Bladder cancer

First Appointment

Your first appointment at Fred Hutchinson Cancer Center is a time for you and your care team to meet. You will talk about your diagnosis, disease outlook and likely treatment. This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your care team will decide what needs to happen next.

We encourage you to bring a family member or friend to your first appointment (and any future visits). 

What to Expect

When you come to Fred Hutch, we match you with the health care services and providers that are right for you. Your care here is always personalized. We tailor your first appointment — and all your visits with us — to your unique situation. 

The plan for your first appointment will depend on if your cancer:

  • Sits on or in the first lining of your bladder (non-muscle invasive, also called superficial or early-stage)
  • Goes into the muscle wall of your bladder (muscle invasive)
  • Has spread to distant parts of your body (metastatic)

We will also think about any treatment you have already had.

If you have a related cancer of the upper urinary tract, such as the ureter, renal pelvis or urethra, your first appointment will be similar to a visit for bladder cancer.

Non-muscle invasive bladder cancer with no prior treatment

If you have non-muscle invasive bladder cancer and you have not had treatment yet, our urologic oncologists are the experts who will plan and provide your care. Your first visit will be with this type of doctor. Most people in your situation have cystoscopy (a procedure to look inside the bladder and remove the tumor). This is often followed by chemotherapy that the surgeon puts directly into the bladder during the cystoscopy procedure. Your urologic oncologist will then decide if you need more treatments (BCG therapy or chemotherapy) directly in the bladder. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Cystoscopy Exam of the bladder and urethra with a cystoscope, inserted into the urethra. This thin, tube-like instrument has a light and lens and may have a tool to remove tissue to be checked for signs of disease.

Examination of the bladder and urethra using a cystoscope, inserted into the urethra. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
Non-muscle invasive bladder cancer with prior BCG therapy

If you have non-muscle invasive bladder cancer that did not respond to BCG therapy or came back after BCG therapy, you may need different types of treatment. These can include surgery, medicine-based options or radiation therapy. Our Bladder Cancer Multispecialty Clinic is designed for you. There, you will see several specialists in a single day. Together, they will recommend a complete, personalized treatment plan for you.  

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Muscle-invasive, nonmetastatic bladder cancer

If cancer has gone into the muscle wall of your bladder but has not spread to distant parts of your body, you may need two or more types of treatment. These can include surgery, medicine-based options or radiation therapy. Our Bladder Cancer Multispecialty Clinic is designed for you. There, you will see several specialists in a single day. Together, they will recommend a complete, personalized treatment plan for you.

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Metastatic bladder cancer

If you have metastatic bladder cancer, our medical oncologists are the right match for your needs. They specialize in medicine-based treatments for bladder cancer and other cancers of the urinary tract. You will likely start by seeing one of them first. Most people in your situation need chemotherapy. They usually do not have surgery. They may have immunotherapy, targeted therapy or other treatment. Sometimes, they need radiation therapy to help with cancer-related symptoms.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

First Appointments at the Bladder Cancer Multispecialty Clinic

Many people with bladder or other urinary tract cancer need more than one type of treatment. This means they need more than one type of doctor. We bring a team of genitourinary specialists together for you in one place: the Bladder Cancer Multispecialty Clinic (BCMC). This clinic is at UW Medical Center – Montlake. It is our one-stop shop, where we guide you through complex treatment decisions. At the BCMC, we provide seamless, comprehensive, patient-centered care.

The BCMC is for people whose cancer has gone into the bladder muscle layer but has not spread to distant parts of the body. It is also for people who started treatment for non-muscle invasive bladder cancer and whose cancer did not respond to BCG therapy or came back after BCG therapy.
 

“At the BCMC, everything revolves around you, the patient. We take a comprehensive, systematic and personalized approach that enables you to be well-informed and empowers you to make the best decisions for you.”
— Petros Grivas, MD, PhD, medical oncologist
What is the BCMC?

The clinic is held once a week in the Genitourinary Oncology Center in the Urology Clinic, which is located in the Surgery Pavilion at UW Medical Center – Montlake. 

Our doctors are from UW Medicine, and they specialize in bladder cancer and other cancers of the urinary tract. They will work with you as a team to plan and provide the care you need. 

Our BCMC is the first clinic in the region to provide this type of multidisciplinary care for people with bladder cancer. We treat all types of the disease, from urothelial cancer, the most common type, to rare types and variants. 

As a new patient, you will get a complete evaluation of your unique case. You will leave your appointment with a personalized treatment plan and a clear set of next steps.
 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What is the BCMC?

The BCMC gives you a “home” where you can see a urologic oncologist, medical oncologist and radiation oncologist all on the same day. 
Your first appointment at the BCMC

Hour 1 – Exam 

You will meet with a resident doctor or fellow, who will talk with you about your health history and do a detailed physical exam.

Hour 2 – Team Meeting

Your team of doctors will meet to talk with each other about your cancer and the most effective and safe ways to treat it. During this time, you can visit the Patient Resource Center and other UW Medical Center amenities.

  • Your resident or fellow will present the details they learned from talking with you and examining you. 
  • Your pathologist and radiologist will review and explain the results of any biopsies, other tests and imaging scans you have had. 
  • Your urologic oncologist, medical oncologist and radiation oncologist will use their high level of experience and knowledge about the best treatment approach for people in your situation.

