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How Do I Know If I Have It?

After your doctor completes a thorough medical history and examination, he or she will probably send you to a urologist, a surgeon who has special training in managing diseases of the bladder.

The first test he or she will probably perform is cystoscopy. The bladder can be viewed through a fiber-optic lighted tube known as a cystoscope. The urologist will pass the cystoscope through the urethra into the bladder. If the doctor sees anything unusual, like a tumor, a tiny tissue sample is taken through the tube and examined in the laboratory (biopsy). Should the tumor be malignant, the treatment will depend on how far, if at all, the cancer has spread.

Blood and urine studies (to look for cancer cells and infection)and imaging studies with X-rays, CT, ultrasound, and MRI of the bladder, ureters, kidneys, and other organs provide information about tumor size, location, and the degree or amount of spread to other parts of the body.

What Are the Treatments?

Treatment depends on the stage of the cancer, a measure of how widespread the bladder cancer might be.

Stage 0 or carcinoma in situ. This is early bladder cancer that just affects the inner lining of the bladder.

Stage I. Here, the cancer has spread deeper into the lining of the bladder but doesn't affect the muscle wall of the bladder.

Stage II. The cancer affects the inside part of the muscles of the bladder.

Stage III. The bladder cancer has spread through the muscle wall of the bladder and may be affecting the tissue that surrounds the bladder or the reproductive organs.

Stage IV. The bladder cancer has spread to the abdomen or to the lymph nodes in the body.

Recurrent Bladder Cancer. This means that the cancer has come back after treatment.

If detected early, superficial malignancies can usually be treated successfully by transurethral resection (TUR). In this procedure, the surgeon inserts a small tube into the bladder through the urethra and removes the tumor surgically or burns it out with heat or a laser beam. Combined with chemotherapy or radiation therapy, TUR may also be successful against more invasive bladder cancer. Using this approach, the abdomen isn't cut. The side effects are usually mild and short-lived and include bleeding and mild pain. You'll be able to go home within a day of the procedure.

Immunotherapy with the bacillus Calmette-Guerin (BCG) vaccine is beneficial in 60% of cases. Injecting BCG into the bladder after the tumor has been removed significantly reduces the chance of cancer recurrence. Immunotherapy is a form of treatment whereby the body's own natural defenses (the immune system) are revved up to attack the cancer.

BCG is often placed directly into the bladder via a catheter. This is called intravesical therapy.

Invasive cancers (those that have spread beyond the inner lining of the bladder) may require radical cystectomy, or bladder removal. The surgeon then diverts the urinary tract and creates an opening, or stoma, through which urine is passed. Patients once had to wear external urine pouches, but new techniques synthesize internal pouches from intestinal tissue. Bladder removal may also mean removing the reproductive organs in women and the prostate and seminal vesicles in men. Although this procedure often renders men impotent, injections or penile implants can help. Women will become infertile but can remain sexually active.

When only part of the bladder is removed, it's called a partial cystectomy. This operation requires that the abdomen be cut. You'll stay in the hospital for about a week to ten days.

After surgery, a combination of radiation and chemotherapy may be necessary to deter recurrence of the cancer. Anyone who has had bladder cancer should have regular follow-up tests, including cystoscopy, since tumors often recur. If the cancer has metastasized, or spread beyond the urinary tract, surgery is not usually considered. Chemotherapy is the primary treatment for recurrent and metastatic cancer.

Survival

Doctors measure prognosis using survival rates. The five-year survival rate is the percentage of patients who live at least five years after their cancer is found. Many people live much longer.

For stage 0. it's 95%.

For stage I. 85%.

For stage II. 65%-75%.

For stage III. 30%-65%, depending on the size of the cancer deposits present in the tissues next to the bladder and whether the cancer has spread to nearby organs.

For stage IV. 10%-15%

These numbers provide an overall picture, but keep in mind that every person's situation is unique and the statistics can't predict exactly what will happen in your case.