Bladder cancer is caused by a number of different cell types, however, more than 98% of bladder cancers are due to one of three cell types: transitional cell, squamous cell or adenocarcinoma. Transitional cell tumors account for the vast majority (90%) of bladder cancers.

There are two degrees of bladder cancer, each of which differs from the other in prognosis and treatment. The division between the two is based on whether or not bladder muscle is involved by the cancer. For those transitional cell cancers, which do not invade the muscle of the bladder, local therapy is usually successful. However, about 20% of these cancers will eventually invade the muscle and therefore convert to the more severe degree. Patients with transitional cell cancers which involve the bladder muscle require a much more aggressive approach to treatment.

Non-muscle Invasive Bladder Cancer

The treatment of non-muscle invasive cancer at Massachusetts General Hospital initially requires biopsy and then diathermy or laser destruction of the remaining tumors. This treatment may be followed by installation of medication directly into the bladder, which is meant to destroy any residual cancer and prevent recurrences.

Muscle-invasive Bladder Cancer

Muscle-invasive bladder cancer may be treated in two ways. For selected patients, a Bladder Preservation Protocol is available. This involves non-incisional resection of the cancer, followed by radiation therapy and chemotherapy. In the properly selected patient, the disease is irradicated and the patient retains their bladder so that they are able to void normally.

The more conventional treatment for this disease is to remove the bladder. This requires a rerouting of the urine. The simplest method is to surgically create a conduit from the bowel and collect the urine in a bag on the abdomen. For selected individuals, a new bladder (neobladder) may be fashioned from bowel so that the patient does not need to wear a bag and can void normally. The latter procedure is performed by the Division of Reconstructive Surgery.