The urinary tract involves the kidneys, the ureters, the bladder, the urethra.

The most common place where urothelial cancer starts is in the bladder.

Sometimes the cancer can be quite advanced before there are any symptoms.

When there are initial symptoms, the most common symptom that patients report is hematuria, or blood in the urine.

Other common symptoms of bladder cancer are frequent urination, urgency (feeling the need to urinate urgently) and painful urination.

When you visit your primary care provider they will typically ask you about your symptoms, your medical history, and lifestyle factors such as smoking (we know that smoking is an important risk factor for developing bladder cancer).

A urologist is a surgeon who specializes in the urinary tract.

The first investigation they would do is called a cystoscopy, which is a procedure where a thin tube with a camera is inserted through the urethra to examine the inside of the bladder.

Determining the stage of bladder cancer looks at how deep the tumor has gone into the urothelium.

Depending on the stage of the tumor and the grade, other treatments may be recommended. Additional tests may be needed including CT scans.

Bladder cancer is an aggressive cancer and despite aggressive treatment, up to 50% of patients will have the cancer come back.

Cancer that has recurred would be outside the bladder and has often spread to other organs. This is called metastatic disease which is considered incurable.

Patients with muscle invasive bladder cancer are treated by a many specialists including a urologist, medical oncologist and radiation oncologist.

Once the diagnosis of muscle-invasion is confirmed, patients are referred to a medical oncologist to discuss neoadjuvant chemotherapy (chemotherapy delivered before surgery). The purpose of this treatment to try to kill any cancer cells which have escaped the bladder and are travelling in the body.

For bladder cancer, a drug called cisplatin is the chemotherapy of choice when the cancer has spread to other parts of the body. It is used in combination with another chemotherapy medication called gemcitabine.

For patients who are very young and healthy, we might use a regimen which includes cisplatin is called dose dense MVAC (4 active chemotherapy drugs), which is slightly more effective but comes with a few more side effects.

Not everyone with muscle invasive bladder cancer is eligible for chemotherapy before surgery. One of the biggest reasons that patients are ineligible is because of their kidney function. If kidney function is impaired, we don't give cisplatin and would recommend the patient goes straight to surgery. Also, if patients have underlying heart failure, or significant hearing loss, they may not be eligible for neoadjuvant chemotherapy.

Chemotherapy is given intravenously at the cancer center. Usually if we're giving cisplatin and gemcitabine, treatment is given on day one and day eight of a three week period. So a patient would have treatment two weeks in a row followed by a one week break.

The patients who were not eligible for neoadjuvant chemotherapy and who go for surgery first, sometimes come back to us after for a discussion about chemotherapy after surgery. If their kidney function is better they may be a candidate for chemotherapy and we would consider that.

The first recommendation is to try to learn about the cancer and treatment options. Understanding the disease and treatment will help you provide informed support and anticipate potential challenges. Learn about bladder cancer, its stages, and treatment options.

Familiarize yourself with the treatment regimen, including medications, side effects, and upcoming appointments. You might need big notebook or binder to keep all of this organized!

The patient may need help to with their medication regimens and monitoring for side effects. Some patients also require assistance with their activities of daily living, such as meal preparation, personal hygiene, and mobility. Reach out to the medical team to find out if there are additional supports which can be leveraged at home, including home care supports.

The third recommendation for caregivers is to find support for the patient and yourself. You may be providing emotional support, encouragement, and reassurance to your loved one. Caregiving can be demanding, so it’s important to take time for self-care.

Caregiving can be demanding, so it’s important to take time for self-care. Maintain your own health, seek relaxation, and engage in activities you enjoy. Establish clear boundaries to balance caregiving with your personal life. Avoid burnout by recognizing when you need to take breaks or ask for help.

Improving nutrition and overall well-being is crucial for patients dealing with bladder cancer, as it can help support treatment, enhance recovery, and improve quality of life.

Eating a variety of foods ensures you get a broad range of essential nutrients. Include a mix of fruits, vegetables, whole grains, lean proteins, and healthy fats in your diet.

Try to prioritize protein as protein helps with tissue repair and maintaining muscle mass, which can be particularly important during and after cancer treatment.

Staying hydrated is important for managing the side effects of treatment, such as the impact on the kidneys and constipation.

Try to reduce intake of highly processed foods, sugary snacks, and foods high in saturated fats. These can contribute to weight gain and other health issues.

For those who experience nausea and a loss of appetite, eating smaller more frequent meals may help. You doctor will also have several strategies and mediations to assist with nausea.

Achieving and maintaining a healthy weight can help improve your overall health and may enhance your ability to tolerate treatment such as surgery. We recommend that all patients stay physically active as much as they can.