Bladder Cancer Treatment Options - Everything You Need to Know Explained by Dr. Ahdoot

Bladder Cancer Treatment Options - Everything You Need to Know Explained by Dr. Ahdoot
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Bladder cancer treatment can be complicated but with the right information there are changes you can make to your care that will improve your chances of cure! In this video we will discuss bladder cancer in general and some of the opportunities to improve your outcomes.
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Our goal at Cancer Better is to provide people with the best possible information to help them make the right health decisions. When it comes to big decisions like cancer treatment, you should know the facts so you can be in control of your health.
Creating these videos takes many hours of research by experts in their field.
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To learn more about Dr. Ahdoot go to: www.michaelahdootmd.com/
Dr. Michael Ahdoot is a urologic oncologist specializing in the care of prostate, bladder, and kidney cancers.
Disclaimer: The topics discussed in this video are for educational purposes only and should not be used to make medical decisions. Every individual has unique circumstances which will influence their medical care and the application of scientific literature should be interpreted within the context of your general health. Please consult a physician before making any clinical decisions.

[@unclefuddelmer8611]

Very informative Dr. I'm 73 yo male. Just diagnosed yesterday at 1st biopsy. Aprox 1/3 of bladder is ca... surgical removal and staging in 2 weeks.

[@user-el7bc6rz2m]

My father Had a turbt surgery around 50 days ago. It was a 2cm Tumor and pathology shows its a low grade papillary urothelial carcinoma. But my father still feels a little Burning during urinating? So what should i do?

[@lindastilley212]

My father is 89 and has non invasive CIS. Does this always need resection, or can he just get immunotherapy treatment?

[@ehsanalkenani8536]

Hi there, I just finish my surgery 12 days ago with my Bladder cancer and it was 2 cm 2 months old . The surgery was painless it went very well. I want everyone to know that its a easy surgery it takes only an hour. The only hard part is the catheter discomfort. I did not know I had bladder cancer i did not have any symptoms until i peed blood thats when i went for checkup and found out I had 2cm and we caught it very early. It was surface only not thru muscle or blood. After the biiopsy it came back as an intermediate cancer. I want to know how fast it will come back or how dangerous is it. and survival rate for intermediate cancer of the bladder. I am a healthy person i work out dont smoke or drink.

[@jerrylee830]

I have had it to come back 3 times in the past 2 years. I have had as many as 5 tumors at once. Make sure and do the follow ups.

[@micahdh]

I had 3 turbt's. The tumors kept coming back. After radiation therapy I had no new tumor growth since February of 2018. I have stage 4 bladder cancer. I was Diagnosed in 2015.

[@cancerbetter]

There is a treatment for bladder cancer that involves radiation and chemotherapy called trimodal therapy. I’ll make a video on this topic in the future.

[@sidney4329]

I'm not sure living without a bladder is the quality of life I want.

[@vlado3304]

You can use another option, your choice.

[@catherinemontalvan4340]

My urine results came back showing negative for high grade urothelia carcinoma but benign urothelia and squamous cells present with benign polymorphnuclear leukocytes. What does that mean ? I’m anxious and my appointment for follow up is not until another week

[@cancerbetter]

Sounds like you had a cytology. This is a urine based test that looks for cancer cells in the urine. If cancer cells are found there is an about 96% chance cancer is present. If the test is negative it’s not that useful at ruling out cancer.

[@sonnysalamone4939]

Good afternoon doctor my ct scan said 1C filling defect lateral anterior to the left UVJ, suspicious fro a small urothelial neoplasm. normal appearance of kidneys and ureters appear so i am going in to have it removed i am 64 years old is the size good or bad and do i have it rechecked with ct scan or another bladder procedure. thank you

[@cancerbetter]

Usually the next step is to biopsy the mass to confirm it’s cancer.

[@user-qm5nw9mk5p]

​@cancerbetter, Hi sir . My father is 68yrs and having Bladder cancer of T1, G3. High grade, non invasive. He has undergone 3 timee TURBT and had taken 17 doses of BCG since 1 year. Until the time from his last TURBT to last cystoscopy there was no recurrence of tumour. But last ultrasound and Today's cystoscopy showed the tumour regrown. Treating Doctor suggesting Cystectomy. Can we go for chemo or any other option for better treatment?

[@cancerbetter]

Intravesical chemotherapy is an option of non muscle invasive bladder cancer after BCG failure. Gemcitabine and docetaxel is a well studied combination. Speak with your doctor to see if this is an option. Please note not I’ll clinics will have access to these treatments and you may need to go to an academic center to get access to these treatments.

