If you have symptoms that may signal bladder cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have bladder cancer and if it has spread. These tests also may be used to find out if treatment is working.

Blood and urine tests

Cystoscopy: This is the most frequent and reliable test for bladder cancer. A thin tube with a camera on the end (cystoscope) is inserted into the bladder through the urethra. The cystoscope also can be used to take a tissue sample for biopsy and treat superficial tumors without surgery. However, cystoscopy is not always accurate when performed alone, and flat lesions (carcinoma in situ) and small papillary tumors can be missed.

We also use white light cystoscopy and NBI to diagnose cancer as well.

Imaging tests, which may include
  • CT Urogram
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • Bone scan
  • Chest X-ray
Bladder Cancer Staging

If you are diagnosed with bladder cancer, your doctor will determine the stage of the disease. Staging is a way of classifying how much disease is in the body and where it has spread when it is diagnosed. This information helps your doctor plan the best type of treatment for you.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Stage 0 (papillary carcinoma and carcinoma in situ): Abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue.

  • Stage 0a (also called papillary carcinoma) may look like tiny mushrooms growing from the lining of the bladder.
  • Stage 0is (also called carcinoma in situ) is a flat tumor on the tissue lining the inside of the bladder.

Stage I: Cancer has formed and spread to the layer of tissue under the inner lining of the bladder.

Stage II: Cancer has spread to the muscle wall of the bladder.

Stage III: Cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV: Cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.



Advanced surgical and reconstructive procedures

  • Laparoscopic robotic surgery
  • Conformal 3D and IMRT radiotherapy / proton
  • Immunotherapy, including Bacillus Calmette-Guérin (BCG)
  • Latest chemotherapy options

Our skilled surgeons, who utilize the latest bladder cancer and reconstruction techniques, are among the most experienced in the nation. This can make an essential difference in the success of your treatment and recovery.

And, as one of the nation’s largest cancer research centres, we offer a variety of clinical trials of new therapies for bladder cancer.


Surgery is a integral part of almost every bladder cancer patient’s treatment. Other types of treatment often are given before or after surgery.

  • Transurethral resection (TUR) may be used for early-stage or superficial bladder cancer. A resectoscope, which is a thin tool with a wire loop on the end, is threaded through the urethra to the bladder, and then the tumor is scraped from the bladder wall. Fluorescence cystoscopy, a special way of looking at the bladder wall, may be used to enhance bladder cancer detection.
  • Cystectomy, which is removal of the bladder, is often used in more advanced bladder cancer. Usually the entire bladder is removed, but partial cystectomies may be appropriate for a small number of patients. Lymph nodes near the bladder also will be removed. The prostate is removed in men, and in women the uterus, ovaries, fallopian tubes and often a small part of the vagina are removed.

MIS such as laparoscopy and robotic procedures for some bladder cancer patients.

Bladder Reconstruction Surgery

When the bladder is removed to treat bladder cancer, surgical procedures known as urinary diversions are performed to give your body a way to store and remove urine. Urinary diversions are done at the same time as a cystectomy. There are three types of urinary diversion:

  • Ilealneobladder: Part of the ileum (small intestine) is used to make a new bladder, allowing for "normal" urination. This procedure is more successful for men. It provides good daytime urinary control, with about a 20% chance of nighttime incontinence. Some women may have trouble completely emptying the neobladder and may sometimes need to use a catheter.
  • Ileal conduit: A piece of the small intestine is used to create a “pipe” that connects the ureters to the surface of the skin in the navel. Urine is continuously drained into a urostomy bag worn on the outside of the body. It is a simple and efficient procedure, but some patients may have issues with wearing an external bag.
  • Continent reservoir: Intestinal tissue is used to create an internal pouch that is connected to the navel. The patient uses a catheter to drain the pouch every three to four hours. This procedure is done less frequently.

Chemotherapy plays a major role in the treatment of bladder cancer in both curative and palliative intent. In locally advanced disease with nodal involvement or with muscle-invasive cancers, the addition of 4 cycles of chemotherapy has improved the survival rates in patients given either before or after surgery or radiation. They help in decreasing the chances of local recurrence and distant metastases. Along with radiotherapy, weekly or 3 weekly chemotherapy acts as radiosensitizers improving tumour control. For bladder cancers that have spread (metastasized) to distant organs like the lungs, liver and other parts of the body, chemotherapy is the frontline treatment. They help in disease control, palliation of symptoms and prolongation of life with good quality of life.

The different options for chemotherapy for metastatic bladder cancer include a combination of four drugs known as MVAC: methotrexate, vinblastine, adriamycin and cisplatin. MVAC has provided good response rates since the 1980s. In recent years, the MVAC treatment regimen has been decreased from four weeks to two weeks, with less impact on the body and an improved response rate of 50% and higher. This is possible with help of the addition of granulocyte colony-stimulating growth factors.

