Making the Most of Your Doctor's Appointments: Essential Questions for Patients with Non-Muscle Invasive Bladder Cancer

I. Introduction: Empowering Patients in Their NMIBC Journey

Non-muscle invasive bladder cancer (NMIBC) is a condition where cancer cells are found in the inner lining of the bladder but have not grown into the deeper muscle layer.1 This is a critical distinction from muscle-invasive bladder cancer, which requires a different and often more aggressive treatment approach.1 Approximately 70% of individuals newly diagnosed with bladder cancer are found to have NMIBC.16 Historically, this condition was also referred to as superficial bladder cancer.1 While the term "non-muscle invasive" might suggest an early or less serious form of cancer, it is important to recognize that NMIBC has a notable tendency to recur.16 This high rate of recurrence necessitates lifelong surveillance and underscores the importance of patients actively participating in their healthcare journey by understanding their condition and adhering to recommended follow-up schedules. Recognizing individual risk factors and diligently attending monitoring appointments are crucial aspects of long-term management.

Active involvement of patients in their care is paramount for achieving the best possible outcomes. Empowered patients who ask informed questions are better equipped to make decisions about their treatment and are more likely to adhere to the agreed-upon plans.19 By asking pertinent questions, individuals with NMIBC can gain a clearer understanding of their specific diagnosis, the various treatment options available to them, and the potential outcomes associated with each.4 Furthermore, establishing open and consistent communication with the healthcare team is fundamental for effective management of the disease.4 This report aims to facilitate this process by providing a comprehensive list of key questions that NMIBC patients should consider asking their doctors. These questions are organized into categories that align with the different stages of the patient's experience, from the initial diagnosis through long-term follow-up care. The overarching goal is to empower patients to engage in meaningful conversations with their healthcare providers, enabling them to become active and informed participants in their own care.

II. Decoding Your Diagnosis: Essential Questions About NMIBC

The first step in actively participating in your care is to fully understand your diagnosis. This involves asking detailed questions about the type, stage, and grade of your bladder cancer.

A. Understanding the Type of Bladder Cancer

The most prevalent type of bladder cancer is urothelial carcinoma, also known as transitional cell carcinoma.4 When meeting with your doctor, it is essential to ask, "What specific type of bladder cancer do I have?".12 While urothelial carcinoma is the most common, other less frequent types exist, such as adenocarcinoma and small cell carcinoma.12 It is also important to be aware that some urothelial carcinomas can exhibit what is called variant histology, including subtypes like plasmacytoid, micropapillary, and microcystic.10 These variants can sometimes indicate a more aggressive nature of the cancer.12 Therefore, beyond identifying the general type, patients should specifically inquire, "Does my urothelial carcinoma have any variant histology, and what does that mean for my treatment and prognosis?" Knowing the specific type and whether any variants are present is crucial because this information can influence both the expected course of the disease and the most appropriate treatment strategies.12

B. Staging and Grading of NMIBC

Understanding the stage and grade of your NMIBC is fundamental to grasping the extent and potential behavior of the cancer.

1. Staging: In the context of NMIBC, the stages include Ta, Tis (carcinoma in situ), and T1.1 Stage Ta indicates that the tumor is only present in the innermost lining of the bladder 1 and often appears as small, mushroom-like growths referred to as papillary tumors.1 Stage Tis, or carcinoma in situ, represents a high-grade, flat tumor that is also confined to the lining.1 It may present as a reddish, velvety patch 4 and is known for its potential to grow quickly.1 Stage T1 signifies that the cancer has begun to grow into the connective tissue layer, known as the lamina propria, which lies just beneath the bladder lining.1 It is essential for patients to ask, "What is the stage of my bladder cancer (Ta, Tis, or T1)?".19 The specific T stage is a key factor in determining the most appropriate treatment approach.1 Therefore, patients should also ask, "Can you explain what my specific stage (Ta, Tis, or T1) means in terms of how far the cancer has grown?"

   
   

2. Grading: The grade of a bladder tumor refers to how abnormal the cancer cells appear under a microscope and provides an indication of how likely they are to grow and spread.6 Bladder cancers are typically graded as low, intermediate, or high grade.1 High-grade cancers are considered more aggressive and have a higher propensity to recur and progress to more advanced stages.1 Patients should ask their doctor, "What is the grade of my tumor (low, intermediate, or high)?".4 Similar to the stage, the grade of the tumor plays a significant role in determining the course of treatment.12 To gain a better understanding of the implications of the grade, patients should also ask, "What does the grade of my tumor tell us about how quickly it might grow or spread?"

C. Inquiring About the Extent of the Cancer and Potential Spread

While NMIBC is defined by its confinement to the inner lining, it is natural for patients to be concerned about potential spread. Therefore, it is important to ask directly, "Has the cancer spread beyond the inner lining of my bladder?".19 This helps to confirm that the diagnosis is indeed non-muscle invasive.1 Additionally, patients should ask, "Do you suspect the cancer has spread to any lymph nodes or other parts of my body?".1 Even though NMIBC, by definition, has not invaded the muscle, explicitly addressing any suspicion of spread can provide reassurance and ensure that the initial staging is comprehensive.

D. Understanding Risk Group Classification and Its Implications

NMIBC is often further categorized into risk