We Treat
Bladder Cancer
Bladder cancer, which is more common in men than in women, usually begins in the lining of the bladder and can grow into the muscle wall as it advances.
The good news is that bladder cancer is treatable, and outcomes continue to improve as research advances. At SCRI Oncology Partners in Nashville, our dedicated cancer doctors provide compassionate, personalized care grounded in clinical expertise. We work with each patient to create a treatment plan tailored to their needs, goals, and overall health. Our team is available for an initial consultation as well as second opinions on the best path forward based on the latest research findings.
Meet Your Bladder Cancer Doctors Located in Nashville
Bladder cancer risk factors
Several factors may increase the likelihood of developing bladder cancer:
- Tobacco use, especially cigarette smoking
- Increasing age
- Chronic bladder irritation or infections
- Personal or family history of bladder cancer
- Exposure to certain industrial chemicals
- Genetic conditions such as Lynch syndrome
- Previous pelvic radiation therapy or certain chemotherapy drugs
It’s important to remember that having risk factors does not mean someone will develop bladder cancer. Likewise, some people diagnosed with bladder cancer have no known risk factors.
What are the signs and symptoms of bladder cancer?
The symptoms of bladder cancer can vary from person to person. The most common sign is visible blood in the urine, known as hematuria. In some cases, only very small amounts of blood are present and can be detected only through testing.
Other common symptoms include:
- Frequent urination
- Pain or burning during urination
- Urinating often at night
- Feeling the need to urinate when the bladder is not full
In more advanced cases, symptoms may include:
- Fatigue
- Weight loss
- Jaundice
- Inability to urinate
- Pain in the abdomen, lower back, or bones
Keep in mind that some non-cancerous conditions can cause similar symptoms. If you notice persistent urinary changes, it’s important to speak with your primary physician or urologist so you can get clear answers.
Types
Staging
Treatment
Clinical Trials
How is bladder cancer diagnosed?
Evaluation typically begins with a review of your medical history, followed by a physical exam and urine or blood testing. A urologist may examine the bladder using a cystoscope and perform a biopsy to collect tissue samples. Imaging tests—such as CT scans, MRIs, PET scans, or bone scans—may be used to determine whether cancer has spread.
If cancer is confirmed, staging is performed to determine how far the disease has progressed. This information plays a key role in guiding treatment decisions.
Types of Bladder Cancer
Staging Bladder Cancer
If you have been diagnosed with bladder cancer, your physician will need to determine whether the cancer has spread, and if so, how far. This process is known as staging.
Grades of Bladder Cancer
Cancer grading describes how similar cancer cells appear to healthy cells under a microscope. There are two grades of bladder cancer:
- Low grade: These cells resemble healthy tissue and may recur. Low-grade tumors may also be referred to as “differentiated.”
- High grade: These cells look very different from healthy tissue and are more likely to progress or recur. High-grade tumors are also referred to as “poorly differentiated.”
Urologic oncologists and surgeons use grade information when deciding on treatment and follow-up approaches.
Stages of Bladder Cancer
The TNM staging system is most commonly used for bladder cancer, where:
- T (Tumor): Size and extent of the primary tumor
- N (Node): Whether cancer has spread to the lymph nodes
- M (Metastases): Whether cancer has spread to other parts of the body
Bladder Cancer Staging Groups
Stages combine TNM findings to determine the stage of each person’s cancer. There are five stages: Stage 0 and Stages I through IV (1 through 4).
Stage 0
This stage is divided into papillary Carcinoma (Stage 0a) and carcinoma in Situ (Stage 0is), depending on the type of tumor:
- Stage 0a (papillary carcinoma): Abnormal cells are found in the tissue lining the inside of the bladder. These cells may appear as small, mushroom-like growths that have the potential to become cancerous and invade nearby normal tissue (Ta, N0, M0).
- Stage 0is (carcinoma in situ): A flat tumor on the tissue lining the inside of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder (Tis, N0, M0).
Stage I
Cancer has formed and spread to the layer of tissue under the inner lining of the bladder. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).
Stage II
Cancer has spread to either the inner half or outer half of the muscle wall of the bladder. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs (T2, N0, M0).
Stage III
Cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina). The cancer may also have spread to the regional lymph nodes.
- Stage IIIA: Tumor has grown into the perivesical tissue or has spread to the prostate, uterus, or vagina, but has not spread to the lymph nodes or other organs (T3a, T3b, or T4a; N0; M0)
OR
Cancer has spread to a single regional lymph node (T1 to T4a, N1, M0)
- Stage IIIB: The cancer has spread to two or more regional lymph nodes or to the common iliac lymph nodes (T1 to T4a, N2 or N3, M0).
Stage IV
Cancer has spread from the bladder to the wall of the abdomen or pelvis and may also have spread to one or more lymph nodes or to other parts of the body.
- Stage IVA: Tumor has spread to the pelvic wall or the abdominal wall but not to other parts of the body (T4b, any N, M0)
OR
The cancer has spread to lymph nodes located outside of the pelvis (any T, any N, M1a)
- Stage IVB: The cancer has spread to other parts of the body (any T, any N, M1b).
How is bladder cancer treated?
Treatment for bladder cancer is personalized based on the location and stage of the tumor, and the patient’s overall health. Many patients undergo surgery to remove the cancerous tissue, followed by additional therapy when needed. At SCRI Oncology Partners, we’re committed to offering a full range of the most advanced bladder cancer treatments.
