Bladder Cancer

Urinalysis

• Checks for blood or inflammation not normally present.

Urine cytology

• Examines urine for shed cancer cells. A positive test strongly suggests urinary tract cancer.

Cystoscopy

• The most essential diagnostic test. A thin scope is inserted through the urethra under local anesthesia to directly visualize the bladder, identify tumors, and obtain biopsy samples.

CT scan

• Assesses tumor location, depth of invasion, lymph node involvement, and distant spread.

Ultrasound, MRI, bone scan

• Used selectively to evaluate tumor spread to adjacent organs or bones, and to assess the urinary tract (renal pelvis, ureters).

Non–muscle-invasive bladder cancer (NMIBC)

• Transurethral resection of bladder tumor (TURBT): Standard initial treatment; allows both diagnosis and removal of the tumor.
• Intravesical therapy (chemotherapy or BCG): For high-risk or recurrent NMIBC, anticancer drugs or BCG (bacillus Calmette-Guérin) are instilled directly into the bladder to reduce recurrence and progression. Treatment usually begins shortly after surgery and continues weekly for 6 weeks, sometimes with maintenance therapy.

Muscle-invasive bladder cancer (MIBC)

• Radical cystectomy: Standard treatment, involving removal of the bladder, nearby lymph nodes, and sometimes adjacent organs (prostate in men; uterus and part of the vagina in women). Because bladder removal eliminates the organ that stores urine, urinary diversion is required:
• Ileal conduit: Uses a segment of the small intestine to create a stoma for urine drainage into an external bag.
• Neobladder reconstruction: Creates an internal reservoir from intestinal tissue, allowing patients to pass urine more naturally.

Bladder-sparing therapy

• In selected patients, a combination of TURBT, chemotherapy, and radiation may be used to preserve the bladder, although survival rates are lower than with radical cystectomy.