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Actos Lawsuit :  With a new diagnosis of bladder cancer, several tests need to be completed. Initially, your urine may be sent to a pa­thologist, who looks for the presence of cancer cells. Then, imaging of your body using a CT or MRI of the abdomen and pelvis and an x-ray or CT of your chest wall be per­formed and read by the radiologist to discern whether the cancer has spread outside of the bladder. Next, a cystoscopy (a surgical procedure done under anesthesia to look at the cancer inside the bladder using a small-caliber telescopic camera) with biopsy, often with resection (removal), of the bladder cancer is performed. The material from the biopsy is sent to the pathologist for microscopic determination of the grade (aggressiveness of the cancer cells) and stage (extent of involvement of your bladder with tumor).

While under anesthesia, a physical examination (called an EUA – examination under anesthesia) is done to assess the can­cer in the bladder. This provides the surgeon with clues as to his or her ability to successfully remove the cancer at the time of definitive surgical treatment of your bladder cancer. Blood is also taken to assess your overall health and physiological preparedness for surgery. Additionally, con­sultations with the anesthesiologist, your primary care phy­sician, a cardiologist, or other medical professional may be required. They will request any additional tests they believe are appropriate to ensure your preparedness for, and safely during, surgery.

The first person you will meet with a new diagnosis of blad­der cancer is your urologic oncologist. When you call to make the appointment, you will be asked whether or not a surgeon (usually a urologist) has already performed a biopsy to confirm that you indeed have bladder cancer. If they have, you will be asked to bring with you (or have sent to the urologic oncologist’s office) the glass slides of the actual pathological material taken at the time of the biopsy for review by another pathologist. You will also be asked for the written report of the original pathologist’s interpreta­tion of your biopsy material, all images taken in evaluation of your bladder cancer (either on CD or printed film) along with the written report of then interpretation, and any sur­gical operative notes from procedures performed by sur­geons seen in the initial evaluation and diagnosis of your bladder cancer.

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Be sure to obtain the address and clear directions, if neces­sary, of specifically where you are to go and what time you are to be at your initial appointment. If you haven’t been to the facility before, allow yourself extra drive time to find it, find parking, and get to the location where the doctor will be. Being late only frustrates and distracts you from your ultimate goal of determining the treatment to help you arrive at your desired outcome. Bring the information requested above to ensure that your visit is as productive and efficient as possible for you and the doctor who will be seeing you. Often, the urologic oncologist or his or her of­fice may have requested that the pathology slides be sent in advance with the goal that his or her urological pathologist can look at them before your arrival and render an opinion about the accuracy of the information provided in the typed report that you will bring from the outside evaluation.

It is also helpful to know in advance if your insurance company requires you to get preauthorization for having additional tests done, such as a CT or MRI. There are situations in which the urologic oncologist, once he or she has reviewed the films, may find them inadequate. If this occurs, he or she may want to get additional imaging done while you are there for this visit. It is also likely the urologic oncolo­gist will want you to leave your imaging studies with them to be reviewed by a radiologist. The imaging studies per­formed on your behalf are your property, but your urologic oncologist may need to retain them for use during your surgical care. Once the surgery and associated care for your bladder cancer is completed, the imaging studies can be returned.

It is helpful if you bring a trusted family member or friend with you. When stressed, we often only hear and retain some of the information that is discussed. You may feel overwhelmed, and the urologic oncologist will have a lot to explain to you. Trying to keep it all straight in your mind can be difficult. Bringing someone with you is helpful in that respect, and they may help you to feel a little more comfortable.

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Surgery plays an important role in both the staging and subsequent treatment of bladder cancer. Transurethral resection of a bladder tumor (TURBT) is the initial treat­ment step in the vast majority of patients with bladder cancer. TURBT provides valuable staging information, and pathological results from these procedures are used to make further decisions regarding what, if any, addi­tional therapy is needed. The gold standard treatment for muscle-invasive bladder cancer is radical cystectomy (removal of the bladder). Advances in surgical technique and anesthesia have reduced the complications associated with this procedure in the last two decades. The develop­ment of continent urinary diversion, which allows one to empty the bladder through the urethra, is an option for certain patients.

Minimally invasive procedures such as laparoscopic or robotic-assisted radical cystectomy may also be treatment options. In addition, bladder-sparing procedures (either with partial removal of the bladder or aggressive TURBT frequently in combination with che­motherapy and/or radiation therapy) have allowed some patients to treat their cancer while leaving their blad­ders intact. Advances in surgical techniques continue to this day with the development of minimally invasive approaches to cystectomy. Both robotic-assisted and lapa­roscopic radical cystectomy have been performed safely in highly specialized centers and have the potential for decreased morbidity and a shorter period of recovery, but longer term follow-up is needed to determine if these pro­cedures are equivalent to open surgical techniques.

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