Bladder Cancer: Warning Signs and Detection
Bladder cancer typically presents with blood in the urine (hematuria), which is often the first sign. Any unexplained hematuria requires thorough investigation to rule out cancer, even if it appears only once. At Riverstone Urology, Dr. Libby has extensive experience in evaluating hematuria and diagnosing bladder cancer at early, treatable stages.
When to Seek Evaluation
Contact Dr. Libby if you experience: visible blood in urine, microscopic blood found in urinalysis, frequent urination, painful urination (dysuria), or pelvic pain. While many causes of hematuria are benign (kidney stones, infections, BPH), bladder cancer must always be ruled out, particularly in patients over 40 or those with significant smoking history.
Hematuria Workup
The evaluation begins with a detailed history and urinalysis to confirm hematuria and look for infection. Imaging of the upper urinary tract (CT scan or ultrasound) assesses the kidneys and ureters for masses or other abnormalities. The gold standard for bladder evaluation is cystoscopy, a minimally invasive procedure allowing direct visualization of the bladder interior.
Cystoscopy
Cystoscopy uses a thin, lighted scope to examine the bladder lining. Dr. Libby performs this in-office procedure with minimal discomfort. If any suspicious areas are found, small tissue samples (biopsies) can be obtained during the same procedure for pathologic analysis. This direct visualization is essential for detecting bladder cancer and determining the extent of disease.
Staging and Grading
Once bladder cancer is diagnosed, staging determines how deeply the cancer penetrates the bladder wall and whether it has spread. Grade and stage guide treatment decisions. Non-muscle-invasive cancers (confined to the lining) have better prognosis and different treatment approaches than muscle-invasive cancers.
Treatment: TURBT
Transurethral Resection of Bladder Tumor (TURBT)
For non-muscle-invasive bladder cancer, TURBT is often the primary treatment. Using a specialized scope, Dr. Libby carefully removes the tumor and surrounding tissue. This procedure is minimally invasive and allows complete tissue analysis. Complete TURBT, removing all visible disease plus a margin of normal tissue, is essential for optimal outcomes.
BCG Therapy
After TURBT, intravesical BCG (bacillus Calmette-Guérin) therapy is often recommended for intermediate and high-risk non-muscle-invasive cancers. BCG is administered directly into the bladder through a catheter in a series of treatments, typically weekly for six weeks, followed by maintenance therapy. BCG stimulates the immune system to attack remaining cancer cells, significantly reducing recurrence and progression rates.
Radical Cystectomy
For muscle-invasive bladder cancer or high-grade disease not responding to BCG, radical cystectomy (surgical removal of the bladder) may be necessary. This is often combined with removal of the prostate and seminal vesicles in men. Dr. Libby works with the care team to discuss reconstruction options, including neobladder creation or continent pouches, allowing urination through a valve system or through intermittent self-catheterization.
Chemotherapy
For advanced or muscle-invasive bladder cancer, neoadjuvant chemotherapy before surgery improves outcomes. Dr. Libby works with medical oncologists to coordinate comprehensive treatment plans.
Follow-Up Surveillance
After treatment, regular surveillance is crucial because bladder cancer commonly recurs. Surveillance includes periodic cystoscopy and urine cytology (microscopic examination of urine cells) to detect early recurrence. The frequency depends on cancer grade and stage.
Your Bladder Cancer Care
If you have hematuria or suspect bladder cancer, Dr. Libby provides expert, thorough evaluation and personalized treatment options. Early detection and appropriate treatment offer excellent outcomes for bladder cancer.