Symptoms of urinary bladder cancer are not always evident. Do as your doctor about bladder cancer if you have anything like:

· Blood in your urine (hematuria); the passing of bloody urine is generally painless

· Blood traces in urine laboratory tests

· Urgency (inability to postpone urination) and frequency (urinating often)

· Discomfort during urination

These symptoms may also appear in other non-malignant diseases such as: urinary tract infection, urinary bladder stones, benign tumors, and others. Only a physician can interpret the meaning of these symptoms; therefore, the appearance of any one of these presentations requires medical attention.

Diagnosing, defining the penetration (stage) and the aggressiveness (grade) of the disease

In order to identify the source of the symptoms, the doctor obtains general data concerning the patient’s health and performs a physical examination. Later, the doctor may use an instrument that enables direct visualization inside the urinary bladder, during an exam called cystoscopy. During this procedure, it is possible to take tissue samples of the bladder wall (biopsy), for examination under the microscope. In case of suspicion of tumor during Cystoscopy, a surgical removal known as Transurethral Resection (TURBT) will normally follow. A tissue sample is usually necessary in order to characterize the tumor (grade) and the extent to which it has penetrated into the bladder wall (stage). The physician may eventually refer the patient for further medical investigation including: CT, MRI, ultrasound, X-rays of the urinary tract (IVP), etc.

Preparing for treatment

Once informed of the disease, many patients wish to become full partners in treatment decisions. There is a lot of information available on urinary bladder cancer and treatment options. We recommend that you consult with the medical staff and ask to be given this information. Feelings of anxiety and tension are normal in this situation and family support is very important. It is advisable to prepare a written list of all questions troubling you, before reporting to your doctor, and for a family member to accompany you during the visit.

Treatment methods

The treatment of superficial urinary bladder cancer includes two main stages:

a. Surgical removal of all tumor(s) (under partial/general anesthesia) (TURBT). This is performed through the urethra, with no need to open the abdominal cavity. In case of numerous tumors, the doctor is compelled to perform successive TURBTs or an extensive operation. Occasionally partial or complete (radical) removal of the urinary bladder is required (Cystectomy), especially when the tumor involves the muscle layer. An alternative route for drainage of urine is then created. In cases of recurrent small tumors, it is possible to fulgurate their roots by laser (TUF), during cystoscopy.

b. After having ascertained the type of tumor and evaluation of the risk for recurrence and progression, preventive therapy is usually administered, by flushing the bladder with various chemically or biologically active materials (bladder instillations). Flushing with chemotherapeutic materials is intended to destroy cancer cells that were not removed during the operation or that have a high malignant potential. Biological flushing materials, such as BCG (tuberculosis bacteria) and others, are intended to create an immune response in the urinary bladder tissue, which leads to the destruction of cancer cells.