Presence of blood in urine is the most common way in which bladder cancer presents. Some patients may also present with pain or burning during urination without any evidence of infection. Ultrasound or a CT scan along with urine cytology will confirm the presence of cancer. Unusually , small cancers can only be diagnosed by doing cystoscpoic evaluation of bladder.
The initial treatment of bladder cancer is trans-urethral resection of bladder tumor. Under general or spinal anesthesia, a thin tube called cystoscope is passed through urine passage into the bladder. The tumor is directly visualized and cut out and sent for biopsy. For small tumors which are not muscle invasive this is all that needs to be done. Patient however has to remain on strict follow up which involves ultrasound, urine cytology and cystoscopy every three months.
For muscle invasive bladder tumors or extensive bladder tumors, the whole bladder is removed and a urinary diversion is created in the form of an ileal conduit or a neo-bladder using patient’s own intestines. This is a major surgery requiring 7 to 10 days of hospitalization.
In advanced and metastatic diseases radiotherapy and chemotherapy are used in conjunction with surgery to achieve maximum control of disease.