Understanding Bladder Cancer - Treatment

How Do I Know If I Have It?

After your doctor completes a thorough medical history and examination, he or she will probably send you to a urologist, a surgeon who has special training in managing diseases of the bladder.

The first test he or she will probably perform is cystoscopy. The bladder can be viewed through a fiber-optic lighted tube known as a cystoscope. The urologist will pass the cystoscope through the urethra into the bladder. If the doctor sees anything unusual, like a tumor, a tiny tissue sample is taken through the tube and examined in the laboratory (biopsy). Should the tumor be malignant, the treatment will depend on how far, if at all, the cancer has spread.

Blood and urine studies (to look for cancer cells and infection)and imaging studies with X-rays, CT, ultrasound, and MRI of the bladder, ureters, kidneys, and other organs provide information about tumor size, location, and the degree or amount of spread to other parts of the body.

What Are the Treatments?

Treatment depends on the stage of the cancer, a measure of how widespread the bladder cancer might be.

Stage 0 or carcinoma in situ. This is early bladder cancer that just affects the inner lining of the bladder.

Stage I. Here, the cancer has spread deeper into the lining of the bladder but doesn't affect the muscle wall of the bladder.

Stage II. The cancer affects the inside part of the muscles of the bladder.

Stage III. The bladder cancer has spread through the muscle wall of the bladder and may be affecting the tissue that surrounds the bladder or the reproductive organs.

Stage IV. The bladder cancer has spread to the abdomen or to the lymph nodes in the body.

Recurrent Bladder Cancer. This means that the cancer has come back after treatment.

If detected early, superficial malignancies can usually be treated successfully by transurethral resection (TUR). In this procedure, the surgeon inserts a small tube into the bladder through the urethra and removes the tumor surgically or burns it out with heat or a laser beam. Combined with chemotherapy or radiation therapy, TUR may also be successful against more invasive bladder cancer. Using this approach, the abdomen isn't cut. The side effects are usually mild and short-lived and include bleeding and mild pain. You'll be able to go home within a day of the procedure.

Immunotherapy with the bacillus Calmette-Guerin (BCG) vaccine is beneficial in 60% of cases. Injecting BCG into the bladder after the tumor has been removed significantly reduces the chance of cancer recurrence. Immunotherapy is a form of treatment whereby the body's own natural defenses (the immune system) are revved up to attack the cancer.

BCG is often placed directly into the bladder via a catheter. This is called intravesical therapy.