At the Johns Hopkins Greenberg Bladder Cancer Institute, we emphasize patient education and encourage patient participation in the decision-making process. Our multidisciplinary team assesses all the information — tumor stage/grade, pathology results, imaging and, when available, tumor genetic sequencing — and teaches patients about their diagnosis, and the risks and benefits of various treatment options. We then provide expert guidance to help patients arrive at care decisions that meet their specific needs.
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Bladder Cancer: The Basics
Specialists at the Johns Hopkins Greenberg Bladder Cancer Institute (GBCI) outline a basic overview of the functions of the bladder, and the different types of cancer that can affect the bladder. Learn about symptoms and risk factors for the disease, and how the GBCI’s multi-disciplinary clinical approach is moving research forward.
About Bladder Cancer
Bladder cancer almost always starts in the lining of the bladder with the uncontrollable growth of urothelial cells. Occasionally, it can also form in other areas of the urinary tract (e.g., renal pelvis, ureter or urethra) that are lined with these same cells. When detected and treated early, bladder cancer can be cured the majority of the time. If a tumor becomes invasive — growing into the bladder’s muscle wall and even spreading to other organs — surgery to remove the bladder is usually required.
Treating Nonmuscle-Invasive Bladder Cancer
Also known as nonmuscle-invasive bladder cancer, this type is considered “early stage” and represents about 70 to 75 percent of all bladder cancer cases. Nonmuscle-invasive bladder cancer means the cancer is found in the lining of the bladder and has not invaded the bladder’s muscle wall or spread outside the bladder.
While easier to treat, nonmuscle-invasive bladder cancer has a high rate of recurrence and a risk of progression that requires patients to undergo a lifetime of regular monitoring. This is a major reason why bladder cancer is the costliest cancer to treat.
Current Approaches
The Greenberg Institute currently offers several approaches to treating nonmuscle-invasive bladder cancer:
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Cystoscopy is the “gold standard” for examining the lower urinary tract and bladder lining. It is used to take photos and biopsies of cancerous lesions. During the cystoscopy, a thin, lighted tube with a camera is inserted through the urethra. For patients who have a bladder tumor identified via cystoscopy, we have the ability to use enhanced blue-light cystoscopy (cysview) to better identify and remove bladder tumors/cancers. Learn more about Blue Light Cystoscopy from UroToday.
While the current standard of care calls for the use of white-light cystoscopy, research shows that blue-light cystoscopy — when used with a photosensitizing drug that is instilled in the bladder — improves tumor detection, which can lead to more accurate resection and lower recurrence rates.
The Greenberg Bladder Cancer Institute offers blue-light cystoscopy as a standard of care.
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The tumor is removed using electrical force during a cystoscopy. This procedure is typically performed in the operating room.
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Chemotherapy or immunotherapy drugs are placed into the bladder via a catheter.
Bladder Cancer Q&A with urologist Max Kates, M.D.
Urologist Max Kates, M.D., answers common questions about bladder cancer, including who is at risk, signs and symptoms, as well as the latest treatment options at the Johns Hopkins Greenberg Bladder Cancer Institute.
Treating Muscle-Invasive Bladder Cancer
Also called advanced bladder cancer, this type represents about 25 to 30 percent of all bladder cancer cases. Muscle-invasive bladder cancer is cancer that has invaded the bladder’s muscle wall. Some invasive bladder cancers have also metastasized, or spread, to surrounding organs or other parts of the body.
Current Approaches
The Greenberg Institute treats muscle-invasive bladder aggressively with curative intent through several patient-centered treatment approaches, including:
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Often, muscle-invasive bladder cancer requires complete surgical removal of the entire bladder. In a small portion of patients, it may be possible to remove just part of the bladder. Robotic-assisted laparoscopic radical cystectomy using a minimally invasive approach to bladder removal may also be an option for some patients.
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After radical cystectomy, the patient’s urinary function must be restored using one of several urinary diversion or bladder reconstruction procedures: ileal conduit, ileal orthotopic neobladder or continent catheterizable reservoirs (Indiana pouch).
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This is an alternative approach to removal of the bladder, in which a thorough, complete TURBT is performed and then followed with systemic chemotherapy and radiation therapy to the bladder. This is used in selective patients with muscle-invasive bladder cancer that meets the criteria for bladder preservation.
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Patients with good kidney function and adequate overall functional capacities are usually offered a combination of systemic chemotherapeutic drugs given prior to radical cystectomy. The chemotherapy is aimed at treating any microscopic spread of cancer that cannot be seen with traditional CT scan imaging, shrinking the known cancer within the bladder to optimize the curative potential of radical cystectomy. About half of patients meet the criteria necessary to undergo chemotherapy prior to surgery.
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While radical cystectomy is often required to effectively treat muscle-invasive bladder cancer, a subset of patients can achieve good outcomes with a combination of tumor resection, chemotherapy and radiation. It’s not common for institutions to offer bladder preservation and do it well and often, but here at the Greenberg Bladder Cancer Institute, we do.
Selection of patients best suited for trimodality bladder preservation is crucial. The expertise among the multimodality team of experts available at the institute allows a thorough individual evaluation of each patient to determine if trimodality bladder preservation can be offered as a therapy option.