Department of Urology

Illnesses We Treat

Bladder Cancer

How Bladder Cancer is diagnosed
The lining of the bladder, known as the urothelium, also lines the upper tracts (the kidney, pelvis and ureters) and the nearest portion of the urethra. Patients with urothelial cancer (most commonly found in the bladder) commonly present with some form of blood in the urine (either gross or microscopic). Because of the potential involvement of the upper tracts, imaging studies (CT, IVP, ultrasound) are generally performed to assess the entire urothelium for this possibility when hematuria (blood in the urine) occurs. Cystoscopy (a direct visual examination of the urinary tract with a cystoscope) is performed to visually examine the bladder. The presence of a bladder tumor then requires resection through the cystoscope in order to determine the extent of disease and the possible need for additional treatments.

Treatment Options
Most bladder cancers are superficial. Although recurrence of these tumors may take place in 70 percent of instances, progression occurs in only 15 percent. If recurrence is frequent, if there are multiple tumors, or if the form of superficial disease carries a greater risk for potential recurrence and/or progression, treatment with various medications instilled into the bladder may successfully control the disease, prevent recurrence, and in some instances prevent progression. In each instance, however, continued surveillance with periodic cystoscopy every three months and monitoring by urinary cytology (determination of malignant cells in the urine) are needed in order to assure that recurrence has not taken place and that progressive disease is not developing.

If the initial bladder cancer has invaded the muscle layer of the bladder wall, cystectomy (removal of the bladder) is needed in order to attempt to cure the disease. In this instance various forms of urinary diversion can be performed in order to preserve the best quality of life possible. It is now possible in both men and women to reconstruct a reservoir from segments of the intestine and attach this reconstructed reservoir to the urethra. This permits preservation of normal urinary function. When this type of reconstruction is not possible, a reservoir can be reconstructed within the abdomen such that no external appliance needs to be worn and the individual only needs to catheterize the reservoir three or four times a day. The Department of Urology has an extensive experience in all forms of urinary diversion, has had good success in preserving normal urinary function and, in some instances, preserving sexual function as well.

In certain situations, an individual’s medical condition may prevent him or her from undergoing this form of surgery. In these instances a combination of transurethral resection of the bladder tumor, radiation therapy, and chemotherapy can be given to achieve control of the regional tumor and maintain an excellent quality of existence. Although there is a higher risk of cancer recurrence, this risk is outweighed by the other conditions that appear to create an even greater risk for the overall health of the individual. The Department of Urology works closely with the Departments of Radiation Oncology and Medical Oncology to offer these options in a highly coordinated multidisciplinary treatment approach.

For more information or to make an appointment, please contact:
Michael J. Droller, M.D.
Simon Hall, M.D.
Michael A. Palese, M.D.
Department of Urology
5 E. 98th Street, 6th Floor
New York, NY 10029
Tel: (212) 241-4812