How is bladder cancer diagnosed?

If your doctor suspects bladder cancer, he may do a physical examination and recommend other tests to confirm the diagnosis and know about the extent of the cancer spread.

• Physical examinations: Your doctor will ask about your medical history, family history, and possible risk factors. He might do a digital rectal exam (DRE), where he inserts the gloved and lubricated finger into the rectum. During this exam, the doctor may sometimes feel a bladder tumor and may suggest some tests to confirm the diagnosis.
• Urine culture: This test helps determine if the urinary symptoms are due to infection or due to cancer.
• Urine cytology for malignant (cancer) cells: Cytology means the study of cells, and this test is done to look for abnormal cells in urine. It is usually done along with various other tests to diagnose bladder cancer. In case of already diagnosed cancer, the patient may be asked to go for this test to check on the recurrence of cancer.
• Ultrasound: It is a painless procedure that gives information about the bladder wall, bladder stone, large tumor, etc.
• Urography: This procedure uses contrast materials and imaging techniques to evaluate and detect blood in urine, bladder stones, kidney stone, or cancer in the urinary tract. It is usually performed with magnetic resonance imaging (MRI) or computed tomography (CT) scan.
• Computer Tomography Urogram: This test is done using a special dye medium that helps with a clear image of the bladder. It can help in seeing the detailed images of soft tissue and blood vessels.
• Cystoscopy and Transurethral resection of bladder tumor (TURBT): It is a minimally invasive procedure. The sample obtained from resection is sent to pathology to determine the grade and spread of the tumor. The one advantage of this procedure is that it can be done multiple times with reduced risk for patients.

How is bladder cancer treated?

There are different treatment options available. Patients are usually given a combination of treatments like radiotherapy, chemotherapy, surgery, etc. The best option of treatment depends on various parameters such as stage of cancer, patient’s response to treatment, etc. Below are some common treatment options available:

• Radiation therapy: Radiation therapy utilizes high-energy x-rays or other types of radiation to kill the cancer cells and keeps them from growing. Radiations that come from outside the body are called external beam radiation, while placing several small radioactive seeds in the tissue that emit high-energy radiation is known as brachytherapy.
• Chemotherapy: Chemotherapy utilises drugs to prevent cancer cells from growing, either by killing the cancer cells or by inhibiting them from multiplying. Chemotherapy is an option for treating cancers that are not responding to hormone therapy.
• Immunotherapy: In this procedure, the patient’s own immune system is used as a tool to fight against the disease. Substances that boost the immunity of a person are made in the laboratory and then used to enhance the person's immunity to help fight cancer. This treatment is also known as biological therapy or biotherapy.
• Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. This treatment targets cancer cells and is less harmful in comparison to radiation and chemotherapy.
• Surgery: There are different types of surgical procedures done, depending upon the grading and type of the tumor.
• • Transurethral resection (TUR) with fulguration: In this procedure, a thin, lighted tube called a cystoscope is inserted into the bladder through the urethra. The tumor is either removed or burnt with the help of a small wire attached at the end of a cystoscope. This process is known as fulguration.
  • Cystectomy: This is a procedure of removal of the bladder and a part of the urethra along with some lymph nodes. This can be performed as an open, minimally invasive, or robotic procedure. This procedure is usually followed by another surgery in order to make a new route for urine to pass out of the body.
  • Radical cystectomy: This is a process of removal of the bladder and any lymph node and nearby organs that have cancer. This surgery is usually done when cancer invades the muscle wall or when there is the involvement of a large part of the bladder.
  • Partial cystectomy: In this procedure, a part of the bladder is removed. Patients with low-grade tumors and involvement of the bladder wall, which is limited to one area only, are usually considered for this procedure. Because only one part is removed, the patient does not have any problem while urinating. This process is also called segmental cystectomy.
  • Urinary diversion: The process of making a new path for the body to store and pass urine is known as Urinary diversion.

What happens after the surgery?

You may have to stay in the hospital for 5 to 6 days. This is the time where your body is in the recovery phase. You may experience some complications like shivering, sore throat, sleepiness, nausea, vomiting, etc. These may last for a few days but will eventually subside. You may also experience pain and discomfort around the incision that will gradually heal. Before leaving for the home, discuss with your doctor about the medications and other ways to improve your comfort.

How to keep a check on reoccurrence?

Bladder cancer has a high chance of recurrence even if it is superficial. Tests that were done initially to diagnose cancer will be done frequently to monitor the cancer status after treatment. Any change in the reports may trigger the need to devise a new treatment plan.

Tips for prevention

There is no way that can assure the prevention of bladder cancer. There are certain factors that can help in reducing the risk of it:

• Avoid smoking.
• Limit exposure to certain chemicals like chemicals used in dyes, etc.
• Drink plenty of water.
• Eat fruits and vegetables (eating healthy strengthens the immune system).