My aunt, 63, has bladder cancer. Should she undergo surgery?

Question

Hello doctor,

My 63-year-old aunt was recently diagnosed with high-grade urothelial carcinoma of the bladder. Her lab reports show creatinine 1.6 mg/dL and hemoglobin 10.2 g/dL. A CT (computed tomography) scan revealed a 3.2 cm mass near the bladder wall. She is postmenopausal and has diabetes and hypertension.

The doctor mentioned TURBT (transurethral resection of bladder tumor) followed by chemotherapy. We are concerned about:

How her kidney function might affect chemo safety.
Whether bladder removal is always necessary, and if she would need a permanent urinary bag.
Burning urination and occasional blood clots, are these from the tumor or an infection?
How to support her nutrition and hydration during treatment.
How surgery might impact her quality of life, confidence, and mobility afterward.
Could you please advise on the best approach for her situation?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I completely understand your concerns and the worry you must be feeling. Let us go step by step.

Burning urination and blood clots. Is it the tumor or an infection?

In her case, both are possible:

From the tumor: High-grade bladder tumors commonly cause burning or pain while urinating, blood in the urine (sometimes with clots), frequent urination, and irritation of the bladder wall. A 3.2 cm mass can easily lead to these symptoms.
From infection: Diabetes and irritation from the tumor increase the risk of urinary tract infections (UTIs). It is important to get a urine culture before procedures like TURBT (transurethral resection of bladder tumor) to prevent infection-related complications.

Is bladder removal (radical cystectomy) always necessary?

Not necessarily. Doctors usually decide based on whether the tumor has invaded the bladder muscle:

Non-muscle-invasive (NMIBC):

Complete TURBT (transurethral resection of bladder tumor) followed by intravesical therapy (for example, BCG (Bacillus Calmette-Guérin) or Mitomycin C).
Repeat cystoscopy every three months.
Bladder removal is only needed if the tumor recurs, progresses to muscle-invasive disease, or if repeated BCG therapy fails.

Muscle-invasive (MIBC):

Standard options include radical cystectomy or bladder-sparing trimodal therapy (TURBT + radiation + chemotherapy).
Many older patients or those with kidney issues opt for bladder-sparing therapy because it avoids major surgery and reduces strain on the kidneys.

Will she need a urinary bag permanently?

Only if she undergoes radical cystectomy. Even then, there are options:
Ileal conduit (stoma with external bag): Most common, simpler, fewer complications. Many women in their 60s adapt well.
Neobladder (internal bladder from intestine): No external bag; urine passes normally; requires good kidney function and is more complex.
Continent catheterizable pouch: No external bag; requires intermittent self-catheterization; rarely chosen for patients with complex medical conditions.

If she chooses bladder-sparing therapy or her tumor is non-muscle-invasive, she will not need a urinary bag.

Chemotherapy and kidney function: Is creatinine 1.6 mg/dL a concern?

Yes, this is important. Standard bladder cancer chemotherapy often uses cisplatin, but it is generally not safe if:

eGFR (estimated glomerular filtration rate) < ~60 mL/min.
Creatinine > 1.5 mg/dL.

Given her age, diabetes, hypertension, and creatinine of 1.6, she may not qualify for Cisplatin. Doctors can consider alternative regimens that are gentler on the kidneys.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.