Symptoms Common symptoms of bladder cancer include: * Blood in the urine (making the urine slightly rusty to deep red), * Pain during urination, and * Frequent urination, or feeling the need to urinate without results. These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. People with symptoms like these may see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system. Diagnosis If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:
- * Physical exam — The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
- * Urine tests — The laboratory checks the urine for blood, cancer cells, and other signs of disease.
- * Intravenous pyelogram — The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
- * Cystoscopy — The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder.
The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure. The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure. Many people with bladder cancer want to take an active part in decisions about their medical care.
They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people often feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor — to take part in the discussion, to take notes, or just to listen. The doctor may refer patients to doctors who specialize in treating cancer, or patients may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about bladder cancer. Surgery Choices Surgery to remove cancer Transurethral resection (TUR) is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. Surgery to remove bladder Cystectomy is the surgical removal of all (total or radical cystectomy) or part (partial cystectomy) of the bladder.
It is used to treat bladder cancer that has spread into the bladder wall (stages II and III) as either a first occurrence or as a cancer that returns (recurs) following initial treatment. A radical cystectomy removes the whole bladder as well as the surrounding pelvic organs. Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body.13 • An ileal conduit (also called a noncontinent diversion) uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. This procedure is called a urostomy. After a urostomy, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day, and a larger bag that allows for longer storage can be worn overnight. You will also learn how to care for your urostomy. • A continent reservoir (continent diversion) uses a segment of your intestine to create a storage pouch that is attached inside your abdomen. There are two types of internal continent reservoirs. o Abdominal diversion reservoir. The pouch inside the abdomen connects to an opening (stoma) in the skin.
This is another form of urostomy. The opening is smaller than the opening for an ileal conduit, and because there is a pouch inside the abdomen no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night. o Orthotopic diversion. The pouch in this procedure is sometimes called a bladder substitution reservoir. If your urethra was not removed as part of the cystectomy, you may be able to have this type of procedure. In an orthotopic diversion, the pouch is attached to your ureters at one end and your urethra at the other. This allows you to pass urine through the same opening as you did before surgery. Some people may need to use a catheter to release the urine. Noncontinent diversions are simpler and may have fewer complications either right after surgery or in the coming months and years. Continent diversion reservoirs eliminate the need for a urine storage bag to be worn outside the body.