Urological Cancers (Kidney, Prostate, Bladder)
Kidney cancer
Diagnosis
Tests and procedures used to diagnose kidney cancer include:
Tests of your blood and your urine may give your doctor clues about what's causing your signs and symptoms.
Imaging tests allow your doctor to visualize a kidney tumor or abnormality. Imaging tests might include ultrasound, X-ray, CT or MRI.
In some situations, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer. This procedure isn't always needed.
Kidney cancer staging
Once your doctor identifies a kidney lesion that might be kidney cancer, the next step is to determine the extent (stage) of the cancer. Staging tests for kidney cancer may include additional CT scans or other imaging tests your doctor feels are appropriate.
The stages of kidney cancer are indicated by Roman numerals that range from I to IV, with the lowest stages indicating cancer that is confined to the kidney. By stage IV, the cancer is considered advanced and may have spread to the lymph nodes or to other areas of the body.
Treatment
Kidney cancer treatment usually begins with surgery to remove the cancer. For cancers confined to the kidney, this may be the only treatment needed. If the cancer has spread beyond the kidney, additional treatments may be recommended.
Together, you and your treatment team can discuss your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment.
Surgery
For most kidney cancers, surgery is the initial treatment. The goal of surgery is to remove the cancer while preserving normal kidney function, when possible. Operations used to treat kidney cancer include:
A complete (radical) nephrectomy involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues such as the lymph nodes, adrenal gland or other structures.
The surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen (laparoscopic or robotic-assisted laparoscopic nephrectomy).
The surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen (laparoscopic or robotic-assisted laparoscopic nephrectomy).
Also called kidney-sparing or nephron-sparing surgery, the surgeon removes the cancer and a small margin of healthy tissue that surrounds it rather than the entire kidney. It can be done as an open procedure, or laparoscopically or with robotic assistance.
Kidney-sparing surgery is a common treatment for small kidney cancers and it may be an option if you have only one kidney. When possible, kidney-sparing surgery is generally preferred over a complete nephrectomy to preserve kidney function and reduce the risk of later complications, such as kidney disease and the need for dialysis.
Kidney-sparing surgery is a common treatment for small kidney cancers and it may be an option if you have only one kidney. When possible, kidney-sparing surgery is generally preferred over a complete nephrectomy to preserve kidney function and reduce the risk of later complications, such as kidney disease and the need for dialysis.
The type of surgery your doctor recommends will be based on your cancer and its stage, as well as your overall health.
Nonsurgical treatments
Small kidney cancers are sometimes destroyed using nonsurgical treatments, such as heat and cold. These procedures may be an option in certain situations, such as in people with other health problems that make surgery risky.
Options may include:
Options may include:
During cryoablation, a special hollow needle is inserted through your skin and into the kidney tumor using ultrasound or other image guidance. Cold gas in the needle is used to freeze the cancer cells.
During radiofrequency ablation, a special probe is inserted through your skin and into the kidney tumor using ultrasound or other imaging to guide placement of the probe. An electrical current is run through the needle and into the cancer cells, causing the cells to heat up or burn.
Treatments for advanced and recurrent kidney cancer
Kidney cancer that comes back after treatment and kidney cancer that spreads to other parts of the body may not be curable. Treatments may help control the cancer and keep you comfortable. In these situations, treatments may include:
If the cancer can't be removed completely during an operation, surgeons may work to remove as much of the cancer as possible. Surgery may also be used to remove cancer that has spread to another area of the body.
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your doctor may recommend testing your cancer cells to see which targeted drugs may be most likely to be effective.
Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones and brain.
Clinical trials are research studies that give you a chance to try the latest innovations in kidney cancer treatment. Some clinical trials assess the safety and effectiveness of potential treatments. Other clinical trials try to find new ways to prevent or detect disease. If you're interested in trying a clinical trial, discuss the benefits and risks with your doctor.
Alternative medicine
No alternative medicine therapies have been proved to cure kidney cancer. But some integrative treatments can be combined with standard medical therapies to help you cope with side effects of cancer and its treatment, such as distress.
