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Bladder Cancer

Malignant Neoplasm of Bladder

What is bladder cancer? — Bladder cancer happens when normal cells in the bladder change into abnormal cells, and grow out of control (figure 1).
What are the symptoms of bladder cancer? — Bladder cancer causes mild symptoms that can come and go. These include:
Blood in the urine, which makes your urine look pink or red
Pain on the sides of your back or above your pubic area
Pain when urinating, urinating often, or leaking urine
These symptoms can also be caused by conditions that are not bladder cancer. But if you have any of these symptoms, you should be checked by a doctor or nurse.
Is there a test for bladder cancer? — Yes. Doctors can use different types of tests to look for bladder cancer. These include:
Urine tests – Urine tests can show what kind of cells are in the urine.
X-rays, CT scans, or other imaging tests – These tests create images of the entire urinary tract, which includes the kidneys, ureters, and the bladder. They can show tumors or abnormal growths.
Cystoscopy – Cystoscopy is a procedure that allows the doctor to look directly inside the bladder. To do a cystoscopy, the doctor inserts a small tube into the urethral opening, the opening through which urine leaves the body. Then they push the tube up into the bladder. The tube has a tiny camera that projects images of the bladder onto a screen. If the doctor sees anything unusual, they might take a sample of tissue (called a biopsy) to look at under the microscope.
How are bladder cancer treatment decisions made? — Once the diagnosis of bladder cancer is confirmed, the treatment depends on the cancer stage and grade. Cancer staging is a way in which doctors find out how far a cancer has spread. Grading refers to the way the cancer looks under the microscope. The right treatment for you will also depend on how old you are and whether you have any other medical problems.
How is bladder cancer treated? — People with bladder cancer often have 1 or more of the following treatments:
Surgery – Bladder cancer is usually treated with surgery. Depending on how large the cancer is and how far it has spread, doctors can do 1 of 3 things:
•Take out the cancer and leave the bladder in place. In many cases this is done through cystoscopy. Usually this procedure has no impact on the ability to urinate.
•Take out the cancer and a part of the bladder. This option depends on how much of the bladder is involved, and is not done very often. After this procedure, people can often urinate normally.
•Take out the cancer, the bladder, and nearby internal organs. This option might be necessary for people with advanced bladder cancer. With this type of surgery, the surgeon also has to create a new way for urine to leave the body, because the bladder has been removed (figure 2).
Medicines – Medicines are an important part of treatment for people with bladder cancer. Doctors use different medicines depending on the extent of the cancer.
•For people with very early bladder cancer that has not spread into the bladder muscle (called "superficial bladder cancer"), medicine is given directly into the bladder.
•For people with cancer that invades the bladder muscle, chemotherapy should be given before surgery. Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. This can shrink the cancer and make it easier to remove.
•For people with invasive bladder cancer who did not go through chemotherapy before surgery, chemotherapy can be given once they are healed from surgery.
•If the bladder cancer has spread beyond the bladder, chemotherapy is used to relieve symptoms and help people live longer. Another kind of treatment called "immunotherapy" might also be an option. This is the term doctors use for medicines that work with the body's infection-fighting system to stop cancer growth.
Radiation therapy – Radiation kills cancer cells. Radiation therapy might be an option for some people instead of surgery. It is often given along with chemotherapy.
What happens after treatment? — After treatment, you will be checked every so often to see if the cancer comes back. Follow up tests can include urine tests, cystoscopy, and X-rays.
Tell your doctor or nurse if you have any of the symptoms listed above. Having those symptoms could mean the cancer has come back.
What happens if the cancer comes back or spreads? — If the cancer comes back or spreads, you might have more surgery, or get chemotherapy, immunotherapy, or radiation.
What else should I do? — It is important to follow all your doctor's instructions about visits and tests. It's also important to talk to your doctor about any side effects or problems you have during treatment.
Getting treated for bladder cancer involves making many choices, such as which type of surgery to have.
Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:
What are the benefits of this treatment? Is it likely to help me live longer? Will it reduce or prevent symptoms?
What are the downsides to this treatment?
Are there other options besides this treatment?
What happens if I do not have this treatment?
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15351 Version 11.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.

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