Another chemotherapy regimen for bladder cancer is a combination of gemcitabine and cisplatin. The renal function of the patient has to be intact to give cisplatin. This regimen has lesser toxicities with equal efficacy as the MVAC regimen. The main side effects of chemotherapy include low blood counts, vomiting, fatigue, diarrhea, renal dysfunction, etc which in current oncology practice can be prevented by the use of GCSFs, supportive medications and precautions.

Radiation Therapy

What is bladder preservation and who is eligible for bladder preservation?
Can we avoid surgery in bladder cancer?

Complete removal of the urinary bladder, prostate which is also referred to as radical cystectomy is the traditional standard in patients with muscle involving bladder cancer. However, in the last few decades, certain groups of patients can be treated with radiation and chemotherapy and can achieve a cure without the need for the removal of the urinary bladder. This is usually done after complete transurethral resection of the bladder tumor. The trimodality treatment which is a combination of cystoscopic resection of bladder tumor, radiation therapy to bladder and chemotherapy is considered for a significant proportion of patients of bladder cancer in the best centres worldwide.

This approach is referred to as bladder preservation where the patient’s native bladder is preserved and there by the patient can micturate naturally. Although this has been extensively tested, it is now considered as an alternate standard for a select group of patients. The patient selection for this type of treatment requires a multidisciplinary approach by a team consisting of urologists, radiation oncologists, medical oncologists, pathologists and radiologists. Patient compliance for surveillance of the urinary bladder is also taken into account during this approach.

Radiation therapy for bladder cancer is a challenging treatment due to continuous alteration of bladder volume, shape and size. Precisely that is the reason for the requirement of daily image guidance to treat bladder cancers with radiation therapy. Daily image guidance consists of CT imaging on the treatment unit.

Treatment planning for Bladder cancers consists of Simulation with a pre-specified bladder protocol which consists of intake of a particular amount of water before a pre-specified interval of time. After the optimal bladder and bowel preparation, patient is taken up for a planning CT scan.

Treatment is delivered under strict daily image guidance.

The external beam radiation therapy for bladder cancers can be delivered with either of the techniques:

  • 3-dimensional conformal radiation therapy (3-DCRT)
  • Intensity-modulated radiation therapy (IMRT)
  • Volumetric Modulated Arc Therapy (VMAT)
  • Helical Tomotherapy
  • Proton beam therapy

Several studies have shown that IMRT/VMAT/Tomotherapy is better compared to 3-DCRT in their ability to restrict doses to normal, healthy structures such as the small bowel, rectum and pelvic bone marrow.

Proton therapy for bladder cancer

Proton therapy is a highly sophisticated form of radiation therapy that delivers doses to the target structures and reduces doses to the surrounding healthy normal tissues. This, in turn, can reduce doses to the normal structures like the small bowel, rectum, prostate, uterus, ovaries, fallopian tubes and bone marrow. In bladder cancers, there is emerging data to suggest that proton therapy is feasible in patients of urinary bladder cancers and can potentially limit the doses to healthy normal structures as mentioned above. The dosimetric study done at our centre, shows that proton therapy can potentially reduce the dose to small bowel, rectum and pelvic bone marrow. This is extremely useful and crucial in elderly or frail patients. This technique also could be considered for patients with unusual anatomy or tumors with unusual locations. Proton therapy can also be considered in younger patients as the likelihood of development of secondary malignancies is significantly low compared to other photon-based conformal techniques such as IMRT/VMAT/Tomotherapy. It can also be used during scenarios like re-irradiation to selectively treat the bladder tumors. With proton beam therapy, the patient can maintain their current quality of life both during and after treatment.


Immunotherapy acts by stimulating the human immune mechanism against the tumour cells. They therefore don’t have the usual side effects of cytotoxic chemotherapy. They are given by 2 weekly or 3 weekly intravenous injections and can be either given alone or in combination with chemotherapy.

Recently, Immunotherapy has been approved for bladder cancers in the metastatic setting. Incase of Cisplatin ineligible patients, first-line monotherapy with Pembrolizumab and Atezolizumab has been approved in view of clinically significant response and progression-free survival rates. Also, in Cisplatin eligible patients, the addition of Atezolizumab to chemotherapy has shown improvement in response rates and overall survival.

The main side effects are fatigue, diarrhea, changes in liver enzymes, etc. Rarely, autoimmune side effects like arthritis, pneumonitis can happen. In such cases, the patient is advised to stop immunotherapy and start with steroids.

Winning Over Cancer

Chances are slim when it comes to Proton therapy. Dr. Srinivas Chilukuri, Senior Consultant, Radiation Oncologist, speaks about the safe, most effective and least impactful treatment that maintains sexual function even after treatment.


Dr. Srinivas Chilukuri, Senior Consultant, Radiation Oncologist, speaks about the care, dedication and expertize that goes into treating a child with cancer. He said that APCC is well equipped to detect cancer very early and has expert oncoloigsts for the treatment, he further added that all the facilites to treat cancer are available under one roof.


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