How a Urologist Approaches Bladder Cancer Treatment

For people with non-muscle-invasive bladder cancer, urologists often perform a procedure called transurethral resection of bladder tumor (TURBT) to diagnose and treat the cancer. They put a cystoscope into the urethra and use a wire loop, laser or high-energy electricity to remove the cancer cells.

If the cancer recurs, doctors will use drugs to kill the cells that surgery missed. They may also do a surgery known as urinary diversion, which creates a new way to pass urine.

Symptoms

Bladder cancer starts in the cells that line the bladder. Usually, the first sign of bladder cancer is blood in the urine (hematuria). This is rusty to bright red in color and may be noticed during urination or reported by your doctor.

If you experience these symptoms, your health care team will perform a test called cystoscopy. This is a procedure in which your doctor inserts a tube with a lens into the urethra and bladder. They look for signs of disease and collect a cell sample (biopsy) from the bladder to be tested. Your doctor will also ask when the symptoms started and how often you have them.

Your test results will determine the type and stage of your bladder cancer. The vast majority of bladder cancers are urothelial carcinoma, which grows in the cells that line the inner lining of your bladder. Some urothelial carcinoma spreads to the tissue of the renal pelvis and ureters, which is considered upper tract urothelial cancer.

Urologist Melbourne will treat your cancer based on the type and stage of it. The most common treatment for bladder cancer is a radical cystectomy, in which your doctor removes your entire bladder along with any nearby lymph nodes and part of the urethra. In men, the prostate and seminal vesicles are removed as well. In women, the uterus, fallopian tubes and parts of the vagina are removed.

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Diagnosis

Your urologist will check your symptoms and do some diagnostic tests to see if you have bladder cancer. These may include a physical exam, blood tests and urine tests. A sample of your urine is sent to a laboratory to look for cancer cells (urine cytology). CT scans or an MRI may help your doctor find out the size and location of tumors in your bladder or surrounding tissues. Your urologist will also look at your kidneys, ureters and urethra to make sure they are healthy.

Your doctor may also do a procedure called cystoscopy. This involves inserting a pencil-sized, lighted tube into your urethra and into your bladder to examine the inside of these tubes and surrounding tissues for signs of disease. Your doctor may pass a tool through the scope to take a small piece of tissue for further testing (biopsy).

If a biopsy shows that you have early stage bladder cancer, your urologist may try to remove only the tumor and surrounding tissue with a surgery called transurethral resection of bladder tumor (TURBT). This can be done in your doctor’s office or in a hospital operating room.

In some cases, your doctor may decide to remove your entire bladder. This is a surgery called radical cystectomy. If this is necessary, your urologist will create a new way for you to pass urine out of your body. It will probably involve using part of your intestine or colon, so you will need to wear a bag attached to the stoma or ostomy.

Treatment

Based on the results of the TURBT and other diagnostic tests, a urologist will determine your cancer’s stage. This describes how far the cancer has spread and is a vitally important factor in treatment.

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Often, a urologist will use a CT scan with contrast dye to create a CT urogram, which takes detailed pictures of your kidneys, bladder and ureters. The contrast dye can help your doctor spot the location of a tumor or other abnormalities.

Other tests may include a urine test that checks for cancer cells in your urine. Blood in the urine (hematuria) can also indicate a bladder tumor. Your urologist will also take a tissue sample — or biopsy — from your bladder to check for signs of cancer, such as growths or infiltration.

Your urologist may prescribe chemotherapy or radiation therapy, both effective options for bladder cancer treatment, to kill fast-growing cancer cells and reduce the chances of the cancer spreading. The medication is usually given into a vein, called intravenous therapy, or directly into the bladder through the urethra, called intravesical chemotherapy

Your urologist will also create a follow-up plan for you. They’ll usually recommend that you have cystoscopy to check the inside of your urethra and bladder every three to six months for the first few years after treatment, then once a year. These follow-up appointments will depend on your cancer type, stage and grade.

Follow-up

When a person has a urinary tract or reproductive problem, they will often be referred to a urologist. This doctor is a surgeon who specializes in conditions of the kidneys, bladder, prostate, penis, and testicles for men and women.

Urologists are a medical specialty that requires a strong background in internal medicine, pediatrics, and gynecology to deal with the variety of problems that affect the genitourinary system. The word urologist comes from the Latin urethra and means “urinary duct” or “water channel.” Many people are uncomfortable talking about urine, sex, and other issues that relate to the genitourinary system, but these concerns should be brought to a physician’s attention because they could indicate a serious health issue.

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If a patient is diagnosed with cancer of the bladder, the urologist may suggest surgery, chemotherapy, or radiation therapy. Surgery options include radical cystectomy (removal of the entire bladder), partial cystectomy (removing part of the bladder), and neoadjuvant chemotherapy (use of drugs to reduce the size of a tumor before surgery). The urologist also may suggest a procedure called intravesical chemotherapy. This uses a tube or catheter to deliver liquid drugs directly into the bladder. These drugs remain in the bladder for several hours and mainly attack cancer cells. Drugs used in intravesical chemotherapy include mitomycin-C (Jelmyto), gemcitabine (Gemzar), and docetaxel (Taxotere).

A urologist may also recommend radiation therapy, which uses high-energy rays to kill cancer cells in the bladder or nearby tissues. Some patients get radiation after surgery to prevent or relieve pain and others have it to help keep the cancer from returning.