

As the only National Cancer Institute-designated comprehensive cancer center in North Texas, we deliver the best cancer care available today and push to discover new treatments. NCI designation means we offer patients the ability to participate in the broadest possible range of clinical trials, with access to potential therapies not available at other facilities.

Access to Bladder Cancer Treatments You Need, When You Need Them

Bladder cancer develops in one of the four layers of the bladder, the organ that stores urine before it passes out of the body. About 80,000 new cases of bladder cancer are diagnosed in the United States each year, and it is the fourth most common cancer diagnosed in men.

UT Southwestern delivers comprehensive, state-of-the-art care to people with bladder cancer. Recent advances, such as enhanced intraoperative detection tools and outpatient use of blue light cystoscopy, allow us to identify hard-to-find recurrent cancers, while robotic surgical techniques and precision radiation therapy allow rapid recovery from therapeutic intervention. For patients with metastatic disease, new immunotherapies and chemotherapeutic regimens offer hope to patients with an incurable and lethal disease.

Our researchers, including urologists Yair Lotan, M.D., Vitaly Margulis, M.D., and Solomon Woldu, M.D. are working to develop biomarkers to detect bladder cancer earlier and biomarkers to predict response to different therapies, such as immunotherapy. We are also working on novel therapies against invasive forms of bladder cancer.

Types of Bladder Cancer

Transitional cell (urothelial) carcinomas make up more than 90 percent of bladder cancer cases. Tumors are either papillary or flat carcinomas. 

Other, very rare types of cancer that can develop in the bladder are:

• Squamous cell carcinoma
• Adenocarcinoma
• Small-cell carcinoma
• Sarcoma 

Risk Factors

Risk factors for bladder cancer include:

• Smoking: People who smoke develop bladder cancer at more than three times the rate of those who don’t, and smoking contributes to about half of all cases of the disease.
• Workplace exposure: People who work with certain industrial chemicals have a higher risk of developing bladder cancer.
• Gender: Men develop bladder cancer at about three times the rate women do.
• Ethnicity: Caucasians develop bladder cancer at about twice the rate of African Americans.
• Age: About 90 percent of people with bladder cancer are older than 55.
• Chronic bladder irritation and infections: These problems are linked to bladder cancer.
• Genetic syndromes: Cowden syndrome, Lynch syndrome, and other genetic syndromes can increase the risk of bladder cancer.
• Certain cancer treatments: People who have received radiation to the pelvic area or had longtime use of the chemotherapy drug cyclophosphamide might be more likely to develop bladder cancer.

Symptoms and Diagnosis

Early-stage bladder cancer – as well as a number of noncancerous conditions – often causes symptoms such as:

• Blood in the urine, present in about 90 percent of cases
• More frequent urination than usual
• Pain or a burning sensation during urination
• Urgently feeling the need to urinate even when the bladder is not full

Symptoms of more advanced bladder cancer can include:

• Inability to pass urine
• Lower back pain on one side
• Swelling of the feet
• Weight loss and loss of appetite
• Bone pain

Bladder cancer is often discovered in its early stages because of its symptoms, and it’s typically diagnosed with urodynamic testing, cystoscopy, or urinary-tract imaging. Consultation with a urologic oncologist is critical for the best outcomes.

Flexible Blue Light Cystoscopy

Traditional cystoscopy uses white light to detect tumors, but it doesn’t always show adequate contrast between benign and malignant cells. Blue light cystoscopy – in conjunction with instillation of Cysview – is better at illuminating cancer than a traditional white-light scope. 

Blue-light cystoscopy has previously been available at some institutions, including UT Southwestern, for use in the operating room, but it wasn’t available for use with a flexible scope until now. UT Southwestern is one of a few institutions in the United States that offers flexible blue light cystoscopy – a newer type of procedure –  for outpatient use. 

During this procedure, a thin tube is placed through the urethra, allowing our doctors to look directly inside the bladder. We use an optical imaging agent to make the abnormal cells glow under the blue-light illumination. This makes it easier for cancer cells to be detected and removed.

Learn more about the diagnosis of genitourinary cancers. 

Treatment

Treatment for bladder cancer depends on its characteristics and stage, as well as patients’ overall health, preferences, and goals. Options include:

• Surgery, with either a minimally invasive transurethral procedure to remove the tumor or a cystectomy, which removes part or all of the bladder.
• Medical treatment, which includes chemotherapy drugs or drugs inserted directly into the bladder (intravesical therapy) – both of which kill the cancer cells.
• Immunotherapy, which has been shown to work for patients with metastatic bladder cancer.
• Radiation therapy, which is combined with chemotherapy for a bladder preservation strategy or added to surgery as an adjuvant treatment.

Learn more about how we treat genitourinary cancers.

Support

UT Southwestern’s comprehensive approach to patient care means our team also strives to help patients with issues such as pain management, nutrition, psychosocial adjustments, and cancer’s impact on their families.

Clinical Trials

UT Southwestern offers clinical trials that might provide patients with an opportunity to complement traditional therapy for bladder cancer with the newest, most promising treatment strategies. Talk with your doctor to determine if a clinical trial is right for you.