[@danapryor8267]

What is a level 20 for bladder cancer

[@cancerbetter]

I’m not sure what this means

[@rafaelcelecia]

My daughter ( 50yrs) has been diagnosed with cis in bladder doctor is going to put Instalation ofan immunotherapy drug ( BCG) into the bladder for aggresive or frequently recurring non-musscle invasive cancer of bladder Can you tell me something more? She had cancer in her left overy 26 years ago

[@cancerbetter]

Success rates for BCG are high. If BCG fails you can try chemotherapy in the bladder.

[@Fezeh-nh9qv]

Hello, doctor, my father underwent sonography with signs of blood in the urine. A calcified mass of 14 m was seen. The doctor says that it may be recurrent. He suggested surgery through the duct. My father does not agree to the operation because of the recurrence. He says that I will live like this for 5 years if I do the operation. If I do chemotherapy, I'm weak and I'll die. I'm left wondering what to do, how to please him and whether it's possible to operate but not do chemotherapy?

[@cancerbetter]

I can’t tell people what to do on this channel. My goal is to educate people so they can have informed discussions with their doctors. If you are in doubt perhaps consider a second opinion.

[@kakarotgoku5361]

How long it takes bladder cancer to move from stage 1 to stage 2?

[@cancerbetter]

It all depends on the cancer. Every individual case is different. Fastest I’ve seen has been over the course of several months but this is highly uncommon. Usually it’s a process that occurs over many months.

[@emrithshakil6750]

Dr is their any food or drinks that remove tumour from the bladder

[@cancerbetter]

Unfortunately there is none that has been discovered.

[@jgadms6461]

How well does this treatment work when patients have difficultly holding their urine do to prostate issues? What sort of changes/alterations are done to ensure the patient can hold the medicine for the necessary amount of time?

[@cancerbetter]

A catheter can be left in during the treatment and closed off until the treatment is done. Also there are medications to treat those symptoms as well.

[@jgadms6461]

@@cancerbetter Thank you very much!

[@musichitpro]

Hi doc,No blood in the urine,abdomen twice are fine,ct are normal ,cystoscopy bladder are red. Burning in penis after toilet.doctor are no clue.should i go for biopsy

[@alicemozingo2598]

Hi im 70 yrs old.. I been bleeding from my bladder when I pee.. and I keep a bladder infection one after another. I took a CT scan.. every thing looked ok but for having a cyes in one of my kidneys and a wall of my bladder had thicken. What makes the wall thicken? Hope you can explain it to me. Thank you.

[@cancerbetter]

There are many causes for bladder thickening ranging from prostate enlargement causing increasing muscle developement of the bladder, infection, cancer and several other causes. The normal work up for blood in the urine is to get a CT of the abdomen and pelvis with contrast and to look inside the bladder with a camera (aka cystoscopy) to find the source of bleeding then address it.

[@realshady6407]

Hey. I was diagnosed with a superficial bladder polyp at the age of 31. I'm not a smoker and my jobs were never at risk. Now I'm 33 and 10 days ago I had my second turbt for 5 recurring polyps. Someday I'm going to start my BCG treatment. There were no instillations. for the first time. I know BC can occur in younger adults, but what shocks me the most is the recurrence of 5 polyps, do you think this is due to what you explain in your video, namely the reimplantation? For other medical reasons, I had to keep my urinary catheter in for 17 days the very first time.

[@cancerbetter]

Likely reimplantation is the cause. Things you can do to reduce the risk are having the doctor put chemotherapy in the bladder after resection or having them use bladder irrigation after the surgery.

[@realshady6407]

Yes the first time was with saltwater .it seems that it wasnt ineffective

[@cancerbetter]

Data shows chemotherapy is more effective than bladder irrigation. Bladder irrigation studies are mixed with some saying it works and others saying it does not

[@realshady6407]

Thanks. I hope bcg will make me cancer free :).

[@J.G.817]

Wishing you well. I lost my bladder in 2022 due to a 5 cm.size tumor.​@@realshady6407

[@EvilWhiteMale63]

I have an upcoming appointment with an oncologist to talk about removing my bladder my prostate and my pelvic lymph nodes because I have high grade invasive bladder carcinoma I've gone through BCD treatments and I have undergone two tumor removal surgeries thus far. I am completely against the removal of my bladder and these other bodily organs and so I am searching for any and all alternatives to this.

[@cancerbetter]

There are alternatives to bladder removal. If the cancer is T1 or Ta then you can try removing these tumors again then doing a treatment with chemotherapy in the bladder. For CIS of the bladder you can also try systemtic immunotherapy. If you have T2 or higher (ie. muscle invasive bladder cancer) and you want to try to keep the bladder you can try something called trimodal therapy. Trimodal therapy involves moving the bladder tumor as much as possible by TURBT then treating with chemotherapy and radiation. This treatment does not always work but recent studies show about 80% of people can keep their bladder over a 5 year period from this treatment. I hope this helps and I wish you a great outcome in whatever treatment you choose. - Michael Ahdoot MD

[@dennishassler605]

@@cancerbetter Never say never though - you must assess the risks and be willing to do a removal if it's absolutely necessary - avoid it until it's necessary!!!

[@J.G.817]

​@dennishassleri if you decide to go with removal of the bladder, it will ultimate a hole lot of pain mentally and physically,mark my words.

[@cancerbetter]

@Joe429 this is a valid point. There is a substantial risk of anxiety with localized treatment of bladder cancer but for many it does result in avoiding the need for cystectomy when done well

[@ratnabanerjee5916]

Hi doctor, recently in ultrasound of my father we get to know, there is a "polypoidal small soft tissue growth noted along left lateral urinary bladder wall" it is 10mm×9.1mm in size. What is it ?? Is it curable?? Plz give suggestion doctor 🙏🏻🙏🏻

[@cancerbetter]

Impossible to say with this information. See a Urologist.

[@themauvemama3064]

My 70yo father was diagnosed with T1 high-grade muscle invasive bladder cancer in March. He qualified for Keynote B15 clinical trial treatment but after 1 treatment decided it was too hard on him and will now be starting radiation therapy. Following that with neobladder surgery. Could you shed some light on what the mindset of the oncologist is? He’s suffering and extremely weak, and it seems like nothing is working. I’m seeking to understand the approach and perspective to the treatment. Thank you in advance.

[@cancerbetter]

This story seems unusual and I imagine there is some information missing from this story to understand the logic of your doctors. However in general for T1 bladder cancer, usually the treatment of choice is removal of the tumor using a procedure called transurethral resection of a bladder tumor (TURBT) followed by placing medication in the bladder such as chemotherapy or BCG. Usually radiation is not used for T1 cancer. In rare cases of T1 bladder cancer that is very extensive or very aggressive the doctor may recommend treating with bladder removal or a combination of radiation and chemotherapy after the tumor is removed as much as possible by TURBT. I hope this is helpful.

[@dennishassler605]

Then it cannot be just T1. T1 is NOT muscle invasive.

[@J.G.817]

​@@dennishassler605your exactly correct, when you get up to around t3 or t4 sometimes becomes muscle invasion.I personally had t3 muscle invasive,they had to remove the bladder.

[@dennishassler605]

@@J.G.817 Blessings to you Joe!!!! I have changed my diet and taking measures like getting up to keep the bladder as empty as I can, because I do NOT want to encourage any resurgence. Every three mos. I return for visual check ups and it's been over a year. If I had to, I'd likely go the neobladder route, BUT I'm praying I never have a reoccurrence. The Urologist says I'm "intermediate" on pathology, but I wonder why I have to continue to get check ups every 3 mos.

[@cancerbetter]

@dennishassler605 recurrences in the bladder are common. They will check your bladder regularly to catch any recurrence before it has time to get large.

[@vlado3304]

I have another question. What do you think about doctor's recommendation to change body position every 15 minutes after BCG induction, front, back, left side, right side. How critical it is? If bladder is a balloon , it shouldn't matter, theoretically. Also, how critical is to empty bladder after 2 hours from the induction, not later? I have the answers from my doctor, but would like to know your opinion. Of course, if you don't mind. Thank you very much.

[@cancerbetter]

A little bubble of gas gets in the bladder when BCG is instilled. The idea is to move around so the bubble doesn’t stay in one place. In my opinion normal movement of life is adequate to move that bubble. The idea is just not to stay perfectly still.

[@vlado3304]

@@cancerbetter Thank you.

[@Samson-EC]

Is the bottom line a complete removal of bladder when you are talking about muscle- invasive Dr? Thks...jc

[@cancerbetter]

Not always. There are actually alternatives but the most definitive option is removal of the entire bladder. If cancer is just in one spot in the bladder you can potentially remove that section of the bladder and reconstruct the bladder or you can do a combination of radiation plus chemotherapy. A small percentage of urologist specialize in bladder cancer, and your best bet is to speak with one of them.

[@Samson-EC]

Thks Dr. Ahdoot

[@majidkhan-fz3hm]

My dad is 75 years old and has bladder cancer. Till now we have done 3 TURBT within 3 months. In first TURBT diagonse with pT1 stage. In second TURBT diagonse with pTa stage. Now waiting for 3rd TURBT report. Doctors told us to go for chemotheraphy now. Do you think chemotherapy is good for this age.

[@cancerbetter]

You should clarify if it's systemic chemotherapy or chemotherapy in the bladder. Chemotherapy in the bladder has been shown to reduce recurrence rates.

[@majidkhan-fz3hm]

@@cancerbetter Thanks for reply. i have send you the details email.

[@kakarotgoku5361]

My father had a turbt surgery on 1st april and Via pathology we found that it's a lower grade papillary urothelial carcinoma,negative invasion in lamina properia and muscularis properia. But i want to know that how long it takes to recover from turbt surgery? also he is feeling burning sensation and pain.

[@cancerbetter]

Depends on the size of the tumor removed but usually 2-6 weeks

[@J.G.817]

It took me 1 week to start feeling better.

[@jjjpetersen]

I’ve had 3 TURBT procedures and both took about 2wks with bits of blood scab clots & intermittent reddish urine. Once had a catheter for about 5days.

[@Wunderpus-photogenicus]

Can anyone answer the following question, please? If a patient is diagnosed to be NMIBC (T-is with carcinoma in-situ cancer), and if he decides (or refuses) to not go through the long (very long) invasive treatment (e.g. years of BCG, cystoscopy, TURBT, repeated numerous times), and insists to go directly with radical cystectomy (RC) and urinary diversion (e.g. Ileal conduit) option, is he allowed to do so, and whether Medicare or other private insurance will cover that? In other words, will such a patient be "forced" to go through years of BCG treatment before he can go to the RC and urinary diversion route? Thanks.

[@cancerbetter]

Yes you can opt for surgery up front but most doctors will discourage this. The reality is BCG success rates are pretty high, especially for CIS only disease so a person should really consider that treatment before surgery. Cystectomy (or bladder removal surgery) is complex and there are risks of complications in both the short and long term. For this reason I'd encourage you to discuss the risks and benefits or surgery vs BCG with your doctor prior to making that decision.

[@vlado3304]

I am doing BCG treatments and don't feel anything, no temperature, bleeding, etc. It means it doesn't work? Thank you very much.

[@cancerbetter]

Nope, most people handle BCG with minimal symptoms and it still works for many patients

[@vlado3304]

@@cancerbetter Thank you.

[@cancerbetter]

@vlado3304 anytime! More videos on bladder cancer to come. There is so much to talk about.

[@vlado3304]

@@cancerbetter Thanks again, will be useful, unfortunately not very uplifting topic. It is what it is.

[@yedapeoples]

hi doctor I was diagnosed with PUNLMP i m 30 year old yes i was a smoker but i never had blood in urine or any symptoms in CT scan it detected a small mass after TURBT i was diagnosed with PUNLMP. is the pattern plays an important role in this my complete reports states palliary urethial neoplasm with low maglinant potential with inverted growth pattern. i m currently on BCG induction course. what are the prognosis. will I be in complete remission after BCG. please help... India

[@cancerbetter]

Recurrence risk for PUNLMP is very low and usually does not require additional treatment like BCG. These are the lowest risk bladder tumors. Recommended management is removal and observation.

[@yedapeoples]

@@cancerbetter thank you doctor for your reply can you just explain me in short will i be cancer free for rest of my life

[@cancerbetter]

PUNLUMP can recur so you should discuss surveillance with your doctor. That being said they are almost never life threatening.

[@yedapeoples]

@@cancerbetter thank you doctor for your support..

[@madinascrap]

Iam 31 y, iam blader cancer patient since 2018. Seeking for the help.

[@cancerbetter]

It’s important to distinguish between low grade and high grade cancer. The cancer aggressiveness is different and will modify your treatment choices. Most young people with bladder cancer have low grade disease.

[@madinascrap]

@@cancerbetter its low grade papillary urothelial carcinoma, this time dr.s are desciding to give me BCG, itz third time i've gone through the TURBT. 1st time in 2018 i was diagnosed with high grade papillary epithelial carcinoma, muscle tumer free. I was given 6x weekly doses of Mitomicyn. And again in 2020 recurented, invasive urothelial carcinoma, low grade, but muscle tumer free, 6x weekly mitomycin and 3x monthly mitomycin doses. So the question is, 1. could it be cured permanently any option/alternative? 2. Is this deadly deseas? 3. Why its recurrenting again and again after 2 or 3 years? 4. When i smell any perfumes/fregrances/chemicals my pee turn into dark brown, and it pains.?

[@cancerbetter]

@madinascrap you should ask you doctor about specifics of your case. Generally low grade cancer has a low risk of being deadly so long as it does not change into high grade later on. Medications inside the bladder such as chemotherapy and BCG after complete TURBT are the best options to try to make the cancer go away for good.

[@prasannapriyarenuchepala1050]

sir blood in urine 15 months continusely freqently urine per day 35 times blood clots in urine iam clarity bladdercancer or intection

[@cancerbetter]

Please see a urologist soon.

[@J.G.817]

Cancer survivor here,get checked as soon as possible.The longer you wait the harder it is to cure.

[@penpatsering4937]

My mom is 72 year old. She has bladder cancer stage 2 also She has a already liver problem . I heard from people their so powerful when you do chemotherapy it’s kills other part of cell too becomes makes weaker body. So I was so confused what to do. Their is anyway to do good treatment without doing chemotherapy & surgery?

[@cancerbetter]

The main treatment options for bladder cancer right now are 1. Surgery alone 2.Chemotherapy then surgery 4-6 weeks later 3. Chemotherapy followed by radiation of the bladder Chemotherapy before surgery leads to a 5-10% higher rate of cure. For some people however, chemotherapy can be too hard on there system or they are not good candidates for radiation so they choose to go straight to surgery. For people who are seeking to do what they can to save their bladder (and are ok with taking some higher risk of cancer recurrence) chemotherapy plus radiation is an option. I would try to find a radiation oncologist at an academic center who has some experience with this and get their opinion as well.

[@penpatsering4937]

@@cancerbetter thank you’ so much sir for your advice!

[@tannd8476]

I had to chime in. I was a 38 yo female who developed bladder cancer, I am now 71. I fell through the cracks again and again because of my age, being a female and a non smoker. My cancer was a very aggressive rash. I went for four opinions and found a doctor who was really in my corner. His decision was to burn the bladder interior ( this was 30 some years ago). So he did stating it would be difficult to track. I did not want to deal with the risk of recurrence and went with my gut and decided to have my bladder removed. I thank God for my gut feel because it had spread to the lymph nodes and if that decision was not made they never would have known. I went on chemo afterwards and then had an external bag for 7 years. I later had an internal bladder made from my intestines and I Cath. I am so thankful for my urostomy and for being my own advocate or I would not be here. God bless you on your journey. ❤️

[@dennishassler605]

@@tannd8476 Excellent story and thank God for your intelligence in educating yourself to be aware of the risks - you did very well.

[@mirzamudassir1008]

PLZ DOCTOR EXPLAIN WHICH STAGE AND WHAT COULD BE BEST TREATMENT MY FATHER IS HEART PATIENT HE GOT HEART ATTACK IN 2020 SPECIMEN Transurethral resection of bladder tumor tissue GROSS Received 4 grey brown tissue bits aggregating 1x1x0.5cm, all submitted. MICROSCOPIC EXAMINATION Features suggestive of Invasive papillary urothelial carcinoma, high grade- TURBT tissue. Tumor arranged in the form of elongated complex papillae with fibrovascular cores lined by multilayered urothelial polygonal cells with moderate to marked nuclear atypia and moderate eosinophilic cytoplasm.Frequent mitoses noted. Lamina propria invasion seen. Deep muscle tissue is not included to comment upon invasion. INTERPRETATION DIAGNOSIS Features suggestive of Invasive papillary urothelial carcinoma, high grade- TURBT tissue Lamina propria invasion seen (pT1) Deep muscle tissue is not included to comment upon invasion. COMMENTS Correlate clinically and with radiology

[@cancerbetter]

Perhaps a repeat TURBT is in order to see if there is any cancer in the muscle.

[@marte1439]

Does anyone here understand the cause of a disease? Does the doctors treat the cause or just the symptoms (because cancer/tumour/disease etc is just a symptom)? I refuse to believe that nowadays the medicine do not know the cause of these diseases... But, of course, they are not learning in the school that the body is a complete body. They are learning to treat the symptoms, not to heal the body, because a healed patient, it's a lost client. Every person is responsible for his/her health. The mechanic is not responsible for the car... So, when you treat the cause and not the symptoms, then you will have the proper health. Until then, you will ruine the body with these poisons. If your plate is dirty, you don't buy another, isn't it?

[@craigmurdock4740]

There are probably hundreds of known causes (we know smoking tobacco is a major one) you can look up that make you at higher risk of developing it.