Online Health Chat with Georges-Pascal Haber, MD, PhD

July 10, 2013


Each year more than 70,000 Americans are diagnosed with bladder cancer and the number continues to increase.

Bladder cancer (BC) most commonly strikes men, and is the fourth leading type of cancer in males. Most people who will get this cancer are older than 55, and risk increases with age. The most common and strongest risk factor for bladder cancer is smoking. Smokers are three times as likely as nonsmokers to develop bladder cancer, according to the American Cancer Society, and causes more than half of the cases of bladder cancer. Other risk factors include workplace exposure to certain chemicals, including those used in the textile industry, machining, printing, hairdressing and truck driving. Other factors associated with increased bladder cancer risk include chronic bladder irritation and infections, cancer in any part of the urinary tract lining, bladder birth defects, and genetic mutations for bladder cancer. Certain medications, such as those who have had long-term use of the chemotherapy drug cyclophosphamide are more likely to develop bladder cancer, as are those who have had pelvic radiation therapy. Drinking well water with increased arsenic content may cause bladder cancer, yet a higher risk of bladder cancer is also seen in those who do not drink enough fluids. Certain lifestyle changes can help in the prevention of bladder cancer, including quitting smoking and eating a diet with plenty of fruits and vegetables. (Consuming a high-fat diet is also linked to an increased risk of bladder cancer.)

Bladder cancer is highly treatable, especially when detected early. Approaches to bladder cancer treatment include chemotherapy, biological therapy, radiation therapy and a number of options for bladder cancer surgery. The best treatment is determined by the individual and the nature of his or her cancer. New advances in technology now available allow our surgeons better visualization of bladder tumors for improved surgical accuracy.

About the Speaker

Georges-Pascal Haber, MD, PhD is a staff urologist in the Glickman Urological and Kidney Institute at Cleveland Clinic. His specialty interests include robotic and laparoscopic surgery for bladder cancer, kidney cancer, prostate cancer, ureteral cancer, adrenal tumors, cryosurgery, needle ablation of kidney tumor, retroperitoneal fibrosis, ureteral strictures and adrenocortical carcinoma.

Dr. Haber helped pioneer the development of scar-free kidney and prostate surgery performed through the belly button. He performed the first-ever scar-free removal of a healthy kidney for transplant in Europe. Dr. Haber also assisted in the first-ever scar-free NOTES Transvaginal Nephrectomy for kidney disease.

Dr. Haber pioneered the concept and initial development of stereotactic navigation for percutaneous cryoablation of kidney cancer. He has also helped refine the technique of robotic partial nephrectomy for treatment of kidney cancer. He also has contributed to the development of the robotic laser technique for treating prostate cancer.

Dr. Haber completed his clinical and research fellowships in urology, robotic urology and advanced urological laparoscopy at Cleveland Clinic. He completed his residency in urology at Centre Hospitalier Régional Universitaire de Lille, in Lille, France after graduating from medical school at Université Joseph Fourier, Grenoble, France.

Let’s Chat About Bladder Cancer: Your Questions Answered

np4175: I was diagnosed with 1 cancerous bladder polyp in 2012 and it was caught completely by accident. Only symptom was frequent urination. No one did further testing beyond a pee test - which was always negative. I have Crohn's and asked GI and also GYN due to meds for vaginal atrophy -- vagifem 10 2xwk for a year prior. I had back pain due to a fall and primary doc decided to do an MRI. That's how the polyp was found! Urologist removed the it and said it did not penetrate the muscle. I am having a cystoscopy every 3 months to confirm it's not returning. Why did I get just one polyp? Did the vagifem 10 have anything to do with it? I was a smoker for 8 yrs but quit 30 yrs ago? tks ~

Georges-Pascal Haber, MD, PhD: Smoking is the an important risk factor for Bladder cancer. However, the biology of this disease is complex. There are mainly 2 subtypes: low grade Bladder Cancer that tends to relapse often but in less than 5% of cases becomes more aggressive and gets into the muscle; and high grade Bladder Cancer: were tendency to progression (go through muscle is about 30%). According to what you mention you were probably diagnosed with low grade so regular flexible cystoscopy are advised.

bladder77: If contributing factors of bladder cancer are hairdressing supplies, do you think that using hair straightening products may have contributed to my getting bladder cancer?