People with cancer often experience distress. If you’re distressed, you may have difficulty sleeping and find yourself constantly thinking about your cancer. You may feel angry or sad.
Discuss your feelings with your doctor. Specialists can help you sort through your feelings and help you devise strategies for coping. In some cases, medications may help.
Integrative medicine treatments may also help you feel better, including:
- Art therapy
- Exercise
- Massage therapy
- Meditation
- Music therapy
- Relaxation exercises
- Spirituality
Talk with your doctor if you’re interested in these treatment options.
Coping and support
Each person copes with a cancer diagnosis in his or her own way. Once the fear that comes with a diagnosis begins to lessen, you can find ways to help you cope with the daily challenges of cancer treatment and recovery. These coping strategies may help:
Ask your doctor for details of your diagnosis, such as what type of cancer you have and the stage. This information can help you learn about the treatment options. Good sources of information include the National Cancer Institute and the American Cancer Society.
Take care of yourself during cancer treatment. Eat a healthy diet full of fruits and vegetables, be physically active when you feel up to it, and get enough sleep so that you wake feeling rested each day.
Set aside time for yourself each day. Time spent reading, relaxing or listening to music can help you relieve stress. Write your feelings down in a journal.
Your friends and family are concerned about your health, so let them help you when they offer. Let them take care of everyday tasks — running errands, preparing meals and providing transportation — so that you can focus on your recovery. Talking about your feelings with close friends and family also can help you relieve stress and tension.
If you feel overwhelmed, depressed or so anxious that it's difficult to function, consider getting mental health counseling. Talk with your doctor or someone else from your health care team about getting a referral to a mental health professional, such as a certified social worker, psychologist or psychiatrist.
Preparing for your appointment
Start by making an appointment with your primary care doctor if you have signs or symptoms that worry you. If your doctor suspects you may have kidney cancer, you may be referred to a doctor who specializes in urinary tract diseases and conditions (urologist) or to a doctor who treats cancer (oncologist).
Consider taking a family member or friend along. Sometimes it can be hard to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
What you can do
At the time you make the appointment, ask if there’s anything you need to do in advance, such as restrict your diet. Then make a list of:
including any that may seem unrelated to the reason for your appointment
including any major stresses or recent life changes
vitamins, herbs or other supplements that you're taking
your doctor
List your questions from most to least important in case time runs out. Some basic questions to ask your doctor include:
- Do I have kidney cancer?
- If so, has my cancer spread beyond my kidney?
- Will I need more tests?
- What are my treatment options?
- What are the potential side effects of each treatment?
- Can my kidney cancer be cured?
- How will cancer treatment affect my daily life?
- Is there one treatment option you feel is best for me?
- I have these other health conditions. How can I best manage them together?
- Should I see a specialist?
- Are there brochures or other printed material that I can have? What websites do you recommend?
Don’t hesitate to ask additional questions that may occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them so that you’ll have time to cover any points you want to focus on. Your doctor may ask:
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
Prostate cancer
Diagnosis – Screening for prostate cancer
Testing healthy men with no symptoms for prostate cancer is controversial. There is some disagreement among medical organizations whether the benefits of testing outweigh the potential risks.
Most medical organizations encourage men in their 50s to discuss the pros and cons of prostate cancer screening with their doctors. The discussion should include a review of your risk factors and your preferences about screening.
You might consider starting the discussions sooner if you’re a Black person, have a family history of prostate cancer or have other risk factors.
Prostate screening tests might include:
During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests.
A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than usual level is found, it may indicate prostate infection, inflammation, enlargement or cancer.
Diagnosing prostate cancer
If prostate cancer screening detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as:
During a transrectal ultrasound, a small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.
In some situations, your doctor may recommend an MRI scan of the prostate to create a more detailed picture. MRI images may help your doctor plan a procedure to remove prostate tissue samples.
To determine whether there are cancer cells in the prostate, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.
Determining whether prostate cancer is aggressive
When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. A doctor in a lab examines a sample of your cancer cells to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly.
