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Bladder Cancer

Medical, surgical and radiation oncology experts at Johns Hopkins work together as a team to coordinate care for bladder cancer patients.  Experts, including those from the Greenberg Bladder Cancer Institute, continue ground-breaking research and clinical trials to improve detection and treatment.

Greenberg Bladder Cancer Institute

Patient Appointments: 410-955-6707

Greenberg L to R: Bill Issacs,Ph.D., former interim director of the Greenberg Bladder Cancer Institute, Stephanie and Erwin Greenberg.

Baltimore-area commercial real estate developer Erwin L. Greenberg and his wife Stephanie Cooper Greenberg have pledged a $15 million gift to create the Johns Hopkins Greenberg Bladder Cancer Institute. Their gift is part of a $45 million co-investment with Johns Hopkins University, which will draw on the Johns Hopkins Kimmel Cancer Center’s multidisciplinary research teams, and will include faculty from the Johns Hopkins University School of Medicine’s Department of Radiation Oncology and Molecular Radiation Sciences, the Brady Urological Institute, and the Departments of Pathology and Surgery. Read more.


 Bladder Cancer Education

Learn more about bladder cancer treatment and research by watching this patient education seminar hosted by The Johns Hopkins Greenberg Bladder Cancer Institute.

Bladder Cancer Experts

Pioneering surgeons, innovative oncologists and world-class researchers use their skills to develop personalized treatment plans for bladder cancer patients.  Bladder cancer experts from a variety of departments and specialties at Johns Hopkins are available to add their knowledge and expertise to the care of patients.

About Bladder Cancer

The bladder is a hollow organ in the lower abdomen that stores urine. Cancer occurs when cells in the bladder begin to grow uncontrollably affecting the normal function of the organ, and, sometimes surrounding organs. When detected and treated early, bladder cancer can be cured the majority of the time.


 Risk Factors

People with a history of smoking, a family history of bladder cancer, or who have had regular exposure to industrial chemical may be at increased risk for bladder cancer.

Diagnostic Tests

There are several different laboratory and clinical tests used to diagnose bladder cancer. They are all relatively simple and painless, though some do require the use of local anesthetics and, in some patients, can cause mild discomfort. View the Bladder Cancer & Bladder Pathology site for more information about diagnostics.

  • Urinalysis - A small sample of urine is examined under the microscope to check for the presence of blood.
  • Intravenous Pyelogram or IVP - Patients receive an injection of a liquid dye though a vein in their arm followed by several x-rays. The dye travels to the kidneys, ureters and bladder and allows the doctors see if there are any suspicious lumps or lesions. Some patients report feeling warm or tingly during this procedure.
  • Cystoscopy - A thin, lighted tube is inserted through the urethra and into the bladder under local anesthesia to allow the doctor to visualize the bladder. If the doctor sees any suspicious areas, a sample of the tissue will be removed and examined under a microscope for cancer cells.
  • Biopsy - A surgical procedure in which a piece of tissue is removed from the bladder and examined for the presence of cancer cells. It is the only definitive way to diagnose bladder cancer.

Cancer Symptoms

The most common symptoms of bladder cancer are:

  • Blood in the urine
  • Increased frequency of urination
  • Pain or burning with urination
  • Incomplete emptying of bladder

Current Treatments

There are a wide variety of methods used to treat bladder cancer, including surgery, radiation treatment and drug therapy. At Johns Hopkins, bladder cancer experts develop a personalized treatment plan for each patient based upon the specific characteristics of the tumor. Treatment may involve a single therapy or a combination of therapies.

Early or superficial bladder cancer - At this stage, the cancer is confined to the inside lining of the bladder. Cancerous cells can often be removed using surgical tools inserted through a cystoscope into the bladder. More than 70 percent of bladder cancers diagnosed are of this type.

Invasive bladder cancer - In these more advanced cases, cancer cells have spread from the lining of bladder into the muscle and possibly surrounding organs, and a radical cystectomy is usually needed. In this treatment, a surgeon removes the diseased bladder and possibly other surrounding organs, including the uterus, fallopian tubes, and ovaries in women, and the prostate and seminal vesicles in men. In the past, the only option for urine collection following surgery was an external bag called an ostomy. Now, because of a new procedure pioneered at Johns Hopkins, most patients are candidates for bladder reconstruction. Doctors use a portion of the large bowel, which they fashion into a new bladder. The new bladder is attached to the urethra allowing patients to urinate normally and eliminating the need for a urine collection pouch or ostomy. Today, most patients are candidates for this procedure. For patients where bladder reconstruction is not possible, doctors can make an internal storage pouch for the urine using a piece of small intestine. Patients are taught to use a small tube or catheter to drain the urine through a tiny, concealable opening in the abdomen. Both of these new techniques have significantly improved the quality of life for bladder cancer patients.

In addition to surgery, radiation therapy or chemotherapy may be recommended to kill cancer cells doctors were unable to remove during surgery or to safeguard against recurrence of the disease. Radiation therapy is a localized treatment that uses targeted beams of x-rays to destroy cancer cells in a specific part of the body. Chemotherapy refers to the use of anticancer drugs administered orally and/or intravenously and travel through the bloodstream to destroy cancer cells that have broken away from the original tumor. Cisplatin is the drug most commonly used in the treatment of bladder cancer.

