Bladder Cancer: Diagnosis and Treatment in Kuala Lumpur
Understanding bladder tumours, how bladder cancer is diagnosed, and the treatment options available.
Bladder Cancer: Diagnosis and Treatment in Kuala Lumpur
Understanding bladder tumours, how bladder cancer is diagnosed, and the treatment options available.
Bladder cancer often begins in the lining of the bladder. One of its most common presenting symptoms is blood in the urine, although some patients have no noticeable symptoms and a bladder abnormality is discovered during imaging or other investigations.
A bladder tumour detected on ultrasound or cystoscopy does not automatically confirm cancer. Further assessment, usually involving cystoscopy and tissue examination, is needed to establish the diagnosis.
Understanding the nature and extent of a bladder tumour is essential because treatment differs considerably between early-stage and muscle-invasive bladder cancer.
What Is a Bladder Tumour?
A bladder tumour is an abnormal growth arising within the bladder. Although some bladder growths are benign, many bladder tumours in adults are malignant.
Most bladder cancers arise from the urothelial cells lining the inside of the bladder. These are known as urothelial carcinomas.
The most important distinction is whether the cancer remains confined to the inner layers of the bladder or has invaded the muscular wall.
Non-muscle-invasive bladder cancer (NMIBC): Cancer that has not invaded the bladder muscle.
Muscle-invasive bladder cancer (MIBC): Cancer that has grown into the muscular layer of the bladder.
This distinction determines the investigations, treatment and follow-up required.
What Are the Symptoms of Bladder Cancer?
Blood in the urine, or haematuria, is the most common presenting symptom of bladder cancer.
It may appear as pink, red or dark-coloured urine. Sometimes the bleeding occurs only once or disappears without treatment.
The absence of persistent bleeding does not exclude an underlying bladder tumour.
Bladder cancer may also cause:
Increased urinary frequency
Urgency to pass urine
Pain or burning during urination
Recurrent urinary symptoms without a clear infection
These symptoms are not specific to bladder cancer and may occur with other urinary conditions.
Some bladder tumours are discovered incidentally during an ultrasound or CT scan performed for another reason.
How Is a Bladder Tumour Diagnosed?
The assessment depends on the patient’s symptoms, imaging findings and clinical risk factors.
1. Cystoscopy
Cystoscopy allows the urologist to examine the inner lining of the bladder using a small camera passed through the urethra.
It helps identify suspicious growths, their location, appearance and whether there are multiple lesions.
Cystoscopy is an important investigation because small or flat bladder lesions may not be reliably detected on ultrasound.
2. Urine Cytology
Urine cytology examines urine samples for abnormal cells.
It may help identify high-grade urothelial cancer but is less sensitive for low-grade tumours. A negative result does not exclude bladder cancer.
3. Imaging
Ultrasound, CT urography or other imaging may be recommended to evaluate the bladder, kidneys and upper urinary tract.
When invasive or more advanced disease is suspected, additional imaging may be needed to assess the extent of the cancer.
4. Transurethral Resection of Bladder Tumour (TURBT)
When a suspicious bladder tumour is identified, a procedure called TURBT is commonly performed.
This procedure provides tissue for pathological examination and is often the first treatment for a visible bladder tumour.
What Is TURBT?
Transurethral Resection of Bladder Tumour (TURBT) is an endoscopic procedure performed through the urethra, without an abdominal incision.
Using a specialised instrument, the urologist removes the visible tumour and obtains tissue for examination.
TURBT serves two important purposes:
Diagnosis: It establishes the tumour type, grade and depth of invasion.
Treatment: For many non-muscle-invasive bladder cancers, removing the tumour is the initial treatment.
Where appropriate and safe, the specimen should include bladder muscle to allow accurate assessment of invasion.
Some patients may require a second TURBT, particularly when the initial resection is incomplete, muscle is absent from certain specimens, or high-risk pathological findings are identified.
What Happens After TURBT?
The next step depends on the pathology report.
The report helps establish:
Whether the tumour is malignant
Whether it is low-grade or high-grade
How deeply it has invaded the bladder wall
Whether additional treatment or further staging is required
Two bladder tumours that appear similar during cystoscopy may require very different treatment once the pathology results are available.
Treatment for Non-Muscle-Invasive Bladder Cancer
Many bladder cancers are diagnosed before they invade the bladder muscle.
Following TURBT, treatment is guided by the risk of recurrence and progression.
Surveillance After TURBT
Some patients with low-risk disease may require cystoscopic surveillance without prolonged additional treatment.
However, bladder cancer can recur even after complete removal, making scheduled follow-up important.
Intravesical Treatment
For selected patients, medication may be introduced directly into the bladder through a urinary catheter.
Depending on the tumour’s risk category, this may involve intravesical chemotherapy or Bacillus Calmette–Guérin (BCG) immunotherapy.
The aim is to reduce recurrence and, for certain higher-risk tumours, reduce the risk of progression.
Treatment for High-Risk Disease
High-risk non-muscle-invasive bladder cancer requires closer surveillance and may need further TURBT, intravesical BCG or consideration of bladder removal in selected circumstances.
Treatment decisions take into account tumour grade, stage, associated carcinoma in situ, recurrence history and response to previous treatment.
Treatment for Muscle-Invasive Bladder Cancer
When cancer has invaded the bladder muscle, treatment generally requires a more extensive approach.
Options may include:
Radical Cystectomy
Radical cystectomy involves removing the bladder, together with additional structures when indicated, and creating a new route for urinary drainage.
This is a major operation and requires careful assessment and counselling.
Systemic Treatment
Chemotherapy and, in selected circumstances, other systemic treatments may be recommended before or after surgery, or as part of treatment for advanced disease.
Bladder-Preserving Treatment
Selected patients may be suitable for bladder-preserving treatment involving maximal TURBT followed by radiotherapy with concurrent chemotherapy.
This approach requires careful patient selection and long-term surveillance.
For muscle-invasive bladder cancer, multidisciplinary discussion helps determine the most appropriate treatment strategy.
Does Bladder Cancer Always Require Bladder Removal?
No.
Many patients with non-muscle-invasive bladder cancer can retain their bladder following TURBT, with additional intravesical treatment and surveillance when indicated.
Bladder removal is generally considered for muscle-invasive disease and certain very high-risk or treatment-resistant non-muscle-invasive cancers.
The decision depends on the stage, grade, overall cancer risk and the patient’s general health.
Can Bladder Cancer Return After Treatment?
Yes. Bladder cancer has a recognised tendency to recur, particularly in patients with non-muscle-invasive disease.
Even after a tumour has been successfully removed, new tumours may develop elsewhere in the bladder lining.
This is why follow-up cystoscopy is an important part of bladder cancer management.
The frequency and duration of surveillance depend on the patient’s risk category and previous findings.
When Should You See a Urologist?
Urological assessment is recommended when:
Blood is visible in the urine, even if it occurs only once
Imaging identifies a suspicious bladder growth
Urine cytology shows suspicious or malignant cells
Urinary symptoms persist without an established explanation
A previously treated bladder tumour requires follow-up
Early investigation can help establish the cause and identify disease at a stage when bladder-preserving treatment may still be possible.
Bladder Cancer Assessment in Kuala Lumpur
Dr Roger Anthony Idi is a Consultant Urologist practising at Prince Court Medical Centre, Kuala Lumpur.
Assessment of suspected bladder tumours involves reviewing clinical symptoms, relevant imaging and cystoscopy findings, followed by tissue diagnosis when indicated.
Treatment planning is guided by the pathology results, tumour stage, risk of recurrence or progression, and the patient’s overall clinical circumstances.
Patients with suspected or confirmed bladder cancer can arrange a consultation to discuss the necessary investigations and available management options.
Frequently Asked Questions
Is a bladder tumour always cancer?
No. A bladder tumour is an abnormal growth that may be benign or malignant. However, suspicious bladder tumours in adults require appropriate assessment, as many are cancerous. Tissue examination is usually necessary to confirm the diagnosis.
Can an ultrasound detect bladder cancer?
Ultrasound can identify some bladder tumours, particularly larger growths projecting into the bladder cavity. However, small or flat lesions may be missed. Cystoscopy remains an important investigation when bladder cancer is suspected.
Is TURBT a major operation?
TURBT is an endoscopic procedure performed through the urethra without an abdominal incision. Although less invasive than open bladder surgery, it carries risks including bleeding, infection and bladder injury. Recovery depends on the extent of resection and the patient’s condition.
Can bladder cancer be cured?
Many patients with bladder cancer can be treated successfully, particularly when the disease is detected before muscle invasion. The likelihood of cure depends on the tumour stage, grade, biological behaviour and response to treatment.
Will I need chemotherapy after bladder tumour removal?
Not everyone requires chemotherapy. Some patients receive medication directly into the bladder, while others require surveillance alone. Systemic chemotherapy or other treatments may be recommended for certain muscle-invasive or advanced cancers.
How often will I need cystoscopy after TURBT?
Surveillance schedules depend on the tumour’s risk category and treatment history. An initial follow-up cystoscopy is commonly performed approximately three months after TURBT, with subsequent intervals adjusted according to clinical findings.
Dr Roger Anthony Idi
Consultant Urologist
Prince Court Medical Centre, Kuala Lumpur