Surgery
Common surgical procedures for bladder cancer include:
Transurethral Resection of Bladder Tumor (TURBT)
A urologic surgeon uses a cystoscope (a thin, lighted tube) to examine the bladder through the urethra. Small instruments are passed through the cystoscope to cut and remove the tumor.
Partial Cystectomy
This surgery involves removing part of the bladder. It may be performed for low-grade tumors confined to a specific area. Because only part of the bladder is removed, patients can typically urinate normally after recovery.
Radical Cystectomy
In this procedure, the entire bladder, affected lymph nodes, and adjacent organs are removed. For men, this may include the prostate and seminal vesicles; for women, it may involve the uterus, ovaries, and part of the vagina.
Urinary Diversion
When the bladder is removed, alternative urine storage methods are created. The surgeon may do this by directing urine to a pouch made from a portion of the colon, called an Indiana Pouch, that drains from a stoma placed at the navel. Alternatively, they can create an opening in the abdomen that connects to an external bag for collecting urine.
Radiation Therapy
External beam radiation therapy can be used after surgery to eradicate cancer cells and prevent the need for bladder removal surgery. It can also be an alternative to surgery for early-stage cancer or to target cells that have spread beyond the bladder.
Medical oncology therapies for bladder cancer
Chemotherapy, immunotherapy, and targeted therapy can be part of your bladder cancer treatment plan.
Intravesical therapy for early-stage bladder cancer
Intravesical therapy is used for non-invasive bladder cancer. Liquid chemotherapy or immunotherapy drugs are directly administered into the bladder via a urinary catheter.
Systemic chemotherapy
These drugs are administered through an IV or pill form to help shrink tumors before surgery or kill any remaining cancer cells after surgery. The choice of treatment depends on whether radiation is included in the treatment plan.
Immunotherapy for bladder cancer
Immunotherapy drugs use the body’s immune system to recognize and attack cancer cells, enabling the body to identify and destroy them like other foreign substances. This treatment can be given directly into the bladder or through an infusion.
Bladder cancer targeted therapy
Drugs have been developed to target specific genetic changes and inhibit cancer growth. Treatment with these targeted therapies will determine whether gene mutations associated with bladder cancer are present.
Antibody–drug conjugates (ADCs) are a type of targeted therapy used for some patients with bladder cancer, especially when it has advanced or returned after using other treatments. These drugs bind to specific markers on cancer cells, such as NECTIN-4 or HER2, and deliver the treatment directly into the cells.
Treatments by bladder cancer stage
The appropriate treatments for bladder cancer depend significantly on whether the cancer is muscle-invasive (MIBC) or non-muscle-invasive (NMIBC).
Stage 0 and I: Non-Muscle Invasive Bladder Cancer Treatments
- Low-risk NMIBC: Typically involves single, small, and low-grade tumors (Ta). Generally, no further treatment is required after their removal.
- Intermediate-risk NMIBC: Characterized by larger or multiple tumors, high-grade cancer, or infiltration into connective tissue. Requires intravesical therapy after Transurethral Resection of Bladder Tumor (TURBT).
- High-risk NMIBC: Involves multiple concerning features such as high-grade or invasive tumors. A second TURBT may be performed, followed by intravesical therapy with Bacillus Calmette-Guérin (BCG). If this is ineffective, options may include further intravesical therapy, immunotherapy, bladder removal, or radiation.
Stage II Bladder Cancer Treatments
Treatment typically begins with TURBT surgery to assess how deeply the cancer has penetrated the bladder wall. Options may include:
- Systemic immunotherapy and targeted therapy combinations prior to surgery or radiation
- Cystectomy (radical or partial) and possibly the removal of pelvic lymph nodes for testing
- Bladder-preserving trimodality with radiation for those who do not opt for radical cystectomy
Stage III Bladder Cancer Treatments
Stage III bladder cancer may have spread to the lymph nodes or nearby areas, requiring systemic treatment to target all cancer cells. Treatments can include:
- Systemic immunotherapy and targeted therapy combinations prior to surgery or radiation
- Cystectomy (radical) and possibly the removal of pelvic lymph nodes for testing
- Bladder-preserving trimodality with radiation for those who do not opt for radical cystectomy
Stage IV Bladder Cancer Treatments
Treatment for stage IV bladder cancer varies based on whether it has spread to distant parts of the body:
- Without distant spread: Options are similar to Stage III bladder cancer
- With distant spread: First-line treatments include combinations of immunotherapy and targeted therapies. SCRI Oncology Partners also makes it possible to access emerging therapies for metastatic bladder cancer through clinical trials. If you qualify to participate, our team will discuss this option with you.
Treatments for recurrent bladder cancer
The treatment approach for recurrent bladder cancer is tailored to the patient’s preferences, overall health, and the extent to which the cancer returned:
- Recurrence in the bladder may be treated with the prior therapies used
- Recurrence to the same area may require a cystectomy
- Metastasis requires immunotherapy, targeted therapy, chemotherapy
Bladder cancer clinical trials
Clinical trials test promising new treatments and can offer access to therapies that may improve outcomes. Through our partnership with the Sarah Cannon Research Institute, eligible patients at SCRI Oncology Partners may take part in leading-edge clinical research. If you are thinking about participating in a clinical trial, speak with a member of our healthcare team.
We’re here when you need us
If you were recently diagnosed or would like a second opinion, request an appointment with one of our experienced cancer doctors right here in Nashville.
We’re here when you need us
If you were recently diagnosed or would like a second opinion, request an appointment with one of our experienced cancer doctors right here in Nashville.
We’re here when you need us
If you were recently diagnosed or would like a second opinion, request an appointment with one of our experienced cancer doctors right here in Nashville.