Treatment Approaches

The collaboration of the many clinicians and researchers at Johns Hopkins has led to many advances in the understanding and treatment of bladder cancer.

  • A combination approach, called bladder-sparing surgery, utilizes drug therapy and radiation therapy prior to surgery to shrink the tumor and possibly completely eliminate the cancer. This experimental technique may soon offer patients an effective alternative to removing the bladder and an improved quality of life.
  • Scientists have begun to identify the genetic changes that contribute to the development of bladder cancer. Their work could very soon lead to new ways of treating the disease, or possibly even preventing it from ever occurring.
  • Johns Hopkins researchers have developed a test using microsatellite analysis that appears to detect bladder cancer at an earlier stage. The test, which uses state-of-the-art molecular genetics technology, detects DNA abnormalities or mistakes specific to bladder cancer in cells found in the urine. Further clinical studies of the test are underway at Johns Hopkins.

Bladder Cancer Research

Greenberg Bladder Cancer Institute Awards First Research Grants

A urine-based test for early detection and monitoring of bladder cancer and nanoparticles that can deliver chemotherapy drugs to bladder tissue are among the first projects awarded research grants by the Johns Hopkins Greenberg Bladder Cancer Institute. Read more.

Trinity Bivalacqua, M.D., Ph.D. - Bivalacqua and colleagues will develop nonadhesive, biodegradable nanoparticles loaded with chemotherapy and other solutions. They will compare the effectiveness of their nanoparticles with standard ways of delivering chemotherapy in a mouse model of bladder cancer. The hypothesis is that the nanoparticles will better sustain delivery of chemotherapy into bladder tissue, preventing tumor recurrence and progression.

George Netto, M.D. - Netto’s project will continue work on a noninvasive, urine-based test to identify mutations in the “on-off switch” of a gene called telomerase reverse transcriptase (TERT), which is present in a range of bladder cancer precursor lesions. New experiments will determine how well a test for TERT mutations can detect bladder cancer in urine samples of individuals at high risk for bladder cancer, determine the utility of detecting TERT mutations among urine samples taken during follow-up of bladder cancer patients to monitor disease recurrence, and see if it is worth expanding the test to include additional genetic mutations found in bladder cancer.

Peter H. O’Donnell, M.D., -assistant professor of medicine at the University of Chicago Medicine Comprehensive Cancer Center, for Genetic Diversity of T Cell Receptors Impacting Anti-tumor Effects in Bladder Cancer.
O’Donnell’s study will test the idea that as some bladder cancers progress, they acquire certain mutations that may activate and expand the number of tumor-infiltrating T lymphocytes (TILs), white blood cells found in tumors that kill cancer cells. Investigators will look for genetic changes in TILs that predict robustness of immune responses against bladder cancer to see if they contribute to better recurrence-free and overall survival.
Armine Smith, M.D., assistant professor of urology at the Johns Hopkins University School of Medicine, for Pilot Study of TRAIL and BCG Combination Therapy in Bladder Cancer.
Smith’s study will see if stimulating a protein called TRAIL (tumor necrosis factor-related apoptosis-inducing ligand), which kick starts the process of cell death, will increase the effect of BCG (Bacillus Calmette-Guerrin), the main biological treatment for non-muscle invasive bladder cancer, in mice. Investigators also will collect tissue from patients with bladder cancer to identify levels of TRAIL receptors before and after BCG treatment and correlate them with treatment outcomes.
Dan Theodorescu, M.D., Ph.D., professor of urology and director of the University of Colorado Cancer Center, for The Role of AGL, a Glycogen Debranching Enzyme in Bladder Cancer.
Theodorescu’s research will study the role of AGL, an enzyme that suppresses bladder tumor growth. Patients with metastatic bladder cancer have lower levels of AGL. Scientists will track levels of AGL and another enzyme called HAS2 to determine their correlation with patient outcomes. The researchers will also study mice that do not express AGL to see if they are more susceptible to bladder cancer.

Bladder Cancer Survivorship

Bladder cancer survivors are urged to be patient when it comes to readjusting to life after cancer, as side effects of treatment can vary but often improve with time. Radiation treatments can result in blood in the urine or stools, and chemotherapy can yield numbness/tingling/pain in the hands and feet (peripheral neuropathy), hair loss, difficulty concentrating or fatigue. Survivors who had surgery may find it challenging adjusting to a bladder with reduced capacity or learning to care for and manage a reconstruction. Don’t try to do too much at once; instead, set small, short-term goals. Always discuss any health concerns and symptoms with your doctor.

Lifestyle changes may be in order. Because bladder cancer patients may have lower levels of selenium and vitamins A, C, and E, it is especially important to eat a healthy diet rich in fruits and vegetables incorporating these and other vitamins. Drinking six to eight 8-ounce glasses of water and other liquids day can keep survivors well hydrated and decrease the risk of urinary infection. Quit smoking if you still smoke. Exercise can help maintain or achieve a healthy weight and stave off depression. Try to avoid stress. Avoid tobacco and limit alcohol intake. Keep up with screenings for other cancers, like mammograms and colonoscopies.

 The Brady Urological Institute at Johns Hopkins has an extensive website devoted to bladder cancer. The Bladder Cancer Advocacy Network lists resources and support groups available to patients and survivors.