What tests follow a bladder cancer diagnosis, and how do results guide treatment options? Bladder cancer specialist Dr. Piyush Agarwal provides an overview of essential testing – including cystoscopy and cytology – and shares how the results help to classify the bladder cancer grade and stage, which may affect therapy decisions.
Dr. Piyush K. Agarwal is the Director of the Bladder Cancer Program at the University of Chicago Medicine Comprehensive Cancer Center (UCCCC), where he also serves as Professor of Surgery, Vice Chief of Urology, and Fellowship Director of Urologic Oncology. Learn more about Dr. Agarwal.
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Transcript
Katherine Banwell:
I’m wondering if you could now provide an overview of the typical testing that follows a bladder cancer diagnosis.
Dr. Piyush Agarwal:
Yeah, so usually this diagnosis comes to light after a patient has blood in the urine, and then eventually patients are referred to us. And there’s an issue with delay in referrals and delay in diagnosis.
Tends to happen more in women, unfortunately, because often blood in the urine is often interpreted as a urinary tract infection and may prompt repeated treatments. Eventually when a patient is referred to us for blood in the urine, we will look inside the bladder visually, with a procedure called cystoscopy, confirm that there is, in fact, a tumor or suspicion for tumor.
We will obtain a urine cytology that will give us a glimpse of whether there’s any high-grade bladder cancer cells. And we’ll get some sort of imaging to make sure there’s no evidence of disease in the upper urinary tract or outside of the bladder or the upper urinary tract.
And so, after that information, if we find something suspicious, we’ll take the patient to the operating room and sample, and potentially remove, all the tumor that we can through an endoscopic minimally invasive procedure using their urethra as a natural opening in the body to get into the bladder and to sample and remove the tumor entirely, if possible. And at that point, we then have our information, which is what is the grade of the tumor and what is the stage of the tumor.
And if it’s a low-grade, low-stage tumor, then those patients often can be treated with local therapies in the bladder and have periodic surveillance with cystoscopy, with agents in their bladder periodically. High-grade tumors that are low-stage, so that they’re not in the deeper layers of the bladder, we potentially could also treat with that option, although the treatments in the bladder may be more intensive and more frequent; but again, in an effort to preserve the bladder.
The grade and the stage are very important to sort of determine how best to treat our patients.
Katherine Banwell:
Well, thank you for explaining that, Dr. Agarwal. What questions should patients be asking about their test results?
Dr. Piyush Agarwal:
I think patients should ask, “What is my grade and stage? What is the risk of recurrence? What is my risk of progression? Are there any other tests that we could potentially do? Is there anything I can do as a patient to lower my risk?”
And I think asking some of these questions will allow the patients to be a little bit more potentially involved in their care, and also try to understand a little bit more about the disease process. I encourage my patients to really ask as many questions as they can, but really grade, stage, prognosis, recurrence, progression, and anything else they can do to lower the risk, I think are all really good basic questions to ask.