Bladder Cancer: What You Need to Know

With the launch of the new Abbhi Family Bladder Cancer Clinic, experts at Miami Cancer Institute, part of Baptist Health, are offering comprehensive and cutting-edge care and clinical trials to those affected by the disease. The Clinic will include the specialists who diagnose and treat bladder cancer, as well as a team that encompasses rehabilitation, psychological care, sexual health and survivorship ― in one convenient location.

Who gets bladder cancer?

More than 83,000 new cases of bladder cancer are expected to be diagnosed this year in the U.S., according to the American Cancer Society. Three times more men than women get bladder cancer, and while incidence among minority and underserved populations isn’t higher than in non-minority groups, Blacks, Hispanics and other minorities do have a higher rate of death.

Murugesan Manoharan, M.D., chief of urologic oncologic surgery at Miami Cancer Institute and Abbhi Family Endowed Chair in Urologic Oncology

“Unfortunately, minorities are at a higher risk of dying from the disease because many have problems accessing care and therefore are diagnosed when the cancer is more advanced,” said Murugesan Manoharan, M.D., Miami Cancer Institute’s chief of urologic oncologic surgery and Abbhi Family Endowed Chair in Urologic Oncology. 

The leading causes of bladder cancer are smoking and environmental exposure in industries that include dyes and petroleum, both higher in men than in women. 

When bladder cancer is caught early, prognosis is very good, Dr. Manoharan said. However, with no screening test for bladder cancer, it’s important for people to be aware of the signs and not delay making an appointment with their doctor if they notice anything unusual or different for them.

Bladder cancer warning signs

“The most common symptom is blood in the urine,” Dr. Manoharan said. “Sometimes that is found through a standard urine test that is done in the doctor’s office. Other times, it is visible in the urine. If you notice blood in your urine, don’t postpone going to your doctor.”

Less common symptoms may include:

·      Changes in urination, such as more frequent urination or pain/burning when urinating

·      A weak urine stream

·      A feeling of urgency

·      If the cancer is more advanced, patients may experience a loss of appetite and weight loss, fatigue or lower one-sided back pain.

Advances in diagnosis and treatment

In recent years, advances in the diagnosis and treatment of bladder cancer are proving to extend and improve quality of life. As physician-investigators better understand the biological and genetic make-up of tumors, they are better able to personalize care.

For diagnosis, blue light cystoscopy helps detect tumors when they are smaller compared with standard cystoscopy with white light. “We can pick up cancer very early with blue light, cancers we might miss with the white light,” Dr. Manoharan said. “And the key to good outcomes is early detection and patient compliance. There is a window of opportunity to cure the disease.”

Surgery is used to remove some tumors, and many times can be performed using robotic-assisted techniques and other minimally invasive techniques. Recently, physicians at the Institute began using a new single-incision robotic-assisted surgery that will soon be available for some bladder cancer patients. 

Specially trained ostomy nurses help patients who require an ostomy bag outside of the body to collect their urine better understand how to swim, bicycle and live an active life with their ostomy.

Immunotherapy is proving extremely valuable, particularly to stop the recurrence of bladder cancer. BCG, or Bacillus Calmette-Guérin, was the first-ever immunotherapy approved for cancer. BCG and checkpoint inhibitors such as pembrolizumab, atezolizumab and nivolumab work by creating an immune response that essentially tells a patient’s immune system to attack any remaining cancer cells in the bladder.

Miami Cancer Institute takes leadership role

The Institute has been involved in a number of bladder cancer clinical trials, some studying combinations of chemotherapy, immunotherapy and radiation therapy. One trial, NCT04919512, is currently enrolling patients at Miami Cancer Institute and has Dr. Manoharan particularly excited.

“A Study of TAR-200 in Combination with Cetrelimab and Cetrelimab Alone in Participants With Muscle-Invasive Urothelial Carcinoma of the Bladder (SunRISe-4)” uses a combination of chemotherapy and immunotherapy to kill microscopic cells prior to the surgical removal of the bladder. “These studies are leading to better outcomes for patients,” he said.

Dr. Manoharan, who pioneered reconstructing a new bladder with tissue from the intestines, is also developing a research unit dedicated to bladder cancer. One initiative involves using AI to better predict patient outcomes using different treatment scenarios.

He also spearheaded the creation of the Global Bladder Cancer Consortium (GBCC), with physician experts from the U.S. joining those from Japan, Australia, Canada, the U.K., Malaysia, India and New Zealand. “By collaborating with others around the world, we are able to share our information, grow research participation and streamline data collection,” Dr. Manoharan explained.

While removing the bladder is a significant surgery, today’s newer techniques result in fewer complications, less blood loss and better outcomes. “In the past, we didn’t often operate on patients older than 80 for bladder cancer, but patients are much more fit now. I had a patient recently who had surgery at 99. He did very well after his surgery.”