Georges-Pascal Haber, MD, PhD: There is evidence that the chemicals contained in the hair dye may be related to developing BC when you used very frequently, no evidence for hair straighteners.

bladder77: I was diagnosed with CIS in May 2012 and have had a round of 6 BCG treatments. After those treatments 3 mos. and 6 months cystoscopies show the cancer is gone. At 6 mos I had 3 BCG treatments and I am again having another cystoscopy at 12 months followed by 3 BCG treatments (on the condition that no cancer is found). If none is found, what are my chances of it reoccurring? I am on a schedule of testing and treatments until 2017.

Georges-Pascal Haber, MD, PhD: Recurrence is usually 30% after BCG but progression can be up to 20% after a complete response to BCG.

Kathy5: My husband was recently diagnosed with bladder cancer involving the muscle. They have recommended his bladder to be removed. I have heard that there are many options including the use of the robot. What are the new advances in bladder removal using the robot?

Georges-Pascal Haber, MD, PhD: At Cleveland Clinic we are now one of few centers performing bladder removal and urinary diversion such as an neobladder ( new bladder made out of bowel) completely using the robot. This is known as Robotic Cystectomy with Intra-corporeal Urinary Diversion. We are able to perform many different types of urinary reconstruction using the robot. We have a Bladder Cancer Treatment Guide, which outlines all of the treatment options we provide at Cleveland Clinic. You can download it for free at

garyzl1: How much blood loss can be expected for a bladder removal? If cancer if in a local area of the bladder, can some still be saved, or is the entire bladder always removed? Is bladder removal a procedure for using robotics?

Georges-Pascal Haber, MD, PhD: Blood loss during robotic radical cystectomy (bladder removal) is minimal. The risk of blood loss and transfusion is higher during open cystectomy. Partial cystectomy (removal of a part of the bladder) is an option in very selected cases (tumors in diverticuli), however it is not the gold standard in Bladder Cancer and should be discussed with your urologist.

Fedor: If carcinoma in situ is present, what are the alternatives?

Georges-Pascal Haber, MD, PhD: Treatment for Cis (carcinoma in situ) is BCG induction (x6) and reassess with bladder biopsy afterwards. If still present another set of BCG is encouraged, however the rate of response at 2nd round is very low. If no response at all, cystectomy is indicated.

cdicks1742: What is the complication rate at CC for radical cystectomy surgery? What incisions are necessary for radical cystectomy surgery?

Georges-Pascal Haber, MD, PhD: Cystectomy is a high risk procedure. Minor complication rate is approx 60% and major complication rate (require additional procedure) is approx 20%. Perioperative mortality rate is 1.5%. Those complications are usually related to the type of urinary diversion. Most common complications in immediate postop are bowel ileus, anemia, and dehydration.

tracie1829: Can hair dyes or acrylic nails cause bladder cancer?

Georges-Pascal Haber, MD, PhD: Yes, hair dyes in large quantities. No evidence about acrylic nails.

rosiebabiarz1: I was diagnosed and had bladder cancer surgery to remove one tumor in March, 2009. I was treated with mitomycin at the time of the surgery. A second surgery to remove two small tumors was December, 2010 followed by BCG treatments. I think it was once a week for 6 weeks. I had check ups every three months and was clean until August 2012. The August 2012 check up was my first check up of six months between checks. The visual check was fine but the urine sample came back with abnormal/possible cancer cells. A second sample was sent out and came back positive after FISH testing . My doctor was concerned and did a ureteroscopy in October, 2012. He did not find anything and I am now back to three month check ups. The check up in February, 2013 was clean but again a second urine sample had to be sent out for FISH testing. This test came back negative. Three month check up in April was clean and an additional urine sample was not needed to be sent out. My next check up is at the end of July 2013. Research indicated that a positive FISH test posed an increase in the possibility " patients with a positive post-therapy result were at a 9.4 fold increased risk for developing more advanced (muscle-invasive) bladder cancer and 75% patients with positive FISH results both pre and post-therapy eventually developed muscle-invasive bladder cancer" This research was fro the Mayo Clinic. To my knowledge my positive test was only post-therapy. Also in that article "FISH testing.....can help predict the risk of a cancer recurrence or the risk of developing a more advanced form of cancer. Patients at a high risk of developing more advanced cancer may wish to undergo more aggressive therapy in the hopes of improving long-term outcomes".