Techniques used to determine the aggressiveness of the cancer include:
The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer), though the lower part of the range isn't used as often.
Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.
Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.
Genomic testing analyzes your prostate cancer cells to determine which gene mutations are present. This type of test can give you more information about your prognosis. But it's not clear who might benefit most from this information, so the tests aren't widely used. Genomic tests aren't necessary for every person with prostate cancer, but they might provide more information for making treatment decisions in certain situations.
Determining whether the cancer has spread
Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, one or more of the following imaging tests may be recommended:
- Bone scan
- Ultrasound
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET) scan
Not every person should have every test. Your doctor will help determine which tests are best for your individual situation.
Your doctor uses the information from these tests to assign your cancer a stage. Prostate cancer stages are indicated by Roman numerals ranging from I to IV. The lowest stages indicate the cancer is confined to the prostate. By stage IV, the cancer has grown beyond the prostate and may have spread to other areas of the body.
Treatment
Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, whether it has spread and your overall health, as well as the potential benefits or side effects of the treatment.
Immediate treatment may not be necessary
Low-grade prostate cancer may not need treatment right away. For some, treatment may never be needed. Instead, doctors sometimes recommend active surveillance.
In active surveillance, regular follow-up blood tests, rectal exams and prostate biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation.
Active surveillance may be an option for cancer that isn’t causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult.
Surgery to remove the prostate
Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes.
Surgery is an option for treating cancer that’s confined to the prostate. It’s sometimes used to treat advanced prostate cancer in combination with other treatments.
To access the prostate, surgeons may use a technique that involves:
During robot-assisted laparoscopic prostatectomy, surgical instruments are attached to a mechanical device (robot) and inserted through several small incisions in your abdomen. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Most prostate cancer operations are done using this technique.
During retropubic surgery, the surgeon makes one long incision in your lower abdomen to access and remove the prostate gland. This approach is much less common, but may be necessary in certain situations.
Discuss with your doctor which type of surgery is best for your specific situation.
Radiation therapy
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy treatments may involve:
During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. Some medical centers offer a shorter course of radiation therapy that uses higher doses of radiation spread over fewer days.
External beam radiation is an option for treating cancer that's confined to the prostate. It can also be used after surgery to kill any cancer cells that might remain if there's a risk that the cancer could spread or come back. For prostate cancer that spreads to other areas of the body, such as the bones, radiation therapy can help slow the cancer's growth and relieve symptoms, such as pain.
External beam radiation is an option for treating cancer that's confined to the prostate. It can also be used after surgery to kill any cancer cells that might remain if there's a risk that the cancer could spread or come back. For prostate cancer that spreads to other areas of the body, such as the bones, radiation therapy can help slow the cancer's growth and relieve symptoms, such as pain.
Brachytherapy involves placing radioactive sources in your prostate tissue. Most often, the radiation is contained in rice-sized radioactive seeds that are inserted into your prostate tissue. The seeds deliver a low dose of radiation over a long period of time. Brachytherapy is one option for treating cancer that hasn't spread beyond the prostate.
In some situations, doctors may recommend both types of radiation therapy.
Freezing or heating prostate tissue
Ablative therapies destroy prostate tissue with cold or heat. Options may include:
Cryoablation or cryotherapy for prostate cancer involves using a very cold gas to freeze the prostate tissue. The tissue is allowed to thaw and the procedure repeats. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.
High-intensity focused ultrasound (HIFU) treatment uses concentrated ultrasound energy to heat the prostate tissue and cause it to die.
These treatments may be considered for treating very small prostate cancers when surgery isn’t possible. They may also be used to treat advanced prostate cancers if other treatments, such as radiation therapy, haven’t helped.
Researchers are studying whether cryotherapy or HIFU to treat one part of the prostate might be an option for cancer that’s confined to the prostate. Referred to as “focal therapy,” this strategy identifies the area of the prostate that contains the most aggressive cancer cells and treats that area only. Studies have found that focal therapy reduces the risk of side effects. But it’s not clear whether it offers the same survival benefits as treatment to the entire prostate.
