Bladder Cancer: Why a Second Opinion Matters

• It’s always a good idea to seek a second opinion for a cancer diagnosis before starting treatment, but in the case of bladder cancer, getting another expert’s take is especially recommended.

  “About 50% of patients seeking a second opinion for bladder cancer are offered different or better treatment options,” said Andres F. Correa, MD, a urologic oncologist at Fox Chase Cancer Center. “This is critical because some bladder cancer treatments can result in significant or permanent changes to a patient’s quality of life.”

  The Benefits of a Second Opinion

  Bladder cancer occurs when healthy cells in the outer lining of the bladder grow out of control and form a tumor. It is grouped into two categories: non-invasive and invasive (depending on if the muscle of the bladder has been affected by the cancer).

  Approximately 80% of bladder cancers are non-invasive, and these tend to be managed with minor surgical procedures to remove the tumor from the bladder. Some patients may need further treatment after surgery (typically bladder installations). The most common bladder installation treatment is Bacillus Calmette-Guerin (BCG), which has been shown to both prevent cancer recurrence and reduce the risk of progression into invasive bladder cancer.

  “Treatment with BCG can have a critical effect on certain patients and their disease,” Correa said.

  Currently, there is a worldwide shortage of BCG, which has made access to this critical medication difficult. As a result, there has been a vast introduction of novel treatments for patients who cannot access BCG, and Fox Chase Cancer Center is at the forefront of these efforts.

  Because of the shortage of BCG, it could be worthwhile seeking a second opinion at an NCI-designated comprehensive cancer center to discuss this or other treatment options.

  For advanced bladder cancer that invades the muscle layer of the bladder wall, treatment typically involves partial or total removal of the bladder. This can require reconstructive surgery and result in side effects (such as the need for a stoma, urinary incontinence, or decreased sexual function), which can affect the patient’s quality of life.

  Getting a second opinion (especially at a major cancer center) could provide access to additional treatment or clinical trial options that don’t require surgical intervention. Some experts, including those at Fox Chase, are currently researching treatment options that could allow certain late-stage bladder cancer patients to retain their bladders and possibly avoid surgery altogether.

  “At major centers like Fox Chase, we tend to look at the patient as a whole and mold their treatment to their individual diagnosis,” Correa said. “Just because the textbook says the best treatment is bladder removal, it doesn’t mean it’s the best option for every patient.”

  Even if bladder removal surgery is the best treatment option for you, a second expert may have other recommendations for reconstruction that could improve your quality of life.

  Seeking a Second Opinion

  If you are interested in getting a second opinion, start by talking with your current doctor. They can help you gather the medical records, imaging studies, and lab and test results you’ll need to share with the second physician.

  Your physician may also be able to recommend someone to get a second opinion from. Other options include asking for references from people you know who’ve been affected by bladder cancer or doing research of your own.

  When it comes time to make your appointment, know that you have options. Whether you’re located far away from the expert you want to see or you’re trying to maintain social distancing, some centers—including Fox Chase—offer second opinion consultations via telehealth (when appropriate).

  In most cases, individuals can feel comfortable taking some time to get a second opinion and research their options before starting treatment.

  “Most patients can feel comfortable waiting one to three weeks to make treatment decisions,” Correa said. “With bladder cancer, it’s more important to get it right than to start treatment quickly.”

  Learn more about bladder cancer treatment at Fox Chase Cancer Center