Bladder Cancer Diagnosis and Treatment

Diagnosing Bladder Cancer

Bladder cancer diagnosis will involve one or more of the tests listed below depending on your unique status. Your doctor will consult with you to determine which of the following methods is appropriate for your situation.

  • Imaging tests: A variety of tests such as IVP (intravenous pyelogram), CT scans, MRI scans, ultrasound, and bone scans may be done to give the doctor more information about the cancer and whether it has spread (metastasized) beyond the bladder.
  • Urine cytology: In this test, urine from the bladder is sent to the lab to see if cancer cells (or pre-cancer cells) are present.
  • Urine culture: A sample of your urine is sent to the lab to see if you might have an infection. Infections can sometimes cause symptoms like those of bladder cancer.
  • Cystoscopy: If bladder cancer is suspected, a urologist may perform a cystoscopy, in which a tiny lighted tube called a cystoscope is inserted into the urethra in order to examine the bladder. If necessary, a biopsy may be performed at the same time (under anesthesia). 

The main types of treatment for bladder cancer are surgery, radiation therapy, chemotherapy, and immunotherapy. Based on the stage of your cancer, your doctor may recommend one or more of these.

Surgery for Bladder Cancer

There are several kinds of surgery for bladder cancer, depending on how invasive the cancer is or how much it has spread.

Transurethral: This minimally invasive surgery is done through a slender scope placed into the bladder through the urethra. This operation is often the initial treatment for bladder cancer, and it may be adequate treatment for early stage bladder cancer.

Cystectomy: This surgery is used only for more advanced cancers, when the tumor has invaded into the deeper layers of the bladder. When only part of the bladder is removed, it is called a partial cystectomy. If the entire bladder is removed it is a radical cystectomy (nearby lymph nodes are also removed). In men, the prostate is removed as well. In women, if the entire bladder is taken out, the uterus, ovaries, fallopian tubes, and a small part of the vagina are usually removed as well. Historically, this surgery has been performed via an inicision in the patient’s abdomen.  Now, Emory has fellowship-trained urologistis who specialize in robotic surgery to remove the patient’s bladder, so that the patient recovers quicker with less blood loss and pain.

Radiation Therapy for Bladder Cancer

Radiation is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. After surgery, radiation can kill small deposits of cancer cells that may not be seen during surgery.

After transurethral surgery, a combination of radiation therapy and chemotherapy is sometimes able to completely destroy cancers that would otherwise require cystectomy. If the tumor is in a position that makes surgery difficult, radiation may be used to shrink the tumor, making surgery easier. Radiation might also be used to ease the symptoms of advanced cancer or limit bleeding from inoperable tumors.

Chemotherapy for Bladder Cancer

Chemotherapy for bladder cancer can be administered intravesically (directly into the bladder) or systemically (injected into a vein or given by mouth).

Chemotherapy placed directly into the bladder (intravesical) only reaches cancer cells near the bladder lining rather than those in other organs or deep in the bladder wall. This treatment is used only for early-stage (superficial) bladder cancer. One of the main advantages of this method of chemotherapy is that the drug doesn't usually spread throughout the body. This means that there are fewer unwanted side effects, but there can be local bladder irritation.

In systemic chemotherapy, the drugs travel through the bloodstream to all parts of the body. In this treatment, the drugs can attack cancer cells that have already spread beyond the bladder to lymph nodes and other organs. While chemotherapy drugs kill cancer cells, they also damage some normal cells and this can lead to side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment.

Immunotherapy for Bladder Cancer

This type of treatment is sometimes used for early or low stage bladder cancer that has high risk for returning (recurrence) or becoming more advanced disease (progression). A weakened bacterium called BCG is placed directly into the bladder. Immune system cells are attracted and activated by BCG, which in turn affects the bladder cancer cells. Treatments are given weekly for six weeks, and may be repeated or used as preventative therapy (maintenance) using three weekly treatments every six months for a few years. Sometimes, a reduced dose of BCG is used with another immune-active agent called interferon, which causes fewer side effects, but maintains effectiveness against tumors that may not have responded to BCG alone.

The Emory Department of Urology is affiliated with The Winship Cancer Institute of Emory University, Georgia's only National Cancer Institute-Designated Cancer Center and serves as the coordinating center for cancer research and care throughout the Emory University system. With NCI Designation Winship joins an elite group of 65 cancer centers in the United States to have earned this coveted status.

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