Management of Non-Muscle Invasive Bladder Cancer

This video goes over the workup and management of non-muscle invasive bladder cancer (NMIBC). Daniel Reznicek, a urologist in Bellingham, WA goes over through the American Urological Association Guidelines on non-muscle invasive bladder cancer for patients. See the full guidelines here: www.auanet.org/guidelines/bla...
07:05 - Risk Category Descriptions
10:17 - Low Risk NMIBC Management
15:26 - Intermediate Risk NMIBC Management
19:15 - High Risk NMIBC Management
This video outlines criteria for low risk, intermediate risk, and high risk as outlined by the AUA guideline and goes through the surveillance and treatment options based on risk.
Other resources:
NCCN Patient Guidelines for Urothelial Cancer:
www.nccn.org/patients/guideli...
Urothelial Field Effect Study: clincancerres.aacrjournals.or...
Non-Muscle Invasive Bladder Cancer risk of progression:
www.ncbi.nlm.nih.gov/pmc/arti...
www.ncbi.nlm.nih.gov/pubmed/1...
Use of BCG therapy in NMIBC:
pubmed.ncbi.nlm.nih.gov/17604...

[@kathrynsurles299]

My husband and I both had symptoms of bladder cancer starting in Oct. 2019. He was diagnosed and had first TURBT in Dec. 2019. He's had 5 more TURBTs since then. He went through the BCG treatments and is now doing the KeyTruda immunotherapy infusions. He still has non-muscle invasive cancer. If this doesn't work, bladder removal is next treatment. It took me 2 years to get diagnosed. My symptoms were urgency, frequency, and pressure. Dr. kept treating me for UTI with antibiotics. Then urinalysis would come back as normal. He said he didn't know what else to do because he couldn't find anything wrong with me. I went to urology clinic at UNC Chapel Hill, NC. They did bladder scan, manual exam, & urinalysis. Everything was normal. Dr. said only thing they could do was cystoscopy and I said, "Yes." They found a small tumor the size of a pencil eraser. I've had 3 TURBTs and been through BCG treatments. I'm cancer free for 2 years now but have cysto every 6 months. We are 74 and 75. Thank you for a very informative video.

[@icediamonds11]

How are you doing ?

[@crystalhale9018]

Yes what happened is your husband ok?

[@kathrynsurles299]

@@icediamonds11 Cancer-free for 3 years. I have a cystoscopy every 6 months.

[@kathrynsurles299]

@@crystalhale9018 The Key Truda stopped working. He became diabetic as a side effect--takes 5 insulin shots a day. He's managing that pretty well. His doctor found a new treatment that he's taking for about 2 years now that is working. They put gemcitabine directly into his bladder and take it out after and hour. Then they insert docetaxel for another hour and take it out. That has worked and no side effects. He's been cancer-free for about a year. He still does the treatment once a month for 2 years. He's doing very well.

[@kathrynsurles299]

@@crystalhale9018 The Key Truda stopped working and he became diabetic as a side-effect. He takes 5 insulin shots a day but he is managing it pretty well. His doctor found a new treatment that a friend of hers developed. She puts gemcitabine directly into his bladder for an hour and takes it out. Then inserts docetaxel for an hour and takes it out. That has worked and no side effects. He's been cancer-free for a year. He has a treatment once a month for maintenance.and a cysto every 3 months. He's doing very well. Our doctor is the head of urology at UNC Chapel Hill, NC. and she is wonderful.

[@kitsonk717]

I feel blessed to have stumbled upon this I fo. You have explained this so beautifully. Just had my 3 mos. visit and they are back. I was told there was nothing I could do to prevent this, but I tried so hard. Now, I want to share this with my Dr. to see what he's going to say. Thank you!

[@johnthorstensen4765]

Great video. I'm 20 monnths into a HG T1 treatement regimen, exactly as you described, and so far, so good! My doctor, Florian Schroeck, is a bladder-cancer specialist with a sizeable case load; he writes articles on how bladder cancer is treated across the country. I have absolute confidence in his judgment, and feel very lucky to have him.

[@terrywilding8580]

Thank you for the detailed info. I have been diagnosed with T1 and went 6 weeks BCG treatments. In rest period for 6 weeks then a cystoscopy in 6 weeks. At 74 I have never been sick, played hockey until 65, black belt Karate, and never smoked. A little over weight. 10 lbs. Trying Holistic help, and completely changing diet. Had a TURBT surgery that was not pleasant. 6 days in hospital. BCG treatment have been no problems. Thank you again

[@rockhips1]

Glad your doing well, I have to do this BCG in a few weeks as well. With T1 as well hopefully you stay strong. I know what you went though with TURBT surgery had my 12/9/20 not pleasant. Glad BCG is going great. Wow your lucky got my in early 50s cancer still kicking . Good luck

[@davecash7669]

Amazing! 💪

[@icediamonds11]

How are u doing today

[@terrywilding8580]

I did more research and decided to change doctors. Going to London instead of Windsor,Ontario. In London I had 6 treatments of Gemcitabine and Docetaxel. Cystoscopy is clear. London was very understanding and communication was far superior. Maintenance protocol under way. God bless all cancer patients and the great doctors and staff, AMEN

[@taniaj.5644]

This is so beautifully said, I love that you stand in your newfound power of healing that is not the Standard of Care. I am always shy to tell anyone about my diagnosis, let alone tell people I said no to all of the treatments offered at the hospital, and yes to working with healing and healers in so many other ways. People think I am doing nothing. They really don't understand how far from the truth that is. I am in Canada but your info rings true here too, I can't imagine where I would be if I had taken all of their suggestions.

[@donaldortiz7011]

The information you give in this video is fantastic. I wish I had it when I had it seven years ago when i had my operation to remove a tumor in my bladder. At that time i was told it was beign. They sad that i didn need any follow cystoscopies. Here I am now with the same symptoms and waiiting for a ct urogram and maybe a cystoscopy to rule out bladder cancer. I wish I had known the need for follow up cystoscpies . Once again thanks for this video i hope anyone with hematuria watches it.

[@margaretrobertson967]

I have a yerry good friend that has recently been diagnosed at a high grade pappilary cancer diagnosed after removal of tumor had history of prostate cancer What are tx. Options

[@debbieharris5667]

My mom had intermittent blood in her urine for more than 6 months. I'm talking lots of visible blood and even some passing of clots. Her general physician kept prescribing antibiotics for treatment of UTI. The bleeding would stop for a period of time while on the antibiotics, but then start again within a couple of weeks after finishing them. This went on for about 6 months, finally resulted in such severe bleeding we took her to the ER. They immediately got a urologist on on the case and he did a cystoscopy and removed a golf ball sized tumor, it was cancer. We are going to him for a follow up visit next week. This video has been very informative, since none of this has been explained to us by the Dr.

[@debbieharris5667]

Just adding an update. Since my last post my mom has had 2 more bladder surgeries/scraping and has begun the Gemcitabine, (gemzar,) docetaxel chemo treatments, so far she has had 2 treatments, and continues to bleed

[@icediamonds11]

@@debbieharris5667 how is your mom doing now ?

[@fairskin62]

Hi Debbie, how is your mum now?

[@debbieharris5667]

@@fairskin62 sadly, she passed away a couple of months ago.. during one of her bladder treatments, the Dr discovered a large tumor, outside of the bladder, she opted for Hospice Carr and passed 5 days later

[@fairskin62]

I am so sorry to hear, big hugs ❤️

[@alsquerrini9608]

Excellent presentation!

[@cd6635]

Excellent information. Extremely helpful. Thank you so much!

[@duhhawaiian]

Excellent Doctor!!!! Thanks much!!!!

[@dominicpascarella1343]

Thank you for thoroughly explaining.

[@joegibbs888]

Thanks for the wealth of information,, its given me more insight as to my bladder cancer and understanding my situation better. Three years ago I was diagnosed with Bladder cancer... had the tumor removed. It was diagnosed as 0A, TAN0M0 high grade noninvasive papillary urothelial carcinoma. Was given the full series of BCG treatment and have no reoccurrence. Will be having yearly checkups now. I'm 77 now (former smoker)... and found that bladder cancer is high risk for my statistics... My Doctor,,,, Dr. Thomas Trono (Hartford, Connecticut) is wonderful and his professionalism is outstanding. thanks again for the great video .. Joeg

[@anjanama6592]

Thank you Dr Denzel 👍👍👍

[@kennedyuche7263]

Thank you for the information 👌🏾

[@nipunjhaveri8724]

Very good information Thank you Sir

[@raramonty5217]

Thank you so very much, I'm high risk as I have lousy cells with mine. My tumor is back and I'm about to have surgery again then treatment. I've learned more here than I have in the docters office how sad it that.

[@davidpickett9133]

I'll be seeing you at 3:45PM this afternoon.

[@tariqhassan3046]

Thank you so much.

[@mohasadd3019]

Very useful. Thanks.

[@sharonmcqueentorres2459]

Great info. Thank you. I just had my 1st (growth removal that was cancer) superficial with after chemo wash. Next surgery 3months for check/dye up to kidneys. I’m shocked .

[@nickthorburn5451]

Have you seen the amazing results from the quilt 3.032 trial for NMIBC

[@jillg3408]

Very informative. Thank you. My husband has just had his 3rd TURBT following his initial round of BCG. He finished the BCG on 12/13/23, and had his scope to check things on 2/13/24. He already had 3 small tumors that had developed. The are high grade, T1. Should he try another round of BCG even though he had reoccurrence or try chemo instead?

[@ayoub5765]

What means : "neoplasia urothelial with low potential of malignity". Is it consedered cancer??

[@edgarlitzinger2822]

following laser cystoscopy to remove 3 large bladder stones, blood in urine was observed in 5 weeks.. urologist scheduled a TURP procedure but observed a bulge in the bladder initially... whenever he opened up the bulge, he found the tumor.. said it was small and that it hadnt invaded into the muscle wall and was caught early... no chemo or radiation is advised at this time, only follow-up cystoscopies every 3 months for a period of time to see if anything returns.. I'm home from the hospital and still seeing a little blood in the urine, but that is said to be normal for a week or so.. this is all new to me and scary as well.. I welcome any remarks..

[@lejlamaqastena5959]

How are u now

[@terrywilding8580]

Taking BCG with Interferon. Is this good?

[@MSDOGS1976]

My pathology report showed low grade non invasive bladder cancer. I had a flat red spot that was large so my dr has me classified at the intermediate level. Took 6 weeks of BCG and it cleared up my problem. No red spot. Unfortunately after a year a couple of small spots appeared and he burned those off. I go back in 3 months for another scope. I can’t get the BCG treatments now as there is a shortage of the drug. My urologist says the chemotherapy mentioned here is half as effective as BCG. If it’s still not available I’m going to push for the chemo as I don’t want to just burn these off as they pop up. If he still wants to wait on the availability of BCG I may change doctors or get a second opinion.

[@BrendaRosePDX]

Is Curcumin being used with the BCG?

[@moonwalker_818]

Had low grade bladder cancer at 27 I’m 30 now still clear but I have cystoscopys every year . Pretty scary I’m a male never smoked or have a family history of bladder cancer. Strange my urologist said the type of cancer I had is nothing I should be extremely concerned about . He said what concerned him was the fact I developed that at 27 he scared I may develop another form of cancer somewhere else in my body .

[@MMA6049]

What were your initial symptoms if you dont mind me asking?

[@moonwalker_818]

@@MMA6049 I only had one symptom which was blood in my urine. The tumor was very tiny like the size of a pea maybe even smaller . I went to the emergency room right away that’s how they found it . I remember going to the restroom and just seeing dark red blood mixed in with my urine . Don’t wait even if your urine doesn’t contain dark blood or if it’s it’s color is off get it checked out. I’m 31 now and have my last cystoscopy next year . Thankfully all these years I haven’t had any reoccurrence.

[@MMA6049]

Great to hear. I have a cystoscopy tomorrow as I also saw blood in my urine (a few droplets on the toilet seat). Ultrasound showed nothing thus far. Male, 29.

[@moonwalker_818]

@@MMA6049 let me know how it goes bro I’m sure you’ll be good !! Best wishes !

[@MMA6049]

@@moonwalker_818 my friend! Just had the cysto done and thankfully nothing! My urethra apparently is a bit more sensitive/thin which may have caused the few drops of blood. I hope all is well with you! Happy to hear you are almost done because I defs wouldn’t want to go through those procedures again!

[@kloatlanta]

I was just diagnosed with T1 high grade urothelial carcinoma after TURBT. Age 53. Starting BCG next week. Informative video but not feeling good about the future.

[@J.G.817]

I am a bladder cancer survivor,and went through the TURP and chemo and removal of bladder and prostate,wound up with a urostomy, very difficult, it was T-3 mussel invasive 5 cm.very large.that was 2022, this is 2024.I am 66 yo.and no recurrence, cystectomy saved my life.I wish you well sir,you can do this.🙏

[@jemalsiraj3452]

Hi Dr Reznicek thank you for your educational clip. i was c scan yesterday and on finding it says "there is wall thickening involving the roof of the urinary bladder measuring up to 10 mm thickness with potential urothelial classification which is nonspecific and neoplasm cannot be excluded and recommend urological consultation" my question is what stage is my cancer you think?i am going to see my urology after 12 days, i am scared. thank you. i will look forward to your answer my 2 questions.

[@pnus]

I see one question. May not even be cancer, you can't know for sure until the cystoscopy.

[@jemalsiraj3452]

@@pnus i forgot to mention that i am seeing a blood in my urine.i have to wait 10 days to see my urology. my question is should i worry waiting ten days to see my urology? the emergency room referred me to my urology.

[@pnus]

@@jemalsiraj3452 10 days is a typical time frame to get seen, can call for an earlier appointment if available

[@crystalhale9018]

What happened I have bc

[@blueoreo8189]

Hi thank you for this video, my brother's biopsy,, came out to be "Non invasive,High grade Papillary Urothelial Ca ,flat Urothelial Carcinoma in situ, muscularis propia , negative for tumor .so is it High risk? (confused because papillary means, low risk but it's says CIS ,so high risk).the management/surveillance differs

[@basantyasin2483]

Is he well now ?