My question. I am 61 years old. Should I seek a second opinion and possibly look into the newly developed Cysview method for Cystoscopic detection of papillary bladder cancer? My doctor does not currently do this but it is done nearby at the University of Rochester. Or, do you suggest I just "stay the course" with the three month check ups?

Georges-Pascal Haber, MD, PhD: Since you were given MMC as first postop treatment we may assume you had low grade BC. We may need the pTNM in order to be able to give an opinion. Cysview is one more tool for urologists in order to identify early recurrences and mainly Cis (carcinoma in situ)

rosiebabiarz1: What does pTNM mean?

Georges-Pascal Haber, MD, PhD: pTNM refers to staging of the cancer. This will guide us in providing the best treatment for the cancer.

lolly: My husband had bladder cancer back in 2012. By the time they did his surgery he had also gotten prostrate cancer. He had 10 weeks of chemo 3 days a week with two days of flushing his kidneys. He had the surgery (neobladder) in November 2012. The surgery was successful but had complications. We have been back in the hospital every month from 5-10 days every month, because of dehydration, kidneys shutting down and chronic diarrhea. No one has any answers as to what is going on and the typical answer we get is "we've never seen this before." Well neither have I so what can we do? Is this normal? As of this week he goes to the bathroom between 6-10 times a day nothing but water but he is scared to eat because he doesn't want to continue to have the runs. What should we do?

Georges-Pascal Haber, MD, PhD: Sorry to hear about your husband. From what you describe, I would recommend seeing a gastroenterologist for his diarrhea.

orion: I have had surgery to remove tumor left ureter, again to remove tumor from bladder, and bio therapy when the cancer returned. Cancer has returned again. What can I expect next in the way of treatment? Thank You, Orion

Georges-Pascal Haber, MD, PhD: This will depend on the stage and grade of the tumor. In the setting of a high grade tumor recurring after BCG treatment, usually the treatment of choice is a radical cystectomy. However, this should be discussed with your urologist.

Maurito: What is the Superficial bladder cancer prognosis after the six week mitomycin treatment with respect to: tumor return? advanced treatment? bladder removal? range in years of life expectancy.

Georges-Pascal Haber, MD, PhD: If you have low grade BC , the recurrence rate is quite high, that’s why we administer MMC. According to the literature there is a 40% decrease in recurrence after MMC for low-grade bladder cancer but not progression or survival.

Maurito: What is the survival rate after initial diagnosis of Superficial Bladder Cancer?

Georges-Pascal Haber, MD, PhD: 70% of superficial bladder cancer recur and 30% of those progress into a more aggressive form. Survival rate depends on the recurrence rate and how aggressive it is.

Maurito: I have completed my mitomycin treatment. What are the odds of recurrence of tumors?

Georges-Pascal Haber, MD, PhD: Mitomycin decreases your chance of recurrence by approximately 40%.

Maurito: After cystectomy, what???

Georges-Pascal Haber, MD, PhD: Usually you will need labs and imaging regularly in order to monitor you for local recurrence (<12% incidence) and/or upper tract recurrence (2-4% and up to 20% if Carcinoma-in-situ present).

Maurito: What is the progression from Superficial Bladder Cancer to each successive stage?

Georges-Pascal Haber, MD, PhD: CIS = 20% progression (after complete response to BCG), Ta = 5% progression to muscle invasion, T1 = 30-40% progression to muscle invasion.

duce: Does smoking cause bladder cancer?

Georges-Pascal Haber, MD, PhD: Smoking is the main risk factor for bladder cancer

BAV3131: What is a cystoscopy?

Moderator: View procedure details

BAV3131: Are chemo drugs included w/BCG treatments? If not, why not?

Georges-Pascal Haber, MD, PhD: BCG is immunotherapy and not chemotherapy .They work in a different manner and achieve similar results. Immunotherapy relies on your body defense system to kill cancer cells. Chemotherapy will kill the tumors on its own.

