Care pathway for bladder cancer

The risk of bladder cancer increases in males over the age of 40 who smoke. The most common first symptom of bladder cancer is hematuria, which occurs in approximately 85–90% of the patients. Hematuria can be detected by the eye as blood in the urine or under a microscope.

One-third of bladder cancer patients experience other symptoms in addition to hematuria, such as frequent urination, pain, or urinary urgency. The intensity or duration of the presence of blood in the urine does not indicate the severity of the potential bladder cancer.

Only one in five patients with hematuria is diagnosed with bladder cancer. If blood is detected in your urine – for example, during a screening test – additional examinations for bladder cancer is not necessary if you have no other symptoms or risk factors for bladder cancer. However, the cause of any abnormal findings in the urine sample should be investigated, even if bladder cancer is not suspected. 

If the patient’s urine is visibly bloody, an urgent ultrasound examination of the urinary tract and necessary additional examinations are performed in primary healthcare. An ultrasound examination excludes possible obstacles to the passage of urine, as well as the possibility of renal cancer.

A physician will make a referral to the HUS Urology Outpatient Clinic if:

• your urine is visibly bloody or
• hematuria is detected under a microscope and you have risk factors for bladder cancer or symptoms related to urination.

When your referral arrives at HUS, the specialist reviews it, assesses its urgency and plans the necessary additional examinations, such as various imaging examinations and blood sampling.

When bladder cancer is suspected, the primary examination is an endoscopy of the bladder, i.e. cystoscopy. We perform endoscopy at the outpatient clinic using a flexible endoscope. The procedure is painless. In the endoscopic examination, bladder cancer is usually easy to identify.

You will receive an invitation letter by mail and in the Maisa Portal. The invitation letter will indicate when and in which hospital you will need to register, the procedure for which you have been booked, and instructions on how to prepare for coming to the hospital. You can reschedule or cancel your appointment by calling the number indicated in the invitation letter.  

Tumor removal is, along with diagnosing, the first step in the treatment of bladder cancer.

Ultrasound imaging cannot completely rule out tumors of the surface of the bladder or upper urinary tract, i.e. the urothelium. Therefore, when bladder cancer is suspected, we also examine the extent of the disease with contrast-enhanced computed tomography.

If you cannot have a CT scan due to an iodine allergy or severe kidney failure, we will examine your upper urinary tract with magnetic resonance imaging. We will renew the cystoscopy, i.e. the endoscopic examination of the bladder as needed.

If the disease has spread, we can take a biopsy of the metastases.

At the appointment, we will make a personal treatment plan for you.

Treatment for bladder cancer depends on the type and stage of the tumor.

Treatment options for bladder cancer include transurethral resection of the bladder tumor, intravesical therapy, cystectomy, and radiation therapy and chemotherapy.

A multiprofessional treatment team is in charge of the treatment of bladder cancer. You can reach your treatment team in the Maisa Portal and by phone. You will find the contact information for the unit treating you on the invitation letter.

• The Comprehensive Cancer Center helpline at 09 471 74900 is open Monday through Friday from 7:30 a.m. to 4:00 p.m.
• If your condition deteriorates suddenly or your fever rises above 38 degrees Celsius, contact the 24-hour emergency Medical Helpline at 116 117 (toll-free) or the nearest hospital with on-call services.
• In an emergency, always call 112.

We monitor patients with low-risk bladder cancer at the urology unit for five years with regular cystoscopies and urine cytology. We monitor patients with high-risk bladder cancer according to their general condition and age.

After surgery with a curative goal, your follow-up with urology will continue for five years.

We monitor metastatic bladder cancer at the Comprehensive Cancer Center. Metastatic bladder cancer is considered an incurable disease, but some patients respond exceptionally well to cancer treatment. If no evidence of cancer is detected within five years, your follow-up will be ended.

If your bladder has been removed in surgery, the monitoring of your urinary tract function will continue for the rest of your life. Follow-up can be carried out in primary healthcare. The function and structure of the kidneys is monitored annually with blood tests and ultrasound examinations.