How is bladder cancer treated in a 68-year-old woman?

Question

Hello doctor,

My 68-year-old wife was just diagnosed with bladder cancer after months of blood in her urine that her primary doctor kept saying was just a UTI. The cystoscopy showed multiple tumors, and the biopsy came back as high-grade urothelial carcinoma.

Her urologist wants to do TURBT surgery next week, followed by BCG treatments, but she is terrified after reading about side effects. She already had radiation for cervical cancer 15 years ago, and I am worried if that increased her risk for bladder cancer.

Her CT scan showed the cancer has not spread beyond the bladder wall yet, which the doctor says is good news. She is having urgency and frequency problems and has to urinate every 20 minutes, and sometimes there are clots in her urine.

The bladder cancer diagnosis came right when we were planning to move closer to our grandkids, and now everything is on hold. She is also dealing with lymphedema in her legs from the previous cervical cancer treatment.

Can the BCG therapy for bladder cancer cause problems with her immune system?

I am also wondering if she should get a second opinion before surgery or if we should just trust the urologist. I really need to understand the prognosis and what to expect with treatment.

Please help

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Based on what you have described, your wife has high-grade urothelial carcinoma (an aggressive form of cancer originating in the urothelium) that appears confined to the bladder, which is good news because it means the cancer was caught before spreading to other organs.

The planned TURBT (transurethral resection of bladder tumor) surgery is the correct first step. It helps remove visible tumors and confirms how deep the cancer has invaded, which guides all further treatment.

Regarding BCG treatment, BCG (Bacillus Calmette-Guerin) is a standard and effective treatment for high-grade non-muscle-invasive bladder cancer. It is given directly into the bladder and works by stimulating a local immune response to reduce the risk of recurrence and progression.

Most side effects are local, such as burning, urgency, and frequency. Serious immune system problems are uncommon, especially when patients are carefully monitored. Having had radiation for cervical cancer in the past does not automatically prevent BCG, but your urologist should be aware of her full history and monitor her closely.

Prior pelvic radiation can slightly increase the long-term risk of bladder cancer, so this history is relevant, but it does not change the current standard treatment approach. Urgency, frequency, and clots are common symptoms of bladder tumors. BCG itself does not usually worsen lymphedema (chronic swelling in the arms and legs).

When high-grade bladder cancer is confined to the bladder and treated appropriately, many patients do well. BCG safety in her case, along with close follow-up planning, is essential. Regular cystoscopic surveillance after TURBT and BCG is required.

Upload the CT (computed tomography) scan, PET (positron emission tomography) scan, renal function tests, complete blood count, urine analysis and culture, and histopathology report after TURBT.

I can review them and provide you with a more specific prognosis.

I hope her treatment goes smoothly and that she responds well.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.