Hormone therapy
Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly.
Hormone therapy options include:
Hormone therapy options include:
Certain medications — known as luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) agonists and antagonists — prevent your body's cells from receiving messages to make testosterone. As a result, your testicles stop producing testosterone.
These medications, known as anti-androgens, usually are given in conjunction with LHRH agonists. That's because LHRH agonists can cause a temporary increase in testosterone before testosterone levels decrease.
Removing your testicles reduces testosterone levels in your body quickly and significantly. But unlike medication options, surgery to remove the testicles is permanent and irreversible.
Hormone therapy is often used to treat advanced prostate cancer to shrink the cancer and slow its growth.
Hormone therapy is sometimes used before radiation therapy to treat cancer that hasn’t spread beyond the prostate. It helps shrink the cancer and increases the effectiveness of radiation therapy.
Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.
Chemotherapy may be a treatment option for treating prostate cancer that has spread to other areas of the body. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Prostate cancer immunotherapy can involve:
Sipuleucel-T (Provenge) treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer and then injects the cells back into your body through a vein. It's an option for treating advanced prostate cancer that no longer responds to hormone therapy.
Immunotherapy drugs that help the immune system cells identify and attack the cancer cells are an option for treating advanced prostate cancers that no longer respond to hormone therapy.
Targeted drug therapy
Targeted therapy drugs may be recommended to treat advanced or recurrent prostate cancer if hormone therapy isn’t working.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.
Alternative medicine
No complementary or alternative treatments will cure prostate cancer. However, complementary and alternative prostate cancer treatments may help you cope with the side effects of cancer and its treatment.
Nearly everyone diagnosed with cancer experiences some distress at some point. If you’re distressed, you may feel sad, angry or anxious. You may experience difficulty sleeping or find yourself constantly thinking about your cancer.
Several complementary medicine techniques may help you cope with your distress, including:
- Art therapy
- Dance or movement therapy
- Exercise
- Meditation
- Music therapy
- Relaxation techniques
- Spirituality
Discuss your feelings and concerns with your doctor. In some cases, treatment for distress may require medications.
Coping and support
When you receive a diagnosis of prostate cancer, you may experience a range of feelings — including disbelief, fear, anger, anxiety and depression. With time, each person finds his own way of coping with a prostate cancer diagnosis.
Until you find what works for you, try to:
Until you find what works for you, try to:
Learn as much as you need to know about your cancer and its treatment in order to understand what to expect from treatment and life after treatment. Ask your doctor, nurse or other health care professional to recommend some reliable sources of information to get you started.
Your friends and family can provide support during and after your treatment. They may be eager to help with the small tasks you won't have energy for during treatment. And having a close friend or family member to talk to can be helpful when you're feeling stressed or overwhelmed.
Friends and family can't always understand what it's like to face cancer. Other cancer survivors can provide a unique network of support. Ask your health care providers about support groups or community organizations that can connect you with other cancer survivors. Organizations such as the American Cancer Society offer online chat rooms and discussion forums.
Take care of yourself during cancer treatment by eating a diet full of fruits and vegetables. Try to exercise most days of the week. Get enough sleep each night so that you wake feeling rested.
If you experience erectile dysfunction, your natural reaction may be to avoid all sexual contact. But consider touching, holding, hugging and caressing as ways to continue sharing sexuality with your partner.
Preparing for your appointment
If you have signs or symptoms that worry you, start by seeing your family doctor.
If your doctor suspects you may have a problem with your prostate, you may be referred to a urinary tract specialist (urologist). If you’re diagnosed with prostate cancer, you may be referred to a cancer specialist (oncologist) or a specialist who uses radiation therapy to treat cancer (radiation oncologist).
Because appointments can be brief, and because there’s often a lot of information to discuss, it’s a good idea to be prepared. Here’s some information to help you get ready and what to expect from your doctor.
What you can do
At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
including any that may seem unrelated to the reason for which you scheduled the appointment.
including any major stresses or recent life changes.
vitamins or supplements that you're taking.