Kali: My husband has had pre superficial and then superficial bladder cancer for the past 25 years, he has had bcg treatment , turp, at various times and two years ago a superficial bladder cancer in the ureter. the last tumor pathology came back as papillary urothelial carcinoma, high grade, invading lamina propria. does that mean the cancer is changing to invasive? the treatment plan in more bcg, is that correct. when do we get an oncologist involved? I was told only when it becomes invasive. can we do anything to prevent this cancer from advancing?

Georges-Pascal Haber, MD, PhD: BCG is an effective treatment for the treatment of tumor invading lamina propria as a first step. Adhering to BCG treatment and stopping smoking are good steps to take. However, since he already failed BCG, and the recurrence is a high grade tumor invading the lamina propria ( T1G3), I would recommend discussing the option of cystectomy with your urologist. If the restaging TURBT that is usually done once the initial scraping showed T1G3 is a tumor invading the detrusor muscle, then I would recommend you see an oncologist to discuss neoadjuvant chemotherapy.

Kali: How many treatments can be done with bcg, is there a cumulative limit on the lifetime doses, and when would mitomycin be used instead? Our urologist says bch is the gold standard.

Georges-Pascal Haber, MD, PhD: BCG is the gold standard treatment for non-invasive high grade bladder cancer. In case of recurrence after BCG would recommend you discuss your treatment options with your urologist.

Kali: the pathology reports do not stage the cancer, at least the reports that I see, does the doctor do the staging, or is it not staged until it becomes invasive.

Georges-Pascal Haber, MD, PhD: The pathology staging (pT) and grading can be determined by the pathologist, however the urologist should be able to determine the staging after reading the pathology report. The grading should be done by the pathologist.

Kali: is there a direct relation between hair dyes and bladder ca, I was unaware of that and I confess I do dye my hair regularly

Georges-Pascal Haber, MD, PhD: There is evidence that the chemicals contained in the hair dye may be related to developing BC, however this is during continuous exposure, as seen with professional hairdressers.

Kali: Please thank the doctor for the very valuable information he has provided, I have learned a lot during this chat!

Georges-Pascal Haber, MD, PhD: Thank you - I am very happy to help!

Philjc: I had a high grade invasive urothelial carcinoma (transitional cell carcinoma) grade 3/3 removed from my bladder 3 years ago. There was no muscle involvement. I then had BCG treatments. I have had periodic cystos - there has been no recurrence of the cancer. what is the probability of future recurrence and what might the time line be. I am 83 years old.

Georges-Pascal Haber, MD, PhD: High grade T1 lesions have a 50-70% chance of recurrence that is decreased by 43% after successful completion of induction BCG.

bladder77: Do all the urologists-oncologists at Cleveland Clinics everywhere follow the same protocols?

Georges-Pascal Haber, MD, PhD: Our physicians follow the AUA recommendations. We work together, on the urology and oncology sides, to provide the most coordinated and customized care possible specific to each patient’s situation.

cdicks1742: I am having radical cystectomy in two weeks. They are planning a 3 - 4 inch incision below the belly button. Is this normal incision for robotic cystectomy?

Georges-Pascal Haber, MD, PhD: it looks like an open incision used to perform the urinary diversion after robotic cystectomy. An alternative, would be all robotic cystectomy and urinary diversion done intracorporeally, without the need for an additional incision below the belly button. Intracorporeal diversion was pioneered at the Cleveland Clinic and we are one of very few centers in the country to regularly perform this procedure.

iluvtotrndgs: My husband has been diagnosed with bladder cancer. His doctor removed a tumor from inside of his bladder on June 19, 2013. The pathology report states, "invasive poorly differentiated carcinoma most compatible with a high grade urothelial carcinoma. The neoplastic cells are positive for pankeratin and p63, in immunoprofile which is compatible with diagnosis." "Tumor has foci of squamous differentiation and some areas with sarcomatoid features." "Carcinoma extensively invades into the lamina propria and also involves the detrusor muscle." "marked areas of necrosis."

The doctor ordered a current CT scan - June 27, 2013 - of abdomen and pelvis without and with contrast. The final report states, "The visualized lung bases appear normal. Small gallstones are noted. The adrenal glands are not enlarged. There is no hydronephrosis demonstrated. A small 9.5 mm left renal cyst is noted. There is no adenopathy. Sigmoid diverticuli are noted without evidence of diverticulitis. There is thickening along the left lateral aspect of the urinary bladder prostate gland is enlarged."

