Bladder Cancer
About bladder cancer
Although bladder cancer is the 9th most common cancer worldwide, it’s often forgotten due to its lack of profile in the community. It can affect both men and women, but is about three times more common in men.
At Paradigm Urology, bladder cancer is managed by Dr Tony Makris. Mr. Makris is a urologic surgeon with extensive experience in urologic oncology.
How is bladder cancer diagnosed?
Early bladder cancer often does not have visible symptoms. Frequent urination, pain when urinating, and blood in the urine may develop as the condition progresses, but often aren’t present in the early stages. Blood in urine is never normal and should always be investigated by a urologist.
Advanced cases may be accompanied by bone pain and unintentional weight loss, but bear in mind that these symptoms can also indicate other conditions. If bladder cancer is suspected, your doctor will usually order a range of tests.
Urine test
A urine test may be used to check for blood or bacteria in the bladder. Also called urinalysis, this test involves taking a small sample of urine which is sent to a pathology lab for testing. You may be asked to repeat this test a few times to measure any changes. Another urine test is called urine cytology; this test involves a urine collection over three days to look for abnormal cells.
Ultrasound and CT Scans
Ultrasound imaging and computerised tomography (CT) scans create images of the urinary tract and surrounding organs. These tests can show bladder cancer if it is present and can also check to see if the kidneys are involved in cancer.
Cystoscopy
If prior tests show an abnormality, your doctor may recommend a cystoscopy. This involves passing a very small camera with a light on it (called a cystoscope) into the bladder, which lets the doctor see the inside. The doctor may then take a biopsy of the bladder tissue, which is analysed by a pathologist to look for cancer cells.
How is bladder cancer treated?
The goal of bladder cancer treatment is to kill the cancer and prevent it from returning. This is usually done with surgery to remove the cancer and medication or radiation therapies to help prevent it from returning. Before any treatments begin, Mr  Makris will discuss the suitable options with you and your family to make sure you fully understand the processes.
Chemotherapy
Chemotherapy may also be used in conjunction with surgery to shrink the cancer beforehand or prevent it from returning. It may also be used as part of a palliative care plan.
TURBT
Bladder cancers that haven’t invaded the muscle can sometimes be removed with a transurethral resection of bladder tumour (TURBT) procedure. In this procedure, the surgeon uses an electric wire loop to burn away the cancer. The surgery is performed through the urethra (water-pipe),  so no incisions are involved.
Cystectomy
In more invasive cases, surgery to remove part or all of the bladder may be needed. This is called a cystectomy. If the cancer is large or in multiple parts of the bladder, a radical cystectomy may be advised. This also removes the nearby lymph nodes to help prevent the cancer from returning.
Bladder procedures
Paradigm Urology performs a range of surgical bladder procedures including:
- Flexible cystoscopy
- Rigid cystoscopy
- Bladder stone crushing
- Bladder tumor resection
- Bladder washout for clots
- Cystoscopy and retrograde studies
- Hydrodistension(stretching) of the bladder
Eliminating urine post bladder removal
After your bladder is removed, your body will need a new way to eliminate urine. You will often be fitted with an ileal conduit or urinary reservoir, which traps the urine in a bag outside of your body.
An alternative to an external urostomy pouch is a neobladder. The surgeon creates this reservoir using a piece of your intestine and attaches it to your urethra, allowing you to urinate normally. Dr. Tony Makris has a special interest in this surgical field and helped introduce the neobladder to Bendigo in 2013.
Are there alternatives to surgery?
Radiotherapy
An alternative in order to preserve the bladder is radiotherapy, often combined with chemotherapy. This treatment involves directing high dose X-rays to the bladder, killing the cancer cells. Radiation is administered by radiation oncologists. Dr Makris has a very close working relationship with the local radiation oncologists at Peter Mac in Bendigo and Melbourne.