• Vaginal or rectal examination will be performed.
• Urinalysis – a lab technician looks at your urine sample with a microscope to see if bladder cancer is there. This test is also used to see if bladder cancer has come back, since these tumours tend to recur. They check the urine for microscopic amounts of blood (urinalysis) and check for cancer cells (urine cytology).
• The urine cytology test examines cells that the bladder wall or the tumour have shed into the urine.
• Cystoscopy: A cystoscope is used to examine the bladder. This is a camera which goes up the urethra into the bladder. The doctor can use the cystoscope to snip off small samples of tissue, which are sent to the pathologist. Some cancers can be partially or totally removed using the cystoscope.
• IVP (intravenous pyelogram)
• A special dye is injected into the bloodstream passing into the urine, outlining the urinary system.
• CT scan:
• Cross section view of the organ; pinpoints the size and location of the tumour. This is used primarily to look for enlarged lymph glands.

Types and Stages

• Urothelial cancer (transitional cell) is the most common type.
• Bladder cancer can be described as either superficial or invasive. Superficial cancers are easier to treat and cure.
• Occasionally bladder cancers are squamous cell carcinomas, or adenocarcinomas or mixed cell.
• Superficial papillary tumours involve only the inner lining of the bladder (stages Ta and T1). They are usually low grade, which means they are less likely to grow and they spread more slowly.
• One type of superficial high grade disease is called carcinoma-in-situ. It is much more likely to behave aggressively, and may require cystectomy (removal of the bladder by surgery) if other treatments are not successful.
• More advanced tumours may go:
• into the superficial or deep bladder muscle (stages T2 and T3a).
• through the muscle (stage T3b).
• into other areas or organs (stage T4). These are usually high grade cancers and require radical treatment.

T describes the site and size of the main tumour (primary)

N describes involvement of lymph nodes

M relates to whether the cancer has spread (presence or absence of distant metastases).

• Removal of the tumour can often lead to cure.
• The extent and type of surgery depends on individual cases.
• Superficial papillary tumours are generally treated by transurethral resection (TUR surgery). A thin tube is inserted up the urethra. It has a camera and a wire loop on the end. The wire loop can be used to grab the cancerous tissue, or to burn the cancer with electricity through the wire.
• This procedure can be repeated as often as necessary. Periodic follow up is essential to detect any new cancers, as papillary tumours tend to keep coming back in different places in the bladder.
• Your urologist may give you some chemotherapy which will be placed in the bladder right after surgery. This will be removed before you leave the recovery room. This treatment prevents new tumours from forming by killing any free floating cells that may occur after surgery.
• More aggressive superficial tumours are treated by transurethral surgery (TUR), with postoperative chemotherapy instilled into the bladder plus a treatment called BCG.
• Once the bladder has healed from the surgery, your urologist may give you a treatment called BCG that is placed in your bladder once a week for six weeks. This is usually given 4-6 weeks after the TUR.
• Invasive or high grade tumours are usually treated by removal of the bladder (cystectomy). When this happens, the surgeon will divert the flow of urine.
• Urinary diversion involves attaching the ureters to a segment of small intestine which has been isolated to form a pouch for urine collection. One end of the pouch is brought through the abdominal wall to form a small opening or stoma. An external bag holds the urine until it is emptied manually.
• Newer methods of urinary diversion have been developed which allow intermittent release of urine from the stoma by catheter, or reconstruction of an internal bladder made from the bowel, which is connected to the urethra.
• In men, the prostate is removed with the bladder. A long term complication of bladder surgery may be erectile dysfunction.
• In women, the uterus, cervix, fallopian tubes and ovaries are usually removed as well as a top of the vagina. These organs are removed in order to ensure that all of the cancer is removed and maximizes the chance of cure in women.

• Chemotherapy shows some results, but the improvements are usually not dramatic or long-lasting.
• Chemotherapy can be done two ways:
• Intravesical – the drug(s) are injected into the bladder.
• Intravenous or systemic – this type of chemotherapy uses a needle in a vein to give the drugs to the patient.
• Intravenous chemotherapy may be administered along with surgery and radiation in the management of deep or metastatic cancer.
• There is evidence that some patients with invasive bladder cancers may benefit from chemotherapy given prior to their cystectomy.
• Chemotherapy is the standard treatment for patients in which the cancer has already spread (ie, to the lymph nodes or other organs).

• Radiation therapy can be an effective curative treatment. This can be a different option than removal of the bladder for some patients. Radiotherapy may be associated with significant bladder and bowel toxicity.
• Radiation interferes with male potency less often.
• In bladder cancer where cure is not possible, radiotherapy is done in some cases to relieve symptoms, discomfort or pain. Tumours can sometimes be effectively controlled in this manner.
• Radiotherapy does not prevent the development of new cancers in the bladder.
• Radiotherapy is not suitable for all patients..

• BCG is sometimes used. It is a drug that is considered a type of immunotherapy. Immunotherapies start your immune system fighting the cancer.
• Interferon is another type of immunotherapy that is sometimes useful in bladder cancer.

Follow-up after Treatment

• You will be returned to the care of your family doctor or specialist for regular followup. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
• Followup testing is based on your type of cancer and your individual circumstances.
• Life after Cancer focuses on the issues that cancer survivors can face.