• Symptoms

Bladder cancer signs and symptoms may include:

• Blood in urine (hematuria).
• Frequent urination.
• Incomplete emptying of the bladder.
• Painful or burning urination.
• Low back pain.

• Risk factors

Factors that may increase bladder cancer risk include:

• Cigarette smoke: Smoking cigarettes more than doubles your risk of developing bladder cancer. 
• Radiation exposure: Radiation therapy to treat cancer may increase your risk of developing bladder cancer.
• Exposure to certain chemicals: Studies show that people who work with certain chemicals used in dyes, rubber, leather, paint, some textiles and hairdressing supplies may have an increased risk.
• Frequent bladder infections: People who have frequent bladder infections, bladder stones or other urinary tract infections may be at an increased risk of squamous cell carcinoma.
• Chronic catheter use: People who have a chronic need for a catheter in their bladder may be at risk for squamous cell carcinoma.

• Diagnosis:

Healthcare providers do a series of tests to diagnose bladder cancer, including:

• Cytology: Providers examine cells under a microscope for signs of cancer.
• Cystoscopy: This is the primary test to identify and diagnose bladder cancer. Providers may also take tissue samples while doing cystoscopies.

If cytology and cystoscopy results show you have bladder cancer, healthcare providers then do tests to learn more about the cancer, including:

• Magnetic resonance imaging (MRI) : This imaging take detailed images of your bladder.
• Computed tomography (CT) scan: Providers may do this test to see if cancer has spread outside of your bladder.
• Bone scan: Like a chest X-ray, bone scans check for signs bladder cancer has spread to your bones.

Healthcare providers then use what they learn about the cancer to stage the disease. Staging cancer helps providers plan treatment and develop a potential prognosis or expected outcome.

• 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:

• Surgery, to remove the cancer cells
• Chemotherapy in the bladder (intravesical chemotherapy), 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
• Chemotherapy for the whole body (systemic chemotherapy), 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
• Radiation therapy, to destroy cancer cells, often as a primary treatment when surgery isn't an option or isn't desired
• Immunotherapy, to trigger the body's immune system to fight cancer cells, either in the bladder or throughout the body
• Targeted therapy, 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.

Surgery:

Surgery is a common bladder cancer treatment. Providers chose surgical options based on the cancer stage. 

• Transurethral resection of bladder tumor (TURBT). 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. Because doctors perform the procedure through the urethra, you won't have any cuts (incisions) in your abdomen.
• Partial cystectomy: Partial cystectomy is surgery to remove part of the bladder that contains the tumor. This may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
• Radical cystectomy with urinary diversion: Radical cystectomy is surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle layers or when non-muscle-invasive bladder cancer involves a large part of the bladder.

When the bladder must be removed, the surgeon performs a procedure called urinary diversion to create another way for the body to store and pass urine.

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:

• Through a vein (intravenously). 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.
• Directly into the bladder (intravesical 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 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:

• Directly into the bladder (intravesical therapy). 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).
• Through a vein (intravenously). 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 cancer care at Shefa-El Orman:

At Shefa-El Orman Hospital, you have access to:

• Surgeons who are specially trained to treat bladder cancers. The Shefa-El Orman onco-surgeons  who treat bladder cancer have additional training and specialize in this area of surgery. This expertise and specialization assures that you receive treatment that's tailored to fit your specific needs and assures the best outcomes possible.
• The latest in bladder cancer treatment. We use the newest technology to improve chances for positive outcomes. If invasive cancer requires bladder removal surgery (cystectomy), surgeons are skilled in advanced techniques, such as surgery to form a new bladder (neobladder reconstruction).
• A full range of treatment options to consider. Our doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals. The range of treatments offered to people with bladder cancer includes surgery, chemotherapy, immunotherapy, and radiation therapy.
• Collaboration. At Shefa-El Orman, urology oncosurgeon, oncologists, radiation oncologists, pathologists, radiologists, and other specialists work as a multidisciplinary team to provide comprehensive care for people with bladder cancer. Your care team is prepared with the knowledge and resources to provide you with exactly the care you need.
• Experience. Shefa-El Orman doctors have extensive experience caring for people with bladder cancer. Each year, more than 4,000 people with bladder cancer seek care at Shefa-El Orman Hospital.

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1. diagnostics:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• general clinical examination
• laboratory tests:
• complete blood count
• clinical urine test 
• kidney function test (creatinine, urea)
• blood coagulation analysis (aPTT, PT, INR)
• inflammation indicators (CRP, ESR)
• tumor markers
• pelvic ultrasound, CT scan, MRI scan (if indicated clinically)
• cystoscopy with biopsy 
• histological examination with immunohistochemistry (if indicated clinically)
• nursing services
• consultation of related specialists
• consultation of the chief physician and all leading experts
• development of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 3 days

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1. surgical:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• urological examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• tumor marker, PSA
• ultrasound of the urogenital system
• CT/MRI of the abdomen and pelvis
• preoperative care
• operations: 
• radical cystectomy and subsequent reconstruction of the bladder
• radical cystectomy and iliac conduit
• partial cystectomy  
• histologically and immunohistochemically examination of the excised tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 10 days

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1. bladder preservation protocol using concurrent chemo radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI and ultrasound abdomen (if indicated clinically)  
• Cystoscopy and biopsy with histopathological evaluation (if indicated clinically)
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators of blood coagulation
• tumor markers (PSA)
• CT planning of radiation therapy
• Physics calculation  
• full course of conventional radiation therapy 
• chemotherapy weekly with radiotherapy, the cost of medicines is included  
• symptomatic treatment
• cost of essential medicines and materials including masks and mattress used for fixation.
• nursing services
• control examinations
• cystoscopy evaluation and follow up every 3 months (after the end of chemoradiotherapy needs more arrangement) (if clinically indicated).
• consultations of related specialists

• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

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1. chemotherapy or immunotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT / MRI and ultrasound scans (if indicated clinically)
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators of blood coagulation
• tumor markers (PSA)
• urine cytology
• individual plan of the chemotherapy (the cost of medicines is included) the cost defined per cycle.
• symptomatic treatment
• nursing services
• control examinations
• consultations of related specialists
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the day hospital procedure, without mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 9 days