Bladder Cancer - Diagnosis and Treatment

Diagnosis

Ways Doctors Detect Bladder Cancer

Doctors use several tests to find out if cancer may be in the bladder. People usually visit a doctor because of symptoms like blood in the urine, frequent urination, urgent urination, pain, or discomfort during urination.

Some people have risk factors such as older age, cigarette smoking, certain chemical exposures, or chronic bladder irritation from repeated infections.

Common Diagnostic Tests:

Test Name	What It Does
Cystoscopy	Looks at the inside of the bladder using a small camera.
Biopsy (TURBT)	Removes tissue sample to check for cancer cells.
Urine cytology	Searches urine for abnormal or cancer cells.
Imaging (CT, MRI, X-ray)	Checks bladder and nearby organs for signs of cancer.
Renal ultrasonography	Looks at kidneys and bladder with sound waves.

Cystoscopy

Doctors often start with a test called cystoscopy. In this test, a thin tube with a light and camera (cystoscope) goes through the urethra into the bladder. This lets the doctor see any lumps, tumors, or unusual patches. Doctors can perform cystoscopy in a clinic or hospital.

Reasons cystoscopy is important:

Doctors can directly view the bladder’s surface.
They can spot flat or small tumors like carcinoma in situ.
Cystoscopy helps guide where to take a biopsy.

Transurethral Resection of Bladder Tumor (TURBT) and Biopsy

If the doctor sees an abnormal area during cystoscopy, they may remove a sample for microscopic examination. This is called a biopsy. Doctors usually perform a transurethral resection of bladder tumor (TURBT) to collect tissue. They use special tools placed through the cystoscope.

Cystoscopy with TURBT:

Doctors use TURBT to diagnose and remove early tumors.
A pathologist examines the sample to identify the type of cancer cells and how aggressive they are.

Examining Urine for Cancer Cells

Doctors may use urine cytology to search for cancer cells in a urine sample. A pathologist looks for abnormal cells under a microscope.

This test can help spot cancers that cystoscopy may miss, including carcinoma in situ. Doctors often use it along with other tests. Urinalysis may also be done to check for blood or infection in the urine.

Imaging Tests

Imaging tests like CT urography provide detailed pictures of the bladder, kidneys, and urine pathways. Healthcare teams may use CT scans, MRI, X-rays, renal ultrasonography, or retrograde pyelogram.

For a CT urogram, doctors inject a dye and take X-rays as the dye moves through the urinary tract. This makes it easier to see blockages, tumors, or disease spread. Imaging tests help doctors find out if tumors have spread beyond the bladder.

Additional Screening Tools

In some cases, doctors use other tests:

Bladder wash cytology (examines fluid rinsed from the bladder for cancer cells),
Magnetic resonance urography (a detailed MRI scan of the urinary system).

Routine screening for bladder cancer is not recommended for people without symptoms. Most cases are found when symptoms appear.

Finding Out How Much Bladder Cancer Has Spread

After finding cancer, doctors order more tests to see how much it has grown or spread. This process is called staging. The stage helps doctors choose the best treatment plan. Doctors use a combination of tests, images, and sometimes surgery to collect this information.

Tools to Determine Cancer’s Spread

Test or Procedure	Purpose
CT Scan	Shows detailed images to check local spread or lymph nodes.
MRI Scan	Gives images of soft tissues and nearby organs.
PET Scan	Highlights areas of high cell activity linked to cancer spread.
Bone Scan	Checks if cancer has reached the bones.
Chest X-ray	Looks for spread to the lungs or chest.

Each test focuses on different areas because bladder cancer can spread to nearby tissues, regional lymph nodes, or distant organs like the lungs, liver, or bones.

Muscular Involvement and Metastasis

When bladder cancer grows into the muscle layer, doctors call it muscle-invasive bladder cancer (MIBC). This type often requires more complex treatments, such as bladder removal and chemotherapy.

If tests show the cancer has spread to other parts of the body, doctors call it metastatic bladder cancer. PET scans and bone scans help check for metastases. Non-muscle invasive bladder cancer means the tumor is only on the surface layers and has not entered deep tissue.

Staging Terms to Know

Carcinoma in Situ: A flat, high-grade tumor on the surface.
Non-Muscle-Invasive: Tumors that do not reach bladder muscle.
Muscle-Invasive: Tumor grows into the deeper muscle wall.
Advanced Cancer: Has spread to organs beyond the bladder or lymph nodes.
Metastatic Disease: Cancer has spread to distant organs, like the lungs or bones.

How Bladder Cancer Cells Are Rated

The pathology team examines cancer cells under a microscope to decide their grade. The grade shows how closely the cancer cells look like normal cells and how quickly they may grow and spread.

Tumor Grading System

Most bladder cancers are classified as either low grade or high grade.

Grade	Description
Low grade	Cells look somewhat like normal bladder cells; tumors usually grow slowly.
High grade	Cells look very abnormal; grow faster, more likely to spread or recur.