[@iqraadenmohamed7281]

Its high risk

[@mathews9274]

radiation is preferable for t1??

[@stephaniedoyle7171]

This must be an old video. There’s a lot of new information out there, saying that there are test studies showing gem/doce more or just as effective as BCG you disagree that claim in this video?

[@ricobonza6145]

I had turbt last month. But it was high grade non muscle invasive. Urothelial carcinoma. May dr. Suggest to remove may urinary bladder. The stage is Ta only Do i need to agree to my doctors suggestion to remove may bladder?

[@muzamildar597]

My friend have same problem... But need bcg and mitomycin I'm doctor

[@kathrynsurles299]

NO!!! Bladder removal is a last resort!. There are many other treatments that may help.

[@chrisjames7680]

, had all my bladder and prostate removed 5 years ago I keep going back for flexible cystoscopy once a year I was just wondering how long will this go on for thanks

[@rockhips1]

For the rest of our lives. Cancer comes back some were Else unfortunately in our body's stay positive.

[@joebruhin2098]

Thank you for this video Dr Reznicek, Just had a cystoscopy bc a ct scan for my back indicated thickening wall on left side of bladder. I have no symptoms at all of bladder cancer but after cystoscopy the urologist said I have bladder cancer and wanted to do surgery as soonest (next day). Can he know that I have cancer without cutting tumor out and have biopsy??? Thank you, not feeling too good about his bed manners...Hope you can shed some light.

[@rockhips1]

I know what your going though I just had 2 cancer tumors in bladder removed in 10/13/20 loma Linda ca. I also got 2nd onion at city of hope, ca. to make sure same results . I thought I was done unfortunately you will be doing follow ups every 3-4. months to make sure cancer stays away . Rest of my life follow ups hope fully i make it to 65. I have the camera that goes inside your private part every 3 months I hate it. Good luck

[@joebruhin2098]

@@rockhips1 Thank you for responding, I hope the tumors will not return and you can be healthy. I live very healthy for many years but still have 2cm tumor in the bladder. I had no trouble with peeing or any symptoms at all but now after cystoscopy it hurts a little to pee now after one month, i also think i had infection after the procedure. I'm trying to decide what to do, i went to another doctor who i liked much better than the first but neither have the blue light for turbt, Did you doctor use blue light for your turbt??????? I'm in arkansas

[@rockhips1]

@@joebruhin2098 Yes, I had the blue like done. Fist doctor did not have the blue light. So found another doctor at city of hope in Duarte ca. waiting to see when I get the BCG therapy sometime in January thats used to make your body cells to keep the cancer from coming back so quickly preventive medicine.

[@joebruhin2098]

@@rockhips1 Thank you for replying...There is no blue light in Arkansas but i found hospital in OK City and Memphis, the one in OK is the VA which i am a veteran. Have not been able to contact the hospitals with blue light yet but keep trying. Of course blue light has to be better way to go than white light. I am scheduled with doc i like in February but he doesn't have the blue light and i hope to get through soon to hospital with blue light. As said i never had symptoms of bladder cancer but after cystoscopy my urination is different and not back to normal after 5 weeks. Would you wait longer to have blue light TURBT? Or go with the other sooner? My tumor is 1.9 cm....Happy New year, wishing you wonderful health my friend!

[@angierecord6619]

What is the blue light?

[@Hollywood32080]

I think I'm screwed, my doctor found blood in my urine yesterday. Yes I have smoked since I was a teenager, I'm 56 now, he is putting me on antibiotics today.

[@davidxiaopingxu]

You need to have a Cystoscopy done ASAP.

[@karenishness1]

Distilled waters one gallon a day and a fruit only diet saved me and I was a smoker. 11 years later...

[@icediamonds11]

@@karenishness1 what types of fruits

[@karenishness1]

@@icediamonds11 organic- non gmo.

[@crystalhale9018]

No treatment or treatment plus this

[@tiyger28]

Had Removal of balder cancer staged at T2 , now can’t pass urinate, after surgery , have catheter still doc still looking for solutions to find a way and see what is wrong with it why urin can’t pass any advice please ?

[@karenishness1]

Had to quit coffee and tea and all animal products and drink a gallon of distilled waters a day but I am OK 11 years later.

[@muzamildar597]

You should take cholinergic drugs..... Like bethechol

[@feliciawest3052]

@@karenishness1 In going to do that

[@karenishness1]

@@feliciawest3052 YOU WON;T BE SORRY. I AM GLAD I DID.

[@williammack3018]

That's why most of us use an 8 inch cooks knife.

[@mrtotoag]

You sounded like you don’t have bcg shortage.

[@danrez06]

We did for awhile, never completely ran out but had a limited supply.

[@margaretrobertson967]

I have friend that f