Also, on June 27, 2013 a full body bone scan was performed. Impression: Findings in the bony skeleton consistent with degenerative change. One focal area of increased tracer activity in the anterior right sixth rib of indeterminate etiology. Recommends radiographs in followups.

We discussed surgery options with the doctor. He recommends the bladder be removed and so far we agree. Because of the limited resources in our area (Greenville, PA) we discussed having the surgery done in a bigger hospital, with a learning environment, and bigger supporting staff.

My husband is 84 years old, going to be 85 years old August 2, but is considered by many doctors and others to be in very good condition physically. He is very active, even throughout this diagnosis. In 2003 he had open heart surgery to have a heart valve repaired. A St. Jude ring was placed in heart valve. He breezed through that surgery, missing only 12 days of work. In January 2012, he was hospitalized for a heart attack and two metal stents were placed in one artery of his heart. During that hospital visit, a pacemaker was also placed into his chest. He has had no complications from either of these events. In March 2012, he had gall stones removed. Again, this barely interfered with his daily routine. In February 2013, the doctor we are working with now, flushed out his bladder and trimmed his prostate gland. My husband had blood in his urine at the time. A few weeks ago, due to blood in his urine, (a lot of blood and it was bright red/black and constantly a problem) he went to the doctor for treatment. His doctor was shocked to find this tumor and says it was not present back in February. The tumor measured 9.5 x 6.0 x 1.5 cm and weighed 20.2 grams. The doctor has stressed the importance of having the bladder removed immediately.

Finally, here is my question. Is it possible for my husband to be seen by a Urologist at Cleveland Clinic and possibly have the surgery performed there? We have been referred to a doctor at Shadyside Hospital in Pittsburgh, PA but haven't heard from that office as of yet.

Georges-Pascal Haber, MD, PhD: Cystectomy is indicated for curative treatment, however risks need to be emphasized. No bladder preservation due to the size of tumor (if pt accepts risks of repeat resection, it could be an option).

Georges-Pascal Haber, MD, PhD: We would be happy discuss further with you. Please contact my office.

iluvtotrndgs: What are the treatment options for bladder cancer (in men) starting with the least drastic treatment to the most drastic treatment?

Georges-Pascal Haber, MD, PhD: The least invasive therapy is cystoscopy with transurethral resection of all visible tumors to the more invasive cystectomy with urinary diversion – which can be performed robotically or open with the option of having your diversion done completely robotically.

iluvtotrndgs: What is bio therapy for bladder cancer?

Georges-Pascal Haber, MD, PhD: I apologize but I am not currently familiar with bio-therapy for the bladder. This is something that I will research further.

jmmani: My brother, aged 37, has been diagnosed with bladder cancer. He has already had 3-4 cystectomies (?)in a two year period to remove the malignant tumors. Most recently, he had a cysview and dr. found that 2 out of the 5 tumors were high grade. He was given options. My question is what is the difference between low grade and high grade tumors and why aren't the tumors staged. Thank you.

Georges-Pascal Haber, MD, PhD: Low grade disease have a risk of recurrence, High grade disease have a risk of progression and invasion. 5% of Low grade progress to high grade.

jmmani: Its been two years of treatments and dr. recommending bladder and prostate removal - 90% success rate; if he opts to have BCG treatment with interferon and cancer returns after - success is 75% that it won't return.

Georges-Pascal Haber, MD, PhD: There are many factors that go into consideration for cystectomy versus a bladder preservation protocol. I need more information regarding the stage and grade of your bladder cancer in order to comment.

jmmani: In your opinion, how many men under age 40 have had bladder removed?

Georges-Pascal Haber, MD, PhD: Bladder cancer can occur at any age, but the average age is 65 with approximately 80% of patients diagnosed after the age of 50. That being said, it is less common to see muscle invasive bladder cancer requiring cystectomy at the age of 40. Cystectomy remains the gold-standard treatment for all muscle invasive bladder cancer regardless of age.

jmmani: Are there any clinical trials for treatment of bladder cancer after two years of repeated BCG treatments?

