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Bladder Cancer

Bladder cancer affects 74,000 men and women each year. Smoking is a significant risk factor, although not all people with bladder cancer have a smoking history. Most commonly a person with newly diagnosed bladder cancer will have gross painless hematuria. Another way of saying this is that they will pee blood without associated pain or discomfort. A person can have blood in the urine and never know it. That is one of the reasons why doctors often collect urine for analysis. Also, there are many things that can cause blood in the urine, and most are not associated with cancer. If a person has blood in the urine, we may recommend additional testing, such as a CT scan or an MRI. They might undergo a simple procedure called “cystoscopy” where the urologist evaluates the bladder directly with a scope that is gently placed into the bladder through the pee tube (urethra). If bladder cancer is detected, a biopsy comes next, and the biopsy often involves removal of all the tumor. This is usually performed in the operating room as an outpatient.

Most newly diagnosed bladder cancer patients can be managed by preserving their bladder. For the majority of newly treated patients, their bladder cancer will come back. Therefore, after initial treatment, ongoing evaluation of the bladder over time is necessary. Cystoscopy is repeated at regular intervals, with additional tumor removal as necessary. Sometimes in this circumstance the patient will receive periodic medicine instilled into the bladder. After a few hours this medication is peed into the toilet. While in the bladder this medication coats the bladder wall, effectively reducing the frequency of repeat tumors and possibly preventing new tumors from becoming more advanced

A minority of patients will present with, or progress to, more advanced bladder cancer. In this instance the bladder cannot be safely preserved and therefore must be removed. This is a large and complex procedure that involves not only treatment of the cancer, but also reconstruction of the lower urinary tract to allow him or her to eliminate urine from the body. A number of sophisticated options are available, all of which are designed to preserve patient satisfaction as much as possible. Removal of the bladder is both lifesaving and life altering. As with prostate cancer, the skill and expertise of the surgeon are of critical importance to maximize cancer cure and satisfaction. Depending on circumstances, chemotherapy may be recommended either before or after bladder removal. For further information, see these links: