Diagnosis and Treatment of
If a patient has symptoms that
suggest bladder cancer, the doctor may check general signs of
health and may order lab tests. The following procedures are
used for diagnosis:
Physical examination of patient
Intravenous pyelogram (IVP) - A
contrast agent is injected in blood and bladder x-rays taken.
Cystoscopy - lighted tube (cystoscope)
is used to look directly into the bladder. Done under
Biopsy - The doctor can remove
samples of tissue with the cystoscope. The removal of tissue
to look for cancer cells is called a biopsy. A pathologist
then examines the tissue to confirm or the presence or
absence of cancer.
Other tests like CT scan,
magnetic resonance imaging (MRI), sonogram, bone scan, or
chest x-ray are usually used later to stage the tumor.
Treatment- The doctors
decide depending on the stage of cancer and the histological
type the treatment of Bladder cancer. Treatment options include
- surgery, radiation therapy, chemotherapy, or immunotherapy.
Some patients get a combination of therapies.
Surgery is a common treatment for
bladder cancer. The type of surgery depends largely on the
stage and grade of the tumor. The doctor can explain each type
of surgery and discuss which is most suitable for the patient:
For early (superficial) bladder cancer transurethral resection
(TUR) might be used. The patient may need to be in the hospital
and may need anesthesia. After TUR, patients may also have
chemotherapy or immunotherapy.
Radical cystectomy: For
invasive bladder cancer, the most common type of surgery is
radical cystectomy. Radical cystectomy is the removal of the
entire bladder, the nearby lymph nodes, part of the urethra and
the nearby organs that may contain cancer cells.
When the entire bladder is
removed, the surgeon makes another way to collect urine. The
patient may wear a bag outside the body, or the surgeon may
create a pouch inside the body with part of the intestine.
Segmental cystectomy: In
some cases, the doctor may remove only part of the bladder in a
procedure called segmental cystectomy. This type of surgery is
usually done when a patient has a low-grade cancer that has
invaded the bladder wall in just one area.
Sometimes, when the cancer has
spread outside the bladder and cannot be completely removed,
the surgeon removes the bladder but does not try to get rid of
all the cancer. Or, the surgeon does not remove the bladder but
makes another way for urine to leave the body. The goal of the
palliative surgery is to relieve urinary blockage or other
symptoms caused by the cancer.
Radiation therapy or
This uses high-energy rays to kill
cancer cells. Like surgery, radiation therapy is local therapy.
It affects cancer cells only in the treated area. Some patients
may have radiation therapy before surgery to shrink the tumor.
Others may have it after surgery to kill cancer cells that may
remain in the area. Sometimes, patients who cannot have surgery
have radiation therapy instead.
Two types of radiation therapy are
used to treat bladder cancer:
Radiation is aimed using an external machine to at the tumor
area. Most people receiving external radiation are treated 5
days a week for 5 to 7 weeks as an outpatient.
Internal radiation: A small
container of a radioactive substance is placed inside the
bladder through the urethra or through an incision in the
abdomen. The patient stays in the hospital for several days
during this treatment. To protect others from radiation
exposure, patients may not be able to have visitors or may have
visitors for only a short period of time while the implant is
in place. Once the implant is removed, no radioactivity is left
in the body.
Some patients with bladder cancer
receive both kinds of radiation therapy.
Drugs are used to kill cancer
cells. The doctor may use one drug or a combination of drugs.
For patients with superficial bladder cancer, the doctor may
use intravesical chemotherapy (drug is put inside the bladder)
after removing the cancer with TUR. This is local therapy. They
mainly affect the cells in the bladder. Usually, the patient
has this treatment once a week for several weeks.
If the cancer has deeply invaded
the bladder or spread to lymph nodes or other organs, then
systemic chemotherapy is used. Doctors give drugs through a
vein. This treatment is called intravenous chemotherapy. The
drugs are usually given in cycles so that a recovery period
follows every treatment period.
Immune therapy or biological
Intravesical biological therapy
with BCG solution is used. BCG solution contains live, weakened
bacteria. The bacteria stimulate the immune system to kill
cancer cells in the bladder. The patient must hold the solution
in the bladder for about 2 hours. BCG treatment is usually done
once a week for 6 weeks.