Georges-Pascal Haber, MD, PhD: currently to my knowledge there is no trials looking at BCG after two years.

Irishrover: June 2012 I had transurethral resection to remove a single tumor, Feb. 2013 had second TUR to remove two tumors, June 2013 had a third TUR to "burn off about 20 very small spots", All superficial and non invasive. Is this a typical progression? I will be beginning BCG treatment in a couple of weeks. How effective is that treatment? Any other questions I should ask my doctor? Also after this latest procedure on June 21, I have been having some mild incontinence problems. Is this typical? Is it permanent? Thank you

Georges-Pascal Haber, MD, PhD: When you say that you have superficial and non-invasive tumors, I am assuming that you have either low/high-grade Ta/T1, which has varying degrees of recurrence and progression rates. Usually if a superficial tumor recurs then BCG is the mainstay of treatment. BCG has a mean reduction rate of recurrence of 43%. It is not uncommon to have voiding symptoms after TUR and typically these resolve after the bladder is given time to heal.

Irishrover: Are there some foods or supplements that have been shown to be beneficial?

Georges-Pascal Haber, MD, PhD: There aren't any foods or supplements that will stop the occurrence of bladder cancer. The most important tip is to not smoke!

toyobob: What is the best treatment for early bladder cancer?

Georges-Pascal Haber, MD, PhD: The initial treatment should be cystoscopy with transurethral resection of all visible tumors. This will provide adequate staging and grading of the cancer.

tarey: I am 42 years old, used to be a smoker. Stopped smoking when I was diagnosed. I had surgery to remove 5 tumors all of which were malignant. 2 of which were the size of 50 cent pieces. I went back in 3 months for the check up..the cancer was back and there were 11 tumors. 3 months after that another check up..23 tumors. Had surgery after each of those and also had 6 weeks of chemo after the 3rd surgery. went back for the 4th check up in another 3 months and it was back yet again, but just 4 small tumors..had surgery again. My next scope is today at 420. I am also sure it is back. what else can be done? I just can not keep doing these surgeries every 3 is making me crazy. I also have not worked since my diagnosis. No will hire me knowing that with my history with the cancer i have to take time off every 3 months to have surgery and recover

Georges-Pascal Haber, MD, PhD: Sorry about your situation, it appears that you have a high grade superficial bladder cancer - that also seems to be refractory to BCG (chemo). In my opinion you should discuss with you urologist a more aggressive treatment such as cystectomy.

tarey: what is the difference between bcg and mitomycin? i have had the bcg and I had much less tumors on the next recurrence..but i have never heard of mitomycin until just now in someone else's post here?

Georges-Pascal Haber, MD, PhD: BCG and mitomycin C are both intravesical treatments to prevent recurrence of bladder cancer. They act very similar, but are used in different situations.

tarey: What are my options after 4 recurrences and bcg if I learn today that my cancer has returned? I can not keep having these surgeries every 3 months. I have no insurance and have not worked in a year. I just cant keep doing this. there has to be a better option?

Georges-Pascal Haber, MD, PhD: I am sorry that you are in a difficult situation. The surveillance and treatment for superficial bladder cancer is repeat cystoscopy with transurethral resection as needed. BCG is also a part of this treatment regimen. Cystectomy is always an option if needed but this is not typically utilized for superficial bladder cancer unless you have high-grade T1 disease.

tarey: What is high grade superficial mean? my dr has only described as low grade superficial every time..are you referring to the high risk i am of recurrence?

Georges-Pascal Haber, MD, PhD: High-grade superficial means that the tumor is of an aggressive type but has not invaded the muscle of the bladder.

bravegirl: Why might my doctor be prescribing BCG treatments rather than radiation or chemo? What is the day of the treatment like? Can a person return to work and/or activity that day?

Georges-Pascal Haber, MD, PhD: BCG is an effective tx for treatment of non-invasive bladder cancer. It reduces risk of progression and recurrence. Chemo and radiation is not used in this setting. On the day patients receives BCG in the bladder . Patients can expect irritative symptoms and some pain and sometimes blood in the urine. Patients reacts to BCG in different way.

bravegirl: After the 6 weeks of BCG treatments, how often should I get checked? How successful is the treatment?

