What the diagnosis means
The bladder stores urine. Most bladder cancers start in the urothelium, its inner lining. A key distinction is whether the tumour has reached the muscle in the bladder wall: it is described as non-muscle-invasive or muscle-invasive cancer. This difference changes the care plan. [1]
Symptoms to have checked
Blood in the urine may be visible or detected in a laboratory test, and it may come and go. Other symptoms include burning, urgency or frequent urination. Infections, stones and other conditions can cause similar symptoms. Do not assume bleeding is caused by an infection without assessment. [2]
What tests can tell us
Assessment includes your history and urine tests. Cystoscopy allows the inside of the bladder to be examined; biopsy or resection provides tissue to establish the diagnosis. Imaging helps assess other parts of the urinary tract and, when needed, the extent of the disease. [3]
The pathology report describes the tumour type and grade, which reflects features of the cells. Stage describes how far it has spread. Non-muscle-invasive does not automatically mean low risk: carcinoma in situ, for example, is a flat, high-grade lesion. [4]
Treatment and follow-up
For non-muscle-invasive tumours, transurethral resection may be the first treatment. Depending on risk, another resection or medicines placed inside the bladder, such as intravesical chemotherapy or BCG, may be considered. These treatments are different from an examination with a camera. [5]
High-risk or muscle-invasive tumours may need other strategies. Options can include removal of the bladder or, in selected patients, a bladder-preserving plan combining resection, chemotherapy and radiotherapy. Cancer that has spread needs a specific oncology plan. [6]
Follow-up remains part of care after the visible tumour has been removed. Its frequency depends on risk and may include cystoscopy and other tests. [7]
Preparing for your visit
Gather cystoscopy, pathology and imaging reports, together with details of previous treatment. Note when bleeding started, whether it has returned and which medicines you take.
- Does the tumour involve the muscle, and how certain is that finding?
- What is its grade and risk of recurrence or progression?
- Did the first resection provide enough information?
- What treatment and follow-up are proposed next?
Seek emergency care if bleeding is heavy or clots prevent you from passing urine. [8] · [9]
The specialist discusses this topic
Watch Dr. Hegel’s conversation on Sanando Dudas, published by Telever. The video is in Spanish.