Sometimes it can be difficult to remember all the information provided during an appointment.
Someone who accompanies you may remember something that you missed or forgot.
Someone who accompanies you may remember something that you missed or forgot.
your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For prostate cancer, some basic questions to ask your doctor include:
• Do I have prostate cancer?
• How large is my prostate cancer?
• Has my prostate cancer spread beyond my prostate?
• What’s my Gleason score?
• What’s my prostate-specific antigen (PSA) level?
• Will I need more tests?
• What are my treatment options?
• Is there one treatment option you think is best for me?
• Do I need cancer treatment right away, or is it possible to wait and see if the cancer grows?
• What are the potential side effects of each treatment?
• What is the chance that my prostate cancer will be cured with treatment? If so, does insurance typically cover the services of a specialist?
• If you had a friend or family member in my situation, what would you recommend?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• How large is my prostate cancer?
• Has my prostate cancer spread beyond my prostate?
• What’s my Gleason score?
• What’s my prostate-specific antigen (PSA) level?
• Will I need more tests?
• What are my treatment options?
• Is there one treatment option you think is best for me?
• Do I need cancer treatment right away, or is it possible to wait and see if the cancer grows?
• What are the potential side effects of each treatment?
• What is the chance that my prostate cancer will be cured with treatment? If so, does insurance typically cover the services of a specialist?
• If you had a friend or family member in my situation, what would you recommend?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
Bladder cancer
Diagnosis – Diagnosing bladder cancer
Tests and procedures used to diagnose bladder cancer may include:
To perform cystoscopy, your doctor inserts a small, narrow tube (cystoscope) through your urethra. The cystoscope has a lens that allows your doctor to see the inside of your urethra and bladder, to examine these structures for signs of disease. Cystoscopy can be done in a doctor's office or in the hospital.
Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, allow your doctor to examine the structures of your urinary tract.
During a CT urogram, a contrast dye injected into a vein in your hand eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.
Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.
During a CT urogram, a contrast dye injected into a vein in your hand eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract and help your doctor identify any areas that might be cancer.
Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, your doctor threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.
Determining the extent of the cancer
After confirming that you have bladder cancer, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.
Tests may include:
Tests may include:
- CT scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
- Bone scan
- Chest X-ray
Your doctor uses information from these procedures to assign your cancer a stage. The stages of bladder cancer are indicated by Roman numerals ranging from 0 to IV. The lowest stages indicate a cancer that’s confined to the inner layers of the bladder and that hasn’t grown to affect the muscular bladder wall. The highest stage — stage IV — indicates cancer that has spread to lymph nodes or organs in distant areas of the body
Bladder cancer grade
Bladder cancers are further classified based on how the cancer cells appear when viewed through a microscope. This is known as the grade, and your doctor may describe bladder cancer as either low grade or high grade:
This type of cancer has cells that are closer in appearance and organization to normal cells (well differentiated). A low-grade tumor usually grows more slowly and is less likely to invade the muscular wall of the bladder than is a high-grade tumor.
This type of cancer has cells that are abnormal-looking and that lack any resemblance to normal-appearing tissues (poorly differentiated). A high-grade tumor tends to grow more aggressively than a low-grade tumor and may be more likely to spread to the muscular wall of the bladder and other tissues and organs.
Treatment
Treatment options for bladder cancer depend on a number of factors, including the type of cancer, grade of the cancer and stage of the cancer, which are taken into consideration along with your overall health and your treatment preferences.
Bladder cancer treatment may include:
Bladder cancer treatment may include:
to remove the cancer cells
to treat cancers that are confined to the lining of the bladder but have a high risk of recurrence or progression to a higher stage
to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment when surgery isn't an option
to destroy cancer cells, often as a primary treatment when surgery isn't an option or isn't desired
to trigger the body's immune system to fight cancer cells, either in the bladder or throughout the body
to treat advanced cancer when other treatments haven't helped
A combination of treatment approaches may be recommended by your doctor and members of your care team.
