Bladder cancer

Clarifying the stage

Cystoscopy and transurethral resection of bladder tumour (TURBT) help establish the diagnosis. The pathology report describes grade and whether the tumour has reached the bladder muscle. Repeat resection or further imaging may sometimes be needed.

Blood in the urine should be assessed even if it is painless or occurs only once. It can have causes other than cancer, but should not be assumed to be harmless.

Different treatment pathways

For non-muscle-invasive disease, care may involve TURBT, medicines delivered into the bladder and continued cystoscopic monitoring. High-risk or treatment-resistant disease may lead to a discussion of bladder removal.

Muscle-invasive cancer may require radical cystectomy with consideration of systemic treatment. A bladder-preserving combination of resection, chemotherapy and radiotherapy is suitable for some patients after careful assessment.

Discussing cystectomy and reconstruction

Dr. Sachin’s practice includes robotic cystectomy and urinary reconstruction. The consultation can explore an ileal conduit, a neobladder where appropriate, and whether organ or nerve preservation is oncologically reasonable.

These decisions require discussion of kidney function, the cancer’s location, continence, sexual health and the ability to manage the proposed reconstruction.

Preparing for a treatment decision

• Bring previous TURBT operation notes, pathology reports and scans.
• Record any BCG or other bladder treatments and their dates.
• Ask whether a repeat pathology or multidisciplinary review would help.
• Discuss stoma support, continence and recovery before surgery.

Common questions