When patients are seen in the office, obviously we’ll take a history, perform physical exam and the key of course is doing a urinalysis or looking at the urine sample under the microscope. Some patients have only microscopic blood in their urine and yet many patients have visible blood or gross hematuria oftentimes with clots in the urine if the bleeding is fairly significant. After determining that a person indeed has blood in the urine and not some other problems such as a urinary infection, we will usually do further studies.

Normally, we’ll do some type of imaging which is most commonly a CAT scan. Typically, we’ll give x-ray or contrast to get a better idea about anatomy. Following x-rays, we’ll normally look in the bladder. Typically, we’ll do that in the office for diagnostic purposes. That’s called a cystoscopy and we’re really trying to just have visible evidence of a bladder tumor or bladder lesion. If we in fact document a lesion in the bladder or tumor, most of the time that looks like a polyp or a small mushroom but depending on the size and the presentation, it can actually be almost a flat type of abnormality of the bladder lining.

Once a tumor is noted, the next step would be removal of that which can also be done with a scope but that typically requires general anesthesia often done in a surgery center or at the hospital and only after removal of the tumor will you document the fact that this is indeed cancer and there are several things on the pathology or biopsy report that are gonna determine the next step as far as treatment is concerned. Over 90% of bladder cancers are what are called urothelial carcinoma. The urothelium is the normal lining of the bladder, the cells that line the bladder and they become cancerous.

If the urothelial carcinoma is documented then the important things are is it in fact cancer? Yes. If it is cancer, what is the grade of the cancer? The grade has to do with how malignant are the cells so to speak. High grade cancers are potentially more dangerous and more likely to spread and then the other factor that’s very important as far as treatment is concerned is whether the cancer cells arise only from the lining of the bladder or whether there might be some roots or penetration into the bladder muscle wall and treatment would vary widely based on those findings.

The most common cause of bladder cancer is actually cigarette smoking and so normally the first question and/or advice to patients is certainly to stop smoking. The treatments of bladder cancer can vary widely. Superficial or low grade tumors may be completely removed by the biopsy. Higher grade tumors or tumors that have invasion into the bladder muscle are gonna require more aggressive therapy and that could involve major surgery including even removal of the bladder. Chemotherapy may be a part of the treatment before or after surgery to eradicate any disease that might be outside the bladder.

If you possibly have noticed blood in the urine on your own or have been informed by your primary doctor that there have been blood cells noted in the urine, it’s important to contact Northwoods Urology of Texas to arrange for a visit and further evaluation.