Bladder cancer surgery
Approaches to bladder cancer surgery might include:
TURBT is a procedure to diagnose bladder cancer and to remove cancers confined to the inner layers of the bladder — those that aren't yet muscle-invasive cancers. During the procedure, a surgeon passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Alternatively, a high-energy laser may be used.
Because doctors perform the procedure through the urethra, you won't have any cuts (incisions) in your abdomen.
As part of the TURBT procedure, your doctor may recommend a one-time injection of cancer-killing medication (chemotherapy) into your bladder to destroy any remaining cancer cells and to prevent cancer from coming back. The medication remains in your bladder for a period of time and then is drained.
Because doctors perform the procedure through the urethra, you won't have any cuts (incisions) in your abdomen.
As part of the TURBT procedure, your doctor may recommend a one-time injection of cancer-killing medication (chemotherapy) into your bladder to destroy any remaining cancer cells and to prevent cancer from coming back. The medication remains in your bladder for a period of time and then is drained.
Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, your surgeon removes only the portion of the bladder that contains a single cancerous tumor.
A radical cystectomy is an operation to remove the entire bladder and the surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy may involve removal of the uterus, ovaries and part of the vagina.
Radical cystectomy can be performed through an incision on the lower portion of the belly or with multiple small incisions using robotic surgery. During robotic surgery, the surgeon sits at a nearby console and uses hand controls to precisely move robotic surgical instruments.
A radical cystectomy is an operation to remove the entire bladder and the surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy may involve removal of the uterus, ovaries and part of the vagina.
Radical cystectomy can be performed through an incision on the lower portion of the belly or with multiple small incisions using robotic surgery. During robotic surgery, the surgeon sits at a nearby console and uses hand controls to precisely move robotic surgical instruments.
After a radical cystectomy, your surgeon must create a new way for urine to leave your body (urinary diversion). One option for urinary diversion is neobladder reconstruction. Your surgeon creates a sphere-shaped reservoir out of a piece of your intestine. This reservoir, often called a neobladder, sits inside your body and is attached to your urethra. The neobladder allows most people to urinate normally. A small number of people difficulty emptying the neobladder and may need to use a catheter periodically to drain all the urine from the neobladder.
For this type of urinary diversion, your surgeon creates a tube (ileal conduit) using a piece of your intestine. The tube runs from your ureters, which drain your kidneys, to the outside of your body, where urine empties into a pouch (urostomy bag) you wear on your abdomen.
During this type of urinary diversion procedure, your surgeon uses a section of intestine to create a small pouch (reservoir) to hold urine, located inside your body. You drain urine from the reservoir through an opening in your abdomen using a catheter a few times each day.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination.
Chemotherapy drugs can be given:
Intravenous chemotherapy is frequently used before bladder removal surgery to increase the chances of curing the cancer. Chemotherapy may also be used to kill cancer cells that might remain after surgery. In certain situations, chemotherapy may be combined with radiation therapy.
During intravesical chemotherapy, a tube is passed through your urethra directly to your bladder. The chemotherapy is placed in the bladder for a set period of time before being drained. It can be used as the primary treatment for superficial bladder cancer, where the cancer cells affect only the lining of the bladder and not the deeper muscle tissue.
Radiation therapy
Radiation therapy uses beams of powerful energy, such as X-rays and protons, to destroy the cancer cells. Radiation therapy for bladder cancer usually is delivered from a machine that moves around your body, directing the energy beams to precise points.
Radiation therapy is sometimes combined with chemotherapy to treat bladder cancer in certain situations, such as when surgery isn’t an option or isn’t desired.
Immunotherapy
Immunotherapy is a drug treatment that helps your immune system to fight cancer.
Immunotherapy can be given:
Immunotherapy can be given:
Intravesical immunotherapy might be recommended after TURBT for small bladder cancers that haven't grown into the deeper muscle layers of the bladder. This treatment uses bacillus Calmette-Guerin (BCG), which was developed as a vaccine used to protect against tuberculosis. BCG causes an immune system reaction that directs germ-fighting cells to the bladder.
