John Han-Chih Chang, MD and Kenneth Blank, MD
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
I would like to find out any information you have on radical cystectomies for bladder cancer. I, specifically, would like to know what the red flags are indicating bladder cancer. How soon should they be investigated (i.e. does hematuria more than once usually tell a doctor to send you to a urologist for a finding)? How many positive hematurias should be found before a doctor would proceed with a urologist consult? Would waiting over two years, to investigate, hinder chances on healing the condition early or would it make no difference at all?
John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants for Oncolink, respond:
Thank you for your interest and question.
Radical cystectomy (removal of the entire urinary bladder) is the definitive treatment for invasive bladder cancer. Superficial bladder cancer would only require transurethral resection of the tumor followed by intravesical chemotherapy.
The "red flags" are hematuria (80-90%), urinary tract infection, urinary frequency or flank pain. Bladder cancer patients nearly all present with hematuria, but everyone with hematuria does not have bladder cancer. Hematuria could be due to kidney stones, urinary tract infections, trauma to kidneys or any urinary organ, etc... One cannot quantify "how many times" it takes before you should be more suspicious of the possibility, but your doctor should have an idea of when to be suspicious.
It is difficult to say whether waiting over two years to investigate will hinder the chance of "healing" or curing the disease. It is also very difficult to determine whether it remained superficial disease during most of the time and just became invasive or whether it has had time to invade deeply. Superficial disease is highly curable, while disease with invasion beyond the wall of the bladder and/or spread to regional lymph nodes are less likely to be controlled.