The treatment of urinary bladder cancer depends on the stage. It also depends on the extent of cancer and whether it has spread to surrounding normal organs. Other factors determining the treatment are the tumor size, how quickly the cancer cells are growing (grade), and an individual's general condition, including age.

What are the different tests used to diagnose urinary bladder cancer?

Using a tiny camera to examine the inside of the bladder (cystoscopy): 

The doctor inserts a small, thin camera called a cystoscope through the urethra (pee hole) to perform a cystoscopy. The cystoscope permits the doctor to see within the urethra and bladder to look for abnormalities like cancer. 

Removing a small part of tissue to look under the microscope (biopsy): 

During cystoscopy, the doctor inserts a unique tool through the cystoscope into the bladder. This instrument collects tissues for testing (biopsy). Besides taking biopsies, this procedure, medically called transurethral resection of bladder tumor (TURBT), is also used to treat bladder cancer.

Urine test to look for cancer cells: 

A urine sample is examined under a microscope to check for cancer cells. This test is called urine cytology. 

Scans:

Imaging tests such as CT, retrograde pyelogram, MRI, or PET CT, allow the doctor to examine the urinary bladder in detail. This test helps the doctor to know whether cancer has spread to the nearby organs.

Treatment of stage 1 urinary bladder cancer

Stage I bladder cancer is a very superficial cancer, which means cancer has not spread into the deeper muscles of the bladder. As explained above, TURBT is the primary treatment for this stage of cancer. This procedure scoops out all the visible cancer tissues seen by the surgeon during the cystoscopy procedure. TURBT is not a very high-risk operation; hence, the patient does not require a lengthy hospital stay.

After the TURBT procedure, the doctor will fill the urinary bladder through the pee hole with a medicine (intravesical therapy with BCG). The patient is required to hold the medicine inside for a while before discarding it by urination. The patient may have to repeat this procedure periodically to prevent cancer recurrence.

Treatment of urinary bladder cancer stages 2 or higher

Unlike stage 1 cancer, this cancer has spread to the deeper muscles of the urinary bladder. Accordingly, there are two options to treat these stages of cancer, and both options have similar results. 

1. The first option is to give chemotherapy and then remove the urinary bladder. The surgeon will then create a new bladder called a neobladder.
2. The main aim of the second option is to preserve the urinary bladder organ. In this treatment option, radiotherapy is given along with chemotherapy. 

Follow-up after treatment

Most early-stage cancer patients do very well after treatment. However, frequent follow-up tests are needed to look for any cancer recurrence. Any such early recurrent cancer should be immediately treated with cancer-directed therapies.