Together, the team will design a treatment plan specifically for you.

Hours 3 and 4 – Recommendations

You will meet one-on-one with each doctor from your team. You will stay in the same room, and the doctors will come to you. We will explain the treatment we recommend for you and why. We are here to answer your questions and talk through your options so you can make well-informed and shared decisions you feel good about.

What Happens Next?

Before you leave, you will meet the BCMC program coordinator. We will help schedule any appointments you need next. Your schedule will depend on your exact needs. We are here to handle the details and make the process as worry-free as possible for you.
 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
“Having the BCMC clinic and the meeting with my team of doctors was invaluable. The fact that it occurred on one day was appreciated by me and my wife, since we were able to ask all our questions while still fresh and receive the most educated answers that would help us confidently determine our course of action.”
— Fred Hutch patient
Dr. Jonathan L. Wright explains what to expect at the BCMC.
Your first appointment at the BCMC

The first visit usually takes about four hours (8 a.m. to 12 p.m.). You will spend about three hours with your doctors. Here is what you can expect to happen.
How does team-based care help?

Having a team of experts in one room at the same time is linked to:1

  • More accurate diagnosis
  • Shorter time from your diagnosis to when you start treatment 
  • A treatment plan that closely matches evidence-based national guidelines about the best ways to treat this disease
  • Better communication between members of your care team
  • More satisfied patients
  • Access to innovative clinical trial options

At the BCMC, we often take another look at the test results and imaging that patients have had elsewhere. This allows us to update your diagnosis and disease stage in important ways that affect your treatment choices.

1. Leonidas N. Diamantopoulos et al, “Bladder Cancer Multispecialty Clinic (BCMC) Model Influences Disease Assessment and Impacts Treatment Recommendations,” Bladder Cancer 5 (2019): 289–298
 
Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
How does team-based care help?

Research shows that our collaborative approach improves bladder cancer care. 

Staging Bladder Cancer

Staging means finding out how far cancer has spread in your bladder or other parts of your body. Knowing the stage of your cancer helps your doctors predict which therapies to use to treat your disease.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
Stages of bladder cancer

Doctors use Roman numerals 0 (zero), I (one), II (two), III (three) and IV (four) to name the stages of bladder cancer. Stage 0 is the least advanced, and stage IV is the most advanced. All stages can be treated. 

  • Stage 0: Cancer is only on the inner lining of the bladder.
  • Stage I: Cancer has grown through the inner lining of the bladder to the layer below. It has not gone into the bladder muscle or other parts of the body.
  • Stage II: Cancer has spread to the muscle wall of the bladder but not further.
  • Stage III: Cancer has spread through the bladder muscle to other tissue. It may be in the fatty layer around the bladder, the prostate, the uterus or vagina or nearby lymph nodes.
  • Stage IV: Cancer has spread further outside the bladder. It may be in the pelvic or abdominal wall, lymph nodes outside the pelvis or other parts of the body.
Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Staging tests

Doctors use these methods to help diagnose bladder cancer and also tell if the cancer has spread.

  • Microscopic urinalysis — testing your urine to help rule out infections and check for blood, sugar, bacteria or proteins that should not be there.
  • Urine cytology — testing your urine to help find cancer cells. This is often done along with fluorescent in-situ hybridization (FISH) or protein tests. 
  • Physical exam — this includes an exam of your abdomen, back and rectum to feel for bumps that may be tumors. If you have a vagina, the exam also includes the vagina.
  • Cystoscopy/ureteroscopy — putting a thin camera through your urethra to check your bladder and maybe your ureters. The doctor may also take a tissue sample (biopsy) to help tell the type and stage of the cancer.
  • Transurethral resection of a bladder tumor (TUR or TURBT) — taking out the tumor and samples from other parts of your bladder. This is done through your urethra. A pathologist can then check the type of cancer and how deep it is in the tissue.
  • Molecular profiling — checking the make-up of your cancer. This allows doctors to choose the most effective treatments and find clinical trials that may be right for you.
  • Imaging tests — such as magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, X-rays, ultrasounds and bone scans. These tests help your doctors tell if cancer has spread beyond your bladder.
  • Blue-light cystoscopy with hexaminolevulinate HCl — makes bladder tumors glow bright pink in blue light. The glow helps your provider see and remove the cancer. 
Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Cystoscopy Exam of the bladder and urethra with a cystoscope, inserted into the urethra. This thin, tube-like instrument has a light and lens and may have a tool to remove tissue to be checked for signs of disease.

Examination of the bladder and urethra using a cystoscope, inserted into the urethra. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Resources for Patients and Caregivers

Here are tips on how to get ready for your first appointment at Fred Hutch and what to bring.
 

Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support during a first visit.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.
Caregiver icon
Caregiving at the first appointment

As a caregiver, you can give your loved one both emotional and practical support for their first appointment. Ask them if you can help with things like these: 

  • Helping them manage their stress, worry or other feelings.   
  • Planning how to get to and from the appointment, what time to leave home and where to park. 
  • Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care (PDF) has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered. 
  • Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes. 

Resources for Caregivers

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