Georges-Pascal Haber, MD, PhD: it is recommended to have a cystoscopy in 3 month after BCG. Treatment success depends on multiple factors depending on the stage, grade, ... overall it is approximately a 40% reduction.

bravegirl: What does rate of response mean? What is cystectomy? Please speak in layman's terms if possible.

Georges-Pascal Haber, MD, PhD: Rate of response is when the tumor disappears after treatment (how it responds to treatment). Cystectomy is complete removal of the bladder and the prostate along with some type of diversion of the urine stream.

Healthinterest: I have completed a course of. BCG. My last cystoscope was clean and no evidence of malignancy in urine analysis. How positive are these outcomes for my chance of recurrence?

Georges-Pascal Haber, MD, PhD: First negative cystoscopy after completion of induction BCG is a great finding however, it does not predict future recurrence and therefore regular surveillance cystoscopies must still be performed.

Cor: I have been found in the past 5 yrs to pass cancer cells in my urine. Every 3 months I drop off urine for testing; every 6 months for cysto. Once a year I go into the hospital for surgery. Last year a piece of the bladder was removed. This year in May a piece of the urethra was removed. Nothing showed. Should I be concerned?

Georges-Pascal Haber, MD, PhD: At this time it seems that you do not have bladder cancer. However, if we continue to find suspicious cells in your urine, workup is warranted with the hope that you continue to not have bladder cancer.

dickgiannelli: What is the percentage bladder cancer will come back?

Georges-Pascal Haber, MD, PhD: Risk of recurrence depends on the grade and the stage of the tumor. Treatment options also impact recurrence.

OMAY: Recently diagnosed with female bladder cancer. Recommended treatment is chemo followed by the radical surgery that involves bladder reconstruction. Have there been any new procedures introduced regarding the surgery?

Georges-Pascal Haber, MD, PhD: Robotic cystectomy with intra-corporeal urinary reconstruction is the newest procedure that we perform. We have a Bladder Cancer Treatment Guide, which outlines all of the treatment options we provide at Cleveland Clinic. You can download it for free at

PaulK15: I had bladder cancer removed in Jan 1995, and was treated with mitomycin (sp). 2 more tumors were removed via cysto in Oct 1997. Bladder has been clean since then until about 3 weeks ago when I passed some blood clots. Cysto confirmed some low grade lesions. Sched for surgery on 7/19. would follow up chemo be advised?

Georges-Pascal Haber, MD, PhD: Single dose of post operative Mitomycin C (within 6 hours) inserted into the bladder after tumor removal is recommended .

PaulK15: How does urologist via cysto determine low or high grade? Thank You

Georges-Pascal Haber, MD, PhD: Certain features on cystoscopy can be suggestive of grading however, ultimately only pathology performed on the tumor can confirm the grade. I was diagnosed with a very low grade bladder cancer in September of last year. Since then I have had two cystoscopes and one planned for a couple of weeks. Still pretty queasy about the test. I took a xanax and then didn't help too much. Is there any other way to relax before the examination? Also, is this going to be a lifetime thing?

Georges-Pascal Haber, MD, PhD: It is important to continue surveillance of your bladder with cystoscopies at an interval chosen by your urologist and you together. Sometimes you can have cystoscopies performed with conscious sedation, but this is something that you need to discuss with your urologist.


Moderator: Thank you for all of your questions. We have run out of time - George-Pascal Haber, MD,PhD will answer your questions and send them back to me. I will email the answers to each of you privately plus put them in the transcripts.

Georges-Pascal Haber, MD, PhD: Your questions are important to me. Thank you for participating. If you have any further questions, feel free to call my office and schedule an appointment.

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Cleveland Clinic’s Center for Urological Oncology, located in the Glickman Urological and Kidney Institute, specializes in the treatment of bladder, prostate, testicular, and kidney cancer. The Center for Urologic Oncology collaborates with physicians from the Taussig Cancer Institute. Through a multidisciplinary approach, Cleveland Clinic urologists in the Glickman Urological & Kidney Institute work with specialists in the Taussig Cancer Institute to explore all medical and surgical options to ensure that our bladder cancer treatment program will result in a successful outcome for each patient.

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