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How Is Bladder Cancer Diagnosed And Treated

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Diagnosis Of Bladder Cancer

Bladder Cancer: Basics of Diagnosis, Workup, Pathology, and Treatment

Diagnosis is the process of finding out the cause of a health problem. Diagnosing bladder cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bladder cancer or other health problems.

The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as bladder cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bladder cancer.

The following tests are usually used to rule out or diagnose bladder cancer. Many of the same tests used to diagnose cancer are used to find out how far the cancer has spread . Your doctor may also order other tests to check your general health and to help plan your treatment.

Surgery For Bladder Cancer

Surgery is done for most bladder cancers. The type you have depends on the stage of the cancer.

Removing the tumor from the inside bladder is the most common surgery for early bladder cancer. This can be done during a cystoscopy. A a cystoscope with a looped wire on the end is used to remove the tumor.

When the cancer is more invasive, the cancer is removed along with part of the bladder or the entire bladder.

If only part of the bladder is removed, you’ll still be able to hold and release urine as normal, though in smaller amounts. If the entire bladder is removed, you’ll need another way to store and pass urine. Your doctor can explain the options for this.

Side effects of surgery

Any type of surgery can have some risks and side effects. For instance, removing the bladder not only changes how your body passes urine, but it can also cause sexual side effects. If you have these or any other problems, let your doctors know. There are ways to help deal with many side effects.

Transurethral Resection Of Bladder Tumor

If an abnormal area is seen during a cystoscopy, it needs to be biopsied to see if it’s cancer. A biopsy is when tiny pieces of the abnormal-looking tissue are taken out and tested for cancer cells. If bladder cancer is suspected, a biopsy is needed to be sure of the diagnosis.

The procedure used to biopsy an abnormal area is a transurethral resection of bladder tumor , also known as just a transurethral resection . During this procedure, the doctor removes the tumor and some of the bladder muscle around the tumor. The removed samples are then sent to a lab to look for cancer. If cancer is found, testing can also show if it has invaded the muscle layer of the bladder wall. For more on how this procedure is done, see Bladder Cancer Surgery.

Bladder cancer can sometimes start in more than one area of the bladder . Because of this, the doctor may take samples from many different parts of the bladder, especially if cancer is strongly suspected but no tumor can be seen. Salt water washings of the inside the bladder may also be collected and tested for cancer cells.

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Changes In Bladder Habits Or Symptoms Of Irritation

Bladder cancer can sometimes cause changes in urination, such as:

  • Having to urinate more often than usual
  • Pain or burning during urination
  • Feeling as if you need to go right away, even when your bladder isn’t full
  • Having trouble urinating or having a weak urine stream
  • Having to get up to urinate many times during the night

These symptoms are more likely to be caused by a urinary tract infection , bladder stones, an overactive bladder, or an enlarged prostate . Still, its important to have them checked by a doctor so that the cause can be found and treated, if needed.

Tests That May Be Done

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Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.

Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .

Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.

Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.

Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.

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Questions To Ask The Doctor

  • What treatment do you think is best for me?
  • Whats the goal of this treatment? Do you think it could cure the cancer?
  • Will treatment include surgery? If so, who will do the surgery?
  • What will the surgery be like?
  • How will I pee after surgery?
  • Will I have other types of treatment, too?
  • Whats the goal of these treatments?
  • What side effects could I have from these treatments?
  • Is there a clinical trial that might be right for me?
  • What about treatments like special vitamins or diets that friends tell me about? How will I know if they are safe?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • Whats the next step?

What Questions Should I Ask My Doctor

Bladder cancer is relatively rare, so you may not know as much as youd like about the condition. Here are some questions that may be helpful:

  • What stage of bladder cancer do I have?
  • What are possible treatments?
  • What are treatment side effects?
  • Will I need surgery?
  • How will surgery affect my daily life?
  • How often does bladder cancer come back?
  • How do you treat recurrent bladder cancer?
  • Are there any cutting-edge clinical trials available?