Immunotherapy can be given intravenously for bladder cancer that's advanced or that comes back after initial treatment. Several immunotherapy drugs are available. These drugs help your immune system identify and fight the cancer cells.
Targeted therapy
Targeted therapy drugs focus on specific weaknesses present within cancer cells. By targeting these weaknesses, targeted drug treatments can cause cancer cells to die. Your cancer cells may be tested to see if targeted therapy is likely to be effective.
Targeted therapy may be an option for treating advanced bladder cancer when other treatments haven’t helped.
Bladder preservation
In certain situations, people with muscle-invasive bladder cancer who don’t want to undergo surgery to remove the bladder may consider trying a combination of treatments instead. Known as trimodality therapy, this approach combines TURBT, chemotherapy and radiation therapy.
First, your surgeon performs a TURBT procedure to remove as much of the cancer as possible from your bladder while preserving bladder function. After TURBT, you undergo a regimen of chemotherapy along with radiation therapy.
If, after trying trimodality therapy, not all of the cancer is gone or you have a recurrence of muscle-invasive cancer, your doctor may recommend a radical cystectomy.
After bladder cancer treatment
Bladder cancer may recur, even after successful treatment. Because of this, people with bladder cancer need follow-up testing for years after successful treatment. What tests you’ll have and how often depends on your type of bladder cancer and how it was treated, among other factors.
In general, doctors recommend a test to examine the inside of your urethra and bladder (cystoscopy) every three to six months for the first few years after bladder cancer treatment. After a few years of surveillance without detecting cancer recurrence, you may need a cystoscopy exam only once a year. Your doctor may recommend other tests at regular intervals as well.
People with aggressive cancers may undergo more-frequent testing. Those with less aggressive cancers may undergo testing less often.
Coping and support
Living with the concern that your bladder cancer may recur can leave you feeling as if you have little control over your future. But while there’s no way to ensure that your bladder cancer won’t recur, you can take steps to manage the stress.
Over time you’ll find what works for you, but until then, you might:
When you finish bladder cancer treatment, ask your doctor to create a personalized schedule of follow-up tests. Before each follow-up cystoscopy exam, expect to have some anxiety. You may fear that cancer has come back or worry about the uncomfortable exam. But don't let this stop you from going to your appointment. Instead, plan ways to cope with your concerns. Write your thoughts in a journal, talk with a friend or use relaxation techniques, such as meditation.
Take care of yourself by adjusting your diet to include plenty of fruits, vegetables and whole grains. Exercise for at least 30 minutes most days of the week. Get enough sleep so that you wake feeling rested.
Connect with bladder cancer survivors who are experiencing the same fears you're feeling. Contact your local chapter of the American Cancer Society to ask about support groups in your area.
Preparing for your appointment
Start by seeing your family doctor if you have any signs or symptoms that worry you, such as blood in your urine. Your doctor may suggest tests and procedures to investigate your signs and symptoms.
If your doctor suspects that you may have bladder cancer, you may be referred to a doctor who specializes in treating diseases and conditions of the urinary tract (urologist). In some cases, you may be referred to other specialists, such as doctors who treat cancer (oncologists).
Because there’s often a lot of information to discuss, it’s a good idea to be well prepared. Here’s some information to help you get ready, and what to expect from your doctor.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
including any major stresses or recent life changes.
vitamins or supplements that you're taking along with dosages.
Sometimes it's difficult to remember all of the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
your doctor.
Preparing a list of questions can help you make the most of your time with your doctor. For bladder cancer, some basic questions to ask include:
• Do I have bladder cancer or could my symptoms be caused by another condition?
•What is the stage of my cancer?
• Will I need any additional tests?
• What are my treatment options?
• Can any treatments cure my bladder cancer?
• What are the potential risks of each treatment?
• Is there one treatment that you feel is best for me?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you’re prescribing me?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?
•What is the stage of my cancer?
• Will I need any additional tests?
• What are my treatment options?
• Can any treatments cure my bladder cancer?
• What are the potential risks of each treatment?
• Is there one treatment that you feel is best for me?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you’re prescribing me?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
Emergency Cases
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