Our Approach to Bladder Cancer

Patients who come to the Siteman Cancer Center for treatment of bladder cancer are seen by a team of Washington University Physicians — surgical, medical and radiation oncologists — often during the same visit.  A health psychologist is also available as needed. Experienced nurses then spend time with you, answering your questions and putting you in touch with resources that may help during this stressful time. These nurses offer patient literature on your condition, chemotherapy, radiation therapy, surgery and other related issues. As a unique feature of your care, we also offer the services of a palliative care specialist who can help you fit treatment into your own special circumstances, if needed.

The Siteman Cancer Center sees on average 200 new cases of bladder cancer a year. Our urological cancer team is one of the most experienced in the world in performing nerve-sparing bladder removal and creating neobladders, replacement bladders made out of intestinal tissue. Instead of creating an opening to the skin to divert urine, the surgeon places the new bladder where the cancerous bladder was removed. This surgical technique allows both men and women to achieve nearly normal continence. Men who have nerve-sparing bladder removal and a neobladder can continue to have normal erections and urinate through their penis. Women also experience more comfortable sexual intercourse with a neobladder.

Medical oncologists at Siteman currently are investigating a series of new anti-cancer drugs that can be placed in the bladder, either in combination with standard medications or alone.

There are three types of bladder cancer that begin in the cells in the lining of the bladder:

  • Transitional cell carcinoma (TCC): These cells in the innermost layer of the bladder are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade. Low-grade TCC often comes back after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body. Only 10 percent of bladder cancers progress to high-grade or invasive.
  • Squamous cell carcinoma: This cancer begins in the thin, flat squamous cells, usually after long-term infection or irritation.
  • Adenocarcinoma: This rare type of cancer begins in glandular (secretory) cells found in the lining of the bladder.

Cancer that is limited to the lining of the bladder is called superficial bladder cancer. Cancer that has spread through the lining of the bladder and invades the muscle wall is invasive. If it is invasive or has spread to nearby organs and lymph nodes it is metastatic bladder cancer and is treated differently.

Treatment used for bladder cancer depends on the stage at which it is diagnosed, whether the cancer has spread outside the bladder, the patient’s age and personal wishes. Therapy is changing rapidly and biologics are taking more of a place in standard treatment.

Washington University Physicians at Siteman are actively involved in clinical trials that investigate new chemotherapy regimens and other approaches to cure. Having your cancer treated at Siteman gives you access to new therapies that are as good as – or potentially better than – current standard therapies available elsewhere.