Bladder Cancer Treatments

Your consultant will talk to you about the treatment options for your particular type of cancer. You may be given a choice of treatments, but we will make sure you are fully informed as to the strengths and weaknesses of each one so you can make an informed decision.

Usual Tests

Physical examination -  the rectum (back passage) in men and the vagina in women is examined to feel for any obvious abnormalities.

Urine tests - a urine sample can be tested using a dipstick to check for blood in the urine. The sample is sent to the laboratory for microscopic examination. This is to check for infection (microscopy & culture) and abnormal cells (urine cytology) in the urine.

Blood tests - a series of blood tests are done to check general wellbeing and kidney and liver function.

Cystoscopy - this involves the urologist looking into the bladder with a thin, flexible tube which has a camera to allow the bladder to be visualised and any abnormalities photographed. This is usually done under local anaesthetic but a general anaesthetic may be required if it is necessary to take biopsies (tissue samples) of any abnormal areas. The samples are sent to a histopathologist to examine them for cancer.
 

Further tests

Ultrasound scan - this is a non-invasive, painless test in which sound waves are used to build up a picture of the internal organs. An ultrasound can be used to check that the kidneys are draining. It can also show whether there are any obvious abnormalities within the bladder and that the bladder is emptying completely.

CT scan (computerised tomography) - this is a non-invasive test in which a series of x-rays are taken to build up a 3D image of the internal organs. A dye is sometimes used to enhance the images. A CT scan of the chest, abdomen and pelvis is usually taken to check the extent of the cancer within and outside of the bladder.

Chest x-ray - this is used to check the health of the lungs and heart.

Bone scan - this scan is taken a few hours after an injection of a mild radio-active substance which is absorbed by abnormal areas within the bones. It is used to check for spread of cancer into the bones.

Stages & grading

Stage

This refers to the size of the cancer and the extent to which it has grown and/or spread.

There are four recognised stages:

  • Stage 1: Small and only growing in the bladder lining
  • Stage 2: When it has spread into the inner muscle layer
    of the bladder wall
  • Stage 3: When it has spread deep into the muscle layer
    of the bladder wall
  • Stage 4: Tumours which have grown out of the bladder wall and into surrounding structures such as the prostate, bowel, etc.

Grade

As with staging, grading is also determined on microscopic examination and refers to the appearance of the cancer cells to indicate how likely they are to grow and develop.

In simplistic terms, there are 3 grades. The lower the grade the less likely the tumours are to grow and spread. The most abnormal cells are usually grade 3; these are therefore more likely to 'behave badly' and also grow quickly.

Bladder Cancer Treatment

Overview of treatment for bladder cancer

Surgery, chemotherapy, radiotherapy and immunotherapy can be used separately or in combination to treat bladder cancer. However, different treatments will be needed depending on grade and stage of bladder cancer.

Your consultant will talk to you about the treatment options for your particular type of cancer. You may be given a choice of treatments, but we will make sure you are fully informed as to the strengths and weaknesses of each one so you can make an informed decision.

Carcinoma in situ (CIS) is very early bladder cancer. It can be fast growing and the usual treatment involves a resection of the bladder tumour (cutting the cancer out of the bladder) followed by treatment of the inside of the bladder (intravesical therapy) with either chemotherapy or immunotherapy. This type of treatment has a 60% success rate for CIS.

If the CIS does not clear up completely, further surgery and intravesical therapy can be used as additional treatment.