High-grade tumors are more likely to become invasive and return after treatment. Carcinoma in situ is always high grade, even if it does not invade muscle.

Why Grade Matters

High-grade cancers often need more aggressive treatments such as immunotherapy, surgery, or chemotherapy.
Higher grade tumors are more likely to come back or spread than low-grade cancers.
Doctors schedule more frequent checkups for high-grade cancers.

Types of Bladder Cancer

Most adults have urothelial carcinoma, the most common type of bladder cancer. Other types include:

Squamous Cell Carcinoma: Linked to chronic irritation such as infections or stones.
Adenocarcinoma: A rare type that starts from glandular cells.
Small Cell Carcinoma: Uncommon and usually aggressive.

High-grade tumors can occur in any of these types. Urothelial carcinoma may have different variants, such as plasmacytoid or micropapillary forms, which tend to behave more aggressively.

Treatment

Surgical Procedures for Bladder Tumors

Doctors often use surgery to manage bladder cancer. Their main goal is to remove as much cancer as possible and preserve bladder function when possible.

Transurethral Resection (TURBT)

Surgeons commonly perform TURBT to diagnose and remove tumors limited to the bladder’s inner lining.
The surgeon inserts a narrow instrument with a wire loop through the urethra to shave, burn, or vaporize tumors inside the bladder without external cuts.

Sometimes, doctors give chemotherapy medicine directly into the bladder after TURBT to lower the risk of cancer returning.

Cystectomy Options

For muscle-invasive cancer, surgeons may remove part (partial cystectomy) or all of the bladder (radical cystectomy).
In a radical cystectomy, the surgeon removes the bladder and nearby lymph nodes, and sometimes nearby organs.
Surgeons can perform radical cystectomy with traditional open surgery or robotic-assisted methods using small incisions.

Urinary Diversion Techniques

After bladder removal, surgeons create a new way for urine to leave the body.

Neobladder: Surgeons use a piece of intestine to create a new bladder, connecting it to the urethra. Some people may need to use a catheter.
Ileal Conduit: A piece of intestine becomes a tube that connects the ureters to an opening on the belly, draining urine into an external bag.
Continent Urinary Reservoir: Surgeons create an internal pouch from intestine, which must be drained with a catheter several times a day.

Surgery Type	Purpose	How Urine Exits Body
TURBT	Eliminate superficial tumors.	Normal urination.
Partial Cystectomy	Remove part of the bladder.	Normal urination, if possible.
Radical Cystectomy	Eliminate all bladder nodes.	Requires urinary diversion.
Neobladder	Create a new internal bladder.	Through the urethra and may need a catheter.
Ileal Conduit	External urine collection.	Through an abdominal stoma to a bag.
Continent Reservoir	Internal pouch and catheter required.	Catheter through stoma.

Cancer Cell-Killing Medications (Chemotherapy)

Chemotherapy uses drugs to destroy cancer cells. Doctors use it at different times and in different ways depending on the stage of bladder cancer.

Methods of Administration

Intravesical Chemotherapy: Doctors place the medicine directly into the bladder to treat early cancers. The medicine stays in the bladder for a set time before being drained.
Intravenous (Systemic) Chemotherapy: Doctors give the drugs through a vein so they reach cancer cells throughout the body. This is often used before bladder removal (neoadjuvant chemotherapy) to shrink tumors or after surgery (adjuvant chemotherapy) to lower recurrence risks. When cancer has spread, doctors use systemic chemotherapy as the main treatment.

When Chemo Is Used with Other Treatments

Doctors may combine chemotherapy with radiation therapy, especially when trying to preserve the bladder.

Key Points

Chemotherapy drugs can cause side effects, so the healthcare team monitors patients closely during and after treatment.
Some patients cannot receive certain drugs, such as cisplatin, due to other health conditions.

High-Energy Treatment (Radiation)

Radiation treatment uses strong energy beams, such as X-rays or protons, to kill cancer cells or shrink tumors.

Doctors often choose radiation for people who cannot have surgery or want to avoid it. Sometimes, doctors combine radiation with chemotherapy to make cancer cells more sensitive to the energy.

A machine outside the body directs radiation at the tumor from different angles. Patients usually receive sessions several times a week for several weeks, depending on the cancer’s size and location.

A radiation oncologist leads the radiation therapy and works with the rest of the treatment team. Radiation can cause burning, fatigue, bladder irritation, or bowel changes. The oncology team explains these effects and helps manage them.

Treatments that Boost the Immune System (Immunotherapy)

Immunotherapy helps the body’s own immune system fight cancer more effectively.

Intravesical Immunotherapy: Doctors often use this for early-stage, non-muscle-invasive bladder cancer. The most common treatment is Bacillus Calmette-Guérin (BCG), which they place directly into the bladder through a catheter after TURBT. BCG triggers the immune system to attack cancer cells in the bladder lining.
Systemic Immunotherapy: Doctors give this treatment through a vein for advanced cancer or cancer that returns. These drugs help the immune system find and attack cancer cells throughout the body.

Immunotherapy can help avoid or delay more invasive treatments in early cancer. It may also help control or shrink advanced cancers.

Medications that Target Cancer Cells (Targeted Therapy)

Targeted therapy blocks specific molecules in cancer cells that help them grow or spread. Doctors sometimes test a person’s cancer cells for certain mutations or markers to see if targeted drugs will help.

These treatments are especially useful when other therapies are not working, particularly in advanced bladder cancer. Some targeted drugs block signals that tumor cells use to grow.

Others stop new blood vessels from forming, which the tumor needs. Patients usually take these drugs as pills or receive them by IV infusion.

Side effects can differ from traditional chemotherapy and may include high blood pressure, skin problems, or fatigue. The medical oncology team decides if and when targeted therapy is appropriate, based on test results.

Keeping the Bladder When Possible (Bladder Preservation)

Some people with muscle-invasive bladder cancer want to avoid removing their bladder. A combination of treatments can sometimes make this possible. Doctors call this approach bladder-sparing or bladder preservation therapy.

Trimodality Therapy: This includes three main parts:
1. TURBT to remove as much of the tumor as possible.
2. Chemotherapy to kill remaining cancer cells.
3. Radiation to target any leftovers.

This combination works best for select patients with limited cancer, a healthy bladder, and a strong desire to avoid surgery. Doctors may recommend radical cystectomy if cancer remains or returns.

Follow-Up Care and Long-Term Monitoring

Ongoing follow-up is important for people who have received bladder cancer treatment. Bladder cancer can come back, even years after treatment.

Doctors usually recommend regular cystoscopy every 3 to 6 months in the first few years. Imaging tests and urine tests may also help check for hidden or returning cancer. Surveillance plans can change based on the type and stage of the original cancer and past treatments.

Patients may need support for changes in urinary or sexual function after treatments like cystectomy. The care team helps manage side effects, bladder health, and emotional challenges.

Managing Emotional and Practical Needs

Coping with bladder cancer brings mental and physical changes. Many people feel uncertain about the future or worry that the cancer may return. Managing these feelings is important for daily life and well-being.

Tips for Self-Care and Support

Attend Follow-Up Visits: Keeping up with follow-up tests and appointments helps track recovery. A regular schedule with a healthcare provider allows quick action if any issues arise.
Care for the Body: Eating nutritious foods like fruits, vegetables, and whole grains can boost energy. Exercise, such as walking, swimming, or cycling, for at least 30 minutes on most days can reduce anxiety and improve strength. Getting enough sleep can lower stress and help the body heal.
Connect with Others: Talking to people who have also faced bladder cancer can provide comfort and advice. Support groups let people share tips and discuss their feelings.

Side Effect	Ways to Manage
Fatigue	Rest often, get help with tasks
Anxiety	Use relaxation methods, talk to others
Appetite Loss	Eat small, healthy meals regularly

Building a support network of family, friends, healthcare providers, and survivor groups helps provide emotional and practical support.

Getting Ready for Your Medical Visit

Steps to Take Before Your Visit

Preparation can make your medical appointment smoother and more effective. Here are key actions to consider before seeing your healthcare provider:

Check for any special instructions. When you set up your visit, ask the clinic if you need to make any changes to your usual routine. Some tests might require you to avoid certain foods or drinks.
Take note of your symptoms. Write down all your symptoms, even if some do not seem related to your bladder or urinary tract.
Record important life details. List major events or stresses that may affect your health. This information can help your doctor understand your situation.
List all medications and supplements. Include prescription drugs, over-the-counter medicines, vitamins, and herbal supplements, along with the amounts you take.
Bring support if possible. A trusted family member or friend can help remember details and take notes during the appointment.
Create a list of questions. Preparing questions in advance helps you get the information you need.

Questions you may want to ask at your appointment:

Suggested Question	Purpose
Could my symptoms be caused by something other than cancer?	Understand other possible causes.
What type of tests are needed?	Know what to expect next.
Which treatments are available for me?	Explore all treatment options.
What side effects might occur with treatment?	Prepare for possible risks.
Is there a treatment you recommend most for my situation?	Learn about the best options.
Should I see a specialist?	Decide if a referral is needed.
Are there resources or brochures I can take home?	Find helpful materials.
Is a follow-up visit necessary, and how will that be decided?	Plan choices.
Will my medicines have generic alternatives?	Discuss cost-saving choices.
What will be the cost of seeing a specialist?	Understand financial impact.

Add any new questions that come to mind during your appointment.

How Your Doctor Will Likely Respond

During the visit, your doctor will probably ask several questions to better understand your condition. If you are ready to answer these questions, you can save time for more important discussions. Some common questions include:

When did your symptoms start?
Do your symptoms come and go, or are they constant?
How strong or severe are your symptoms?
Does anything make the symptoms better?
Are there specific things that seem to make your symptoms worse?

Tip: Give honest and detailed answers. This will help your doctor make a more accurate diagnosis and choose the best treatment.

Bladder Cancer – Diagnosis and Treatment