A note from Cleveland Clinic

If you have bladder cancer, it may help to know about half of all people with the condition receive treatment when their tumors are limited to the inner layer of their bladder wall. For them, surgery to remove tumors means theyre cancer-free. But bladder cancer often comes back . If youre worried about recurring cancer, talk to your healthcare provider. Theyre your best resource for information on risk factors that increase the chance youll have another bout of bladder cancer. Theyll help you stay vigilant about symptoms that may be signs of recurring bladder cancer and be there for you if you need more bladder cancer treatment.

Last reviewed by a Cleveland Clinic medical professional on 08/26/2022.


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Understanding The Statistics: Cancer Survival

It is important to remember that all cancer survival numbers are based on averages across huge numbers of people. These numbers cannot predict what will happen in your individual case.

Survival rates will not tell you how long you will live after you have been diagnosed with bladder cancer. But, these numbers can give you an idea of how likely your treatment will be successful. Also, survival rates take into account your age at diagnosis but not whether you have other health conditions too.

Treating Stage 0 Bladder Cancer

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Stage 0 bladder cancer includes non-invasive papillary carcinoma and flat non-invasive carcinoma . In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded the bladder wall.

This early stage of bladder cancer is most often treated with transurethral resection with fulguration followed by intravesical therapy within 24 hours.

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Connect With Other Patients

When Atlanta resident Brittany Tellekamp, 32, was first diagnosed with cancer, there was debate among her doctors about what type it might be. At the time, she was 28and the average age for bladder-cancer diagnosis is 73. About 90% of those diagnosed with the condition are over age 55. In addition to being younger than most patients, Tellekamp didnt have any of the top risk factors associated with bladder cancer, such as smoking or regular exposure to chemicals like paint or solvents.

When doctors finally settled on a diagnosis, the news was worse than she feared: metastatic, stage IV bladder cancer. One doctor told Tellekamps husband and mother that it was doubtful shed make it to her next birthday, which was three months away. Thanks to immunotherapy, she sailed past that birthday and a couple more since then, but she feels like shes in extra innings now.

The confusion, terror, and dramatic news in those first few monthspaired with frustrating insurance issuesled Tellekamp to start a blog, even though she didnt think anyone would read it.

It felt like screaming into the void, she recalls. But it was very cathartic from the start. Also, I thought maybe there would be a chance Id find other young people with bladder cancer, which tends not to be the case in support groups. Not only did she find those connections, but she extended her outreach onto social media and began contributing to a group chat of people with metastatic cancer.

Treating Bladder Cancer That Progresses Or Recurs

If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patient’s overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.

For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.

Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.

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Is Bladder Cancer A Fatal Illness

Left untreated, bladder cancer may spread to other parts of your body. Cancer thats metastasized, or spread, may affect how long youll live with bladder cancer. Like many types of cancer, early detection and treatment increase the chance of living longer with bladder cancer. According to the National Cancer Institute, 96% of people who received treatment for early-stage cancer were alive five years after diagnosis. Overall, 77% of people with bladder cancer were alive five years after diagnosis.

Radiation Therapy For Bladder Cancer

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Radiation therapy uses high energy radiation to kill cancer cells or slow their growth. In bladder cancer, this type of treatment is given as external-beam radiation, which uses a machine to carefully direct the radiation at the cancer.

Radiation therapy may be used after surgery to remove any remaining cancer cells. Its also a potential option for people who cant have surgery or chemotherapy. Lastly, it may be used as a part of treatment for advanced bladder cancer.

Chemotherapy uses drugs that affect the growth and division of cells. Because cancer cells grow and divide more quickly than many other types of cells, chemotherapy can kill them or reduce their growth.

There are two types of chemotherapy for bladder cancer:

  • Intravesical:Intravesical chemotherapy is given directly into the bladder via a catheter. Its used for very early stage bladder cancers, typically after transurethral resection.
  • Systemic: Systemic chemotherapy for bladder cancer is given via IV. It may be used before surgery to help shrink a tumor or after surgery to get rid of any remaining cancer cells. Systemic chemotherapy is also used for advanced bladder cancers.

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Targeted Therapy For Bladder Cancer

Targeted therapy is a type of treatment thats directed specifically at different markers associated with cancer cells. While some treatments, such as chemotherapy, have broad effects, this treatment hones in on cancer cells.

Monoclonal antibodies, such as those discussed above, are a type of targeted therapy. Another type of targeted therapy drug for bladder cancer is called erdafitinib , which blocks an enzyme that helps bladder cancer cells grow.

Targeted therapy is used for more advanced bladder cancers. It may also be recommended when bladder cancer has recurred.

Doctors and scientists continue to develop newer, more effective treatments for bladder cancer. These can include things like newer combinations of existing therapies or completely new treatments. Lets look at a few examples.

About 25% to 45% of people dont respond to BCG. As such, researchers are working on ways to improve BCG treatment. One 2022 trial looked at combining BCG with an immune-stimulating drug called N-803 in people who didnt respond to BCG.

At a 2-year follow-up this treatment led to a 99% bladder cancer-specific overall survival. Additionally, over 90% of participants avoided having a cystectomy in this time period.

Another 2022 trial looked at using chemotherapy after transurethral resection instead of BCG. Researchers explored this option due to a BCG shortage that was present even before the COVID-19 pandemic.

The overall outlook for bladder cancer depends on many factors, such as:

Differences In Bladder Cancer Diagnosis In Women

Even though men are more likely to develop bladder cancer, women usually have a much worse prognosis at the time of diagnosis. Scientists are not exactly sure why women are usually diagnosed after the cancer has progressed. Some possible reasons include:1,2

  • Hormones Estrogen, one of the 2 main sex hormones in women, might play a role. At first, it might help protect against bladder cancer, but later, it can quicken the tumor’s growth.2
  • Confusion about symptoms Many symptoms of bladder cancer are similar to those of bladder infections. This includes blood in the urine, pain while urinating, increased urination frequency, and urinating at night.
  • Ignoring blood in the urine Blood in the urine can occur during menstruation or menopause. However, this is often the first sign of bladder cancer, yet women may not be alarmed enough to see a doctor.
  • Lack of awareness Many people still think of bladder cancer as an older man’s disease. The average age at diagnosis in men is 73. This lack of awareness may lead women to dismiss their symptoms and concerns.

However, if bladder cancer is present, not seeing a doctor gives the tumor time to continue growing. You should see a doctor if you have blood in the urine that does not go away within a few days. Bladder cancer can affect women of any age and is usually treatable when caught early.3,4

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Medical History And Physical Exam

Your doctor will want to get your medical history to learn more about your symptoms. The doctor might also ask about possible risk factors and your family history.

A physical exam can provide information about possible signs of bladder cancer and other health problems. The doctor might do a digital rectal exam , during which a gloved, lubricated finger is put into your rectum. If you are a woman, the doctor might do a pelvic exam as well. During these exams, the doctor can sometimes feel a bladder tumor, determine its size, and feel if and how far it has spread.

If the doctor finds things that aren’t normal, you may to have lab tests done and you might be referred to a urologist for further tests and treatment.

Blood In Urine May Be Interpreted Differently In Men Vs Women

Bladder Cancer: What to Know If Youâve Just Been Diagnosed

While the symptoms may be similar for both genders, how they are interpreted can be different. In women, blood in the urine may be overlooked as a possible sign of bladder cancer, since it has a far less serious explanation for most people. Blood in the urine may be assumed to be a urinary tract infection or confused with postmenopausal uterine bleeding.

Symptoms of bladder cancer can be very similar to those of urinary tract infections, which are common in women, says Memorial Sloan Kettering Cancer Center medical oncologist and genitourinary cancer specialist Emily Feld. If blood in the urine is being attributed to a urinary tract infection, it is important to check a urine culture to confirm you actually have an infection. If the culture is negative and/or your symptoms persist despite treatment with antibiotics, you should have a urologist evaluate you. Hematuria, even when it is painless, is not something to ignore.

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