Cancer Information

Diagnosis and Treatment of Bladder Cancer


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

  • Urine tests

  • 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 anesthesia.

  • 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:

Transurethral resection: 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.

Palliative surgery

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 radiotherapy

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:

External radiation: 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 therapy:

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.