Bladder Cancer, diagnosis and treatment:
It is an insidious cancer that at the initial stage could be asymptomatic and the only early sign could be a one time episode of urine mixed with blood (gross hematuria) that needs immediate attention of an Urologist. Treatment with PO antibiotics could only delay treatment and deprives the patient from a chance to be diagnosed and treated early. Another episode may follow months later and the cancer may be at an advanced stage, beyond cure.
Another symptom is microscopic presence of blood in the urine (microhematuria). It needs the same attention and work up by an Urologist.
It usually consists of performing a CT scan with contrast that permits to outline all details of the urinary tract and of cystoscopy (looking into the bladder with a fiberoptic instrument with a micro camera). The cystoscopy permits to detect small lesions that the resolution of the CT scan can miss.
After detecting a lesion, it is removed by transurethral resection to determine its nature, aggressiveness and depth of growth. Usually multiple biopsies from different areas of the bladder are performed to detect Carcinoma in Situ that requires more aggressive treatment.
For cancers not invading the bladder musculature the treatment ends there. From then on the patient must come back for a very rigorous follow up consisting of having a cystoscopy every 3 months. The cancer recurs in a number of patients and these patients need treatments with instillations of medications into their bladder. These treatments lower the incidence of recurrences.
The patient free of recurrences should have a cystoscopy 1 x a year for the rest of his life. Recurrences do occur many years after the initial treatment and sometimes in a more aggressive form. During the remissions the patients are offered a follow up with cytological examination of the urinary sediment (FISH, UROVISION). That permits early detection of recurrent cancer and early intervention at stages where cancer eradication is possible.
For cancers invading the muscle layer of the bladder surgery is the standard of treatment. The patient undergoes a Radical Cystoprostatectomy and extended resection of the pelvic lymph nodes.