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Diagnosis and Treatment of Bladder Cancer - A Detailed Guide

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What are the Diagnostic Tests for Bladder Cancer?

If an individual is suspected of having bladder cancer, the specialists will begin with a physical examination and medical history assessment to understand the cause of the symptoms. If the observations are alarming, additional tests may be recommended. The commonly recommended tests for the diagnosis of bladder cancer include:

Medical History and Physical Examination

The patient undergoes a detailed physical evaluation to identify the causes of their symptoms. The doctor may inquire about the symptoms experienced. The severity of symptoms is also evaluated to get more information about the underlying causes. The physical examination includes a digital rectal examination and a pelvic examination (in the case of women).


The doctor may also inquire about the medical and family history of the patients to determine the risk of bladder cancer. The social and occupational history of the patients, such as smoking and chronic exposure to toxic substances, is also examined to detect risk factors for bladder cancer. If the doctor suspects bladder cancer or other serious medical conditions, the patients are recommended for further tests.


Urinalysis

Analysis of the urine provides vital information about the health of the kidney and bladder. During urinalysis, the doctors determine the content, characteristics, and concentration of various substances in urine. Chemical, physical, and microscopic evaluations are performed under urinalysis. The presence of occult blood is also determined during urine evaluation. The chemical evaluation involves qualitative and quantitative determination of red blood cells, glucose, white blood cells, urobilinogen, proteins, bilirubin, leukocyte esterase, ketone bodies, and nitrites. Urine culture tests are also performed to detect the presence of a urine infection.


Imaging Tests

Several imaging tests are done to determine the presence and extent of cancer. These imaging tests include:


Cystoscopy

Doctors advise the patients to undergo cystoscopy if they suspect that they have any problems with the bladder. Cystoscopy is performed with the assistance of a cystoscope. A cystoscope is a thin, long tube with a camera at the end. The doctor inserts the cystoscope into the urethra to reach and examine the bladder. The images of the internal tissues of the bladder are transmitted on the screen. The doctor evaluates these images and determines if there is any problem with the bladder.

CT Scan

A CT scan of the bladder, ureters, and kidney is known as a CT urogram. It provides clear images of the organs of the urinary tract. A CT scan offers detailed information about the shape, size, presence, and site of tumors in the bladder. The detailed CT examination of the abdominal area determines the spread of cancer to the lymph nodes, pelvis, and other regions of the abdominal cavity.

Biopsy

A biopsy is a confirmatory test recommended for the diagnosis of bladder cancer. The procedure involves taking samples of the abnormal tissues through a needle or surgery and examining the sample under a microscope to find malignant cells.


Transurethral resection of bladder tumor (TURBT)

Transurethral resection of bladder tumors is the method for performing a bladder biopsy. During this procedure, the doctor obtains the abnormal tissues of the bladder and some surrounding healthy tissues. The sample is evaluated under the microscope. If the presence of cancer is confirmed, the doctors also test to see if the cancer has invaded the bladder muscles.


Urine Cytology

Urine cytology is a method to detect the presence of cancer cells in urine, and it is one of the commonly recommended tests for the diagnosis of bladder cancer. This test helps in diagnosing cancers of the kidney, ureter, prostate, and urinary bladder. The pathologists evaluate the urine sample under the microscope to detect cancer cells in the urine.


Imaging for Staging

Once bladder cancer is diagnosed, the next step is to determine the type and stage of the cancer. It assists the oncologists in optimizing the treatment strategy. Some bladder cancer types are rapidly progressive and require aggressive treatment. The imaging tests recommended for bladder cancer staging include a CT scan, magnetic resonance imaging, PET scan, and ultrasound for bladder cancer. A chest X-ray is also performed to determine the spread of cancer to the lungs.


Intravenous Pyelogram (IVP)

An intravenous pyelogram involves examining the organs of the urinary system with the help of X-rays. Before the procedure, a special dye is administered intravenously. The dye travels to the kidneys through the bloodstream, where it is filtered. This dye later gets collected in different organs of the urinary system.


The X-ray radiation tracks the movement of the dye. The dye outlines the internal tissues of these organs and provides information about the presence of any abnormal masses.


Bone Scan

If the patients diagnosed with bladder cancer complain about bone-related symptoms, such as bone pain, the oncologists may recommend they undergo a bone scan. It helps in detecting the spread of cancer to the bones.


Molecular Tests

Specialists also recommended specific molecular tests for the diagnosis of bladder cancer. These tests look for specific molecular tumor markers in the urine and blood samples. These include detecting and determining the levels of prostate-specific antigen, carcinoembryonic antigen, HCG, alpha-fetoprotein, prostatic acid phosphatase, lactate dehydrogenase, and CA-125.

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What are the Different Treatments for Bladder Cancer?

Bladder cancer will often need a comprehensive treatment approach, wherein the multidisciplinary clinical team will thoroughly study the diagnosis, understand the patient’s overall condition, and thereafter devise a personalized treatment plan. The following procedures are commonly recommended for the treatment of bladder cancer:

Surgery

Surgery is usually the first line of bladder tumor treatment and is the only treatment used if the cancer is localized and limited to the bladder. The type of surgery depends on the stage and extent of bladder cancer. The types of surgeries are:

Partial Cystectomy

Partial cystectomy is a bladder cancer surgery that involves the removal of the damaged portion of the bladder. The procedure is usually recommended for early-stage bladder cancers. The remaining bladder is still functional.

Radical Cystectomy

Radical cystectomy is a bladder cancer surgery that removes the complete urinary bladder. This surgery is performed in cases where cancer spreads to a significant portion of the bladder, usually during the advanced stage of the disease. Radical cystectomy in men also involves the removal of seminal vesicles, the prostate, and the bladder. In women, the ovaries, fallopian tubes, uterus, and a portion of the vagina are also removed along with the bladder during radical cystectomy.

Transurethral resection of bladder tumor (TURBT)

TURBT is a bladder cancer surgery that is both diagnostic and therapeutic. It is performed to remove tumors limited to the inner layer of the bladder (early-stage bladder cancer) that have not invaded the bladder's muscle wall.

Neobladder reconstruction

Neobladder reconstruction is the procedure performed after radical cystectomy to create a new route for urine drainage. A piece of intestine is taken to form a sphere-shaped reservoir, which functions as a bladder.

Chemotherapy

Chemotherapy is a bladder cancer therapy for treating bladder cancer that uses bladder cancer medications to kill cancer cells. Chemotherapy for bladder cancer may be administered intravenously or orally.


It is usually used in combination with surgery or radiation therapy. When used before surgery, it is known as neoadjuvant therapy, and it helps shrink the tumor size. When used after surgery, it is known as adjuvant therapy, and it helps destroy the residual cancer cells.


Radiation Therapy

Radiation therapy is a bladder tumor treatment that involves using high-energy ionizing radiation to destroy cancer cells. It may be administered in combination with surgery or chemotherapy. It may also be recommended for advanced bladder cancer treatment and as a part of palliative care to minimize cancer symptoms. External beam radiation therapy is commonly used to treat bladder cancer.


Immunotherapy

Immunotherapy is bladder cancer therapy that uses drugs to strengthen the patient's immune system to detect and kill cancer cells. Immunotherapy drugs interfere with the specific pathways of cancer cells that allow them to hide from the immune system. Several classes of drugs are used in immunotherapy, such as immune checkpoint inhibitors and PD-1 and PD-L1 inhibitors.


Targeted Therapy

Certain biomolecules and pathways are present specifically in cancer cells, and these allow their uncontrolled division and proliferation. Targeted therapy is a bladder tumor treatment that targets these molecules and pathways and affects the growth of cancer cells. This treatment helps delay the disease progression and prolong survival. The classes of drugs used include antibody-drug conjugates and FGFR inhibitors.


Intravesical Therapy

This treatment of bladder cancer involves delivering the drug directly into the bladder. Immunotherapy and chemotherapy drugs can be administered through this approach. It treats non-muscle invasive bladder cancer and higher-stage, invasive bladder cancers. The therapy is used in combination with radiation therapy and surgery.


Clinical Trials

Bladder cancer patients who have exhausted all standard treatment options may enroll in clinical trials related to bladder cancer management. These clinical trials test new treatments, diagnostic tests, and interventions to detect, prevent, and treat bladder cancer. Enrolling in clinical trials helps patients access new bladder tumor treatments before they become widely available.


Why Choose HCG for Treatment and Diagnosis of Bladder Cancer?


HCG Centre is one of the most advanced cancer care centers in India. It had state-of-the-art facilities for the diagnosis and treatment of bladder cancer. All diagnostic tests, including molecular and genetic tests, are available under a single roof. The center uses modern surgical equipment for improved outcomes during bladder cancer surgeries. The bladder cancer care team comprises experienced urologists, medical oncologists, and oncological surgeons.


Conclusion


Diagnosis of bladder cancer is done through medical history and physical examination, urinalysis, urine cytology, imaging tests, biopsy, intravenous pyelogram, CT urogram, and molecular tests. Urinary bladder cancer treatment includes surgery, immunotherapy, bladder cancer chemotherapy, targeted therapy, and intravesical therapy.

Frequently Asked Questions

What is the best diagnostic test for bladder cancer?

A biopsy is usually used as a confirmatory test for bladder cancer. Samples from the bladder are obtained through TURBT.

Surgery is the first line of treatment for bladder cancer. However, in most cases, the treatment of bladder cancer demands a multidisciplinary approach.

Bladder cancer patients can lead normal lives after the treatment; however, they should practice a healthy lifestyle and regularly visit the hospital to monitor recurrence.

After completing bladder cancer treatment, the doctor schedules a follow-up visit with the survivor. The survivors should not skip any of the scheduled follow-up visits. During these visits, doctors may recommend various tests to see if the patient is still in remission or if there is any risk of recurrence. The survivors should immediately inform the doctor about any new symptoms.

The success rates of bladder cancer treatment depend on several factors, such as stage of disease diagnosis, response to treatment, and overall health. Early-stage bladder cancers have better clinical outcomes than those in the advanced stages.

Removing the bladder or the extent of removal depends on the extent of the spread of bladder cancer. The doctor may opt for bladder preservation surgery if the cancer is present only in the inner lining.