Cancer - Bladder - Cystoscopy with Tissue Removal

This surgery involves the removal of abnormal tissue from the bladder. It is done by either cutting away the tissue or burning it.

This surgery involves the removal of abnormal tissue from the bladder. It is done by either cutting away the tissue or burning it.

The bladder is a hollow organ that holds urine. The urethra is the tube urine goes through as it leaves the bladder and exits the body. Bladder cancer refers to the growth of abnormal cells in the bladder. The growth of these abnormal cells is known as a malignant or cancerous tumor.

  • The type of bladder cancer depends on where the growth started in the bladder wall.
  • Some of the different types of bladder cancer include transitional cell cancer, squamous cell cancer, adenocarcinoma, small cell carcinoma and sarcoma.
  • Bladder cancer can also be described as non- invasive (the abnormal cells have not grown into other layers of the bladder) or invasive (the abnormal cells have grown into deeper layers of the bladder).
  • Invasive bladder cancer is harder to treat and is more likely to spread to other parts of the body.

Bladder cancer usually begins in the cells that line the inside of the bladder. This is known as transitional cell bladder cancer. This type of cancer can be:

  • Flat
  • Look like a wart with a stem that attaches it to the bladder wall (papillary tumor)
  • Non-invasive or invasive

Other types of bladder cancer are rare, but include:

  • Squamous cell cancer, which is almost always invasive
  • Adenocarcinoma, which is similar to colon cancer and is almost always invasive
  • Small cell cancer, , which tends to grow quickly and require chemotherapy
  • Sarcoma, which starts in the bladder's muscle cells and is very rare

Your healthcare provider will look to see if your bladder cancer has spread to other areas of the body. This process is called “staging.” Metastatic bladder cancer is cancer that started in the bladder and has spread to other organs and tissues.

  • Bladder cancer can spread to the pelvic lymph nodes.
  • In advanced cases, it can involve the bones, lung and liver.

Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.

  • What does the cancer look like under the microscope?
  • How deep does the cancer invade the bladder wall?
  • How large is the primary cancer in the bladder?
  • Does the bladder cancer go to the outside of the bladder?
  • Has the cancer spread to pelvic lymph nodes or anywhere else in the body?

There are several surgical treatments for bladder cancer. The surgery your healthcare provider recommends will depend on your specific circumstances and personal preferences.

  • A cystoscopy is an exam of the bladder and urethra using a thin, lighted tube with a camera on the end (cystoscope). The cystoscope is inserted into the urethra and is then advanced into the bladder.
  • A cystoscopy with fulguration is when, after the bladder is examined, an instrument is inserted to either cut away or burn off the cancerous tissue (fulguration).
  • Another possible surgical treatment is partial or total removal of the bladder (cystectomy). If the entire bladder is removed, more surgery will be needed to create a new “artificial” bladder for holding urine.

Several factors may raise your chance of developing bladder cancer.

  • Smoking - You are a smoker.
  • Chemical exposure - You work with certain chemicals that are known to cause cancer.
  • Chemotherapy - You have received a certain type of chemotherapy.
  • Radiation treatment - You have received radiation treatment for cervical cancer.
  • Chronic bladder infections - You have a history of frequent or long-term bladder infections.

At this time, there is no definite evidence that links artificial sweeteners and bladder cancer.

The symptoms of bladder cancer can also be caused by other common bladder conditions, such as a urinary tract infection. Some of these symptoms include:

  • Urine that is bloody
  • Pain when you urinate
  • Having to pee frequently
  • Having to pee urgently or quickly

As the cancer advances, other symptoms can occur. These symptoms can include weight loss, feeling tired all the time, pain or tenderness in your bones, inability to hold urine, low iron and abdominal pain.

Contact your healthcare provider if you have any of the above symptoms. He or she will go over your symptoms and perform a physical exam. They may also recommend one of the following tests:

  • A urinalysis
  • An intravenous pyelogram (IVP)
  • An exam of your bladder (cystoscopy) with removal of tissue for exam under a microscope (biopsy)

A biopsy is needed to determine if an abnormality is cancer. If your bladder biopsy indicates you do have bladder cancer, more testing (CT scan or MRI) may be needed.

The treatment for bladder cancer is based on many factors, including:

  • Your overall health
  • Your age
  • The type and stage of the cancer
  • ther tests that determine the specific characteristics of the cancer

Treatments are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:

  • Surgery to only remove the cancer (cystoscopy with fulguration)
  • Surgery to remove the bladder (cystectomy)
  • Radiation to kill the cancer cells
  • Chemotherapy inserted directly into the bladder to kill the cancer cells
  • Systemic treatments include:

    • Chemotherapy to kill the cancer cells
    • Targeted or biologic therapy to interfere with the changes in cells that help cancer grow
    • Immunotherapy to help your body kill the cancer cells

    Treatment for bladder cancer usually involves a combination of local and systemic treatments. You may have more than one type of treatment at a time. Depending on your situation, you may rotate between chemotherapy and radiation before or after surgery.

    • Radiation and chemotherapy are usually given in a doctor's clinic or hospital by specially trained medical people.
    • In some cases, you may be able to receive chemo at home with the help of specially trained nurses.

    To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:

    • Your primary care physician
    • A urologist or surgeon with experience in bladder cancer
    • A medical oncologist (a doctor who specializes in the treatment of cancer)
    • A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)

    If your healthcare provider recommends a cystoscopy with fulguration, it will be done in an operating room with medication to help you relax.

    • If you are a male, you will need to lie on your back for the exam. If you are a female you will need to lie on your back with your feet in stirrups. The position is the same as when you have a Pap smear or other vaginal exam.
    • You may feel some discomfort when the cystoscope is inserted and your bladder is filled with water or salt water. Although filling your bladder is uncomfortable, it is necessary to see the entire lining of the bladder.
    • You may feel a pinching or burning sensation when the abnormal tissue is removed or burned.
    • There may be a small amount of blood in your urine after the test. It may also hurt to pee. This discomfort should clear up after you pee a few times. Drinking four to six glasses or more of water a day after the procedure may help.

    Prior to the procedure, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). You should also ask about specific instructions to follow before and after the procedure. These include:

    • Medications you should not take before the procedure, such as blood thinners
    • Regular medications you should continue to take on the day of your procedure
    • How many hours you should stop eating and drinking before the procedure

    It is important to remember that the total cost of this care path does not include all possible medications, lab work or imaging studies. Those charges can add up. If your healthcare provider recommends any lab work or imaging studies, you may need to search for their costs separately.

Contact your healthcare provider if you have symptoms of bladder cancer. Be prepared to discuss your symptoms and how long you've had them.

  • Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
  • Make a list of your medications (including over-the-counter).
  • Write down any questions, symptoms or concerns you want to talk about.
  • If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having a cystoscopy with fulguration?

  • What is my diagnosis? What type of cancer do I have?
  • What is the reason for the surgery? Are there any alternatives to surgery?
  • What tests are you recommending and why? Will the test results change my treatment plan? If not, then why do I need them?
  • How will I feel after the surgery? Will I have to modify my activity?
  • What are the possible complications for this surgery
  • What happens if I do not go through with the surgery?
  • What is your experience in doing this type of surgery? What is your complication rate?
  • Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)
  • Will I be receiving other treatments before or after my surgery?

Do not forget to arrange for transportation to and from the facility and for help at home.

Before you go home, make sure you understand all home care instructions (including medications and side effects), what symptoms you should report to your healthcare provider after discharge and follow-up plans. Your surgeon should also communicate with your primary care physician.


Also known as:

Cancer of Bladder
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