After your initial diagnosis and once the determination has been made as to which type of bladder cancer you are facing, it will then be time to decide on a method of treatment. Your doctor and medical care team will advise you of your best options with all possible outcomes.
If you have not yet been through the diagnosis, here are the ways that testing is done to find out which type of cancer it may be.
A cystoscopy is done by inserting a narrow, small tube through the urethra and bladder to examine the internal structures for disease.
A biopsy can be done alone, or during a cystoscopy, and your doctor will collect a small sample of your bladder cells to test. This procedure can also be referred to as transurethral resection of bladder tumor, which is also used to treat this type of cancer.
Urine cytology tests can be performed on a sample of your urine under a microscope to check for any abnormal or cancerous cells.
Image testing like CT scans, urograms or retrograde pyelograms, are done to allow your doctor a better view of all the structures in your urinary tract. During these tests, dye is injected into a vein in your hand and that eventually flows into your kidneys, ureters, and finally bladder. X-ray images are then taken and reveal any discrepancies in your urinary system.
After confirming your type of bladder cancer, your doctor may wish to order further tests. Some of these tests may include an MRI scan, bone scan, chest x-ray, or another CT scan for the whole body. Your doctor uses the results and information from all of these tests to help determine the grade, or stage, your cancer is at. The system that doctors base the “stages of cancer” on is always changing and being updated.
These are the ‘grade’ or stage levels of bladder cancer:
A low-grade bladder tumor is a tumor that has cells that are closer together in appearance and organization. Low-grade tumors are normally slow to grow and do not invade the muscular wall of the bladder.
A high-grade bladder tumor is a type where the cells that are abnormal also lack any resemblance to normal-appearing cells, being poorly differentiated. High-grade tumors tend to be more aggressive and tend to spread more frequently through the muscular wall of the bladder, other tissues, and into other organs.
What are the treatment options available for bladder cancer?
The type of treatment you qualify for will depend on the type of cancer you have, the grade and stage of cancer, and your overall health. Bladder cancer treatment may include one or a mix of the following:
Surgical intervention to remove any cancerous tissues, including removing the bladder when necessary. There are different methods of bladder removal. Here are some:
- Transurethral resection of the bladder tumor surgery is done when the cancer is confined to the inner layers of the bladder or any cancer which is not yet muscle involved. This procedure is done with a wire loop that burns away the cancer cells. This requires full anesthesia in almost all parts of the country, but you will not have any cuts or scars on the outside of your abdomen.
- Cystectomies are done to surgically remove all or part of the bladder. During a partial removal, your surgeon will remove the cancerous portions of your bladder. In a radical cystectomy, the entire bladder part of the uterus, and surrounding lymph nodes are removed. In men, this could also mean removal of the prostate and seminal vesicles. This is done by placing an incision in the lower abdomen or belly by your doctor’s hand, or by robotic medical machines. There are many risks with cystectomies and your doctor will cover those in your preregistration meetings.
- Neobladder reconstruction happens after the bladder has been removed and a new exit for urine must be created. This procedure installs a new sphere-shaped reservoir out of your intestine, called a neobladder, which sits inside your body attached to your urethra. In most cases, a neobladder does allow you to urinate normally, although some do occasionally need to use a catheter for complete bladder draining.
- Ileal conduit is a type of urinary diversion when your surgeon creates a tube using a piece of your intestine. The tube will run from your ureters, and as they drain your kidneys, the tube leads the urine flow to the outside of the body. The urine then rests in a urostomy bag, or bag that holds urine, which is worn on the outside of the body much like a colostomy bag.
- Continent Urinary Reservoir is a style of urinary diversion procedure in which your surgeon creates a pouch to hold the urine inside your body using your intestines. With this method, you drain the pouch using a special catheter multiple times per day.
- Chemotherapy directly in the bladder, or intravesical chemotherapy. This treatment can be confined inside the bladder but does end with a higher risk of reoccurrence to a higher grade of bladder cancer. This type of chemotherapy is given via a protective tube inserted into the bladder. The lining of the bladder helps to keep all the chemotherapy inside of the bladder where it belongs.
- Reconstruction will create a new way for urine to leave the body after the bladder has been surgically removed.
- Systemic chemotherapy will increase the chance for a cure when the person is also having surgery for bladder removal, or as a primary treatment in any case where surgery is not a viable option. This type of chemotherapy is given through IV in the hospital.
- Radiation therapy destroys cancer cells and can be used as a primary treatment when surgery is not an option. This therapy utilizes high-energy waves and beams aimed at cancer in your body. Radiation therapy is often combined with chemotherapy in many types of cancer.
- Immunotherapy is done to trigger the body’s own immune system to fight the cancer cells in the bladder or throughout the body. This treatment is administered through the urethra directly into the bladder and works alongside your body’s protein base. This is a biological therapy that works to jump start and signal your own immune system. Immunotherapy is a growing method for treating many complex cancers and illnesses.
I have an appointment to discuss my bladder cancer. What things should I ask of my doctor and generally be aware of?
There are many questions that you can ask to give yourself a better understanding and more comfort in knowing what is coming with your treatment. Never hesitate to ask your doctor any question that comes to mind and be sure to write down the answers that you are given. Here are some common questions for your medical care team related to bladder cancer:
- Is there one treatment you feel is best for me?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Is there a generic alternative to the medicine you’re prescribing me?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
- Do I have bladder cancer, or could my symptoms be caused by another condition?
- What is the stage of my cancer?
- Will I need any additional tests?
- What are my treatment options?
- Can any treatments cure my bladder cancer?
- What are the potential risks of each treatment?
Things to be aware of:
- Write down any questions you have for your doctor, even if they seem silly or uneducated.
- Take a family member or friend with you to your appointment. Sometimes having another set of ears and eyes there with you ensures you will not miss any important information. They could even take notes about the visit and things your specialist has instructed or told you to do.
- Make a list of all the medications, supplements, pharmaceuticals, holistic and herbal remedies you regularly take, along with their dosages and prescribing doctors.
- Make notes about any important personal information or copious amounts of stress you are facing. This would count as divorce, family illness, major life changes, etc.
- Write down and track any symptoms you are dealing with daily. Include all symptoms and abnormalities, including anything that seems unrelated to the medical issue you are facing.
- Take note of any pre-appointment restrictions like not eating for twenty-four hours before endoscopies or fasting for blood work.
After your diagnosis, you will begin treatment to regain control of your life, and bladder. Your medical care team can answer any of your questions about your condition and give you the vital information necessary to wholly heal this illness.
Citations:
American Cancer Society
National Institute of Health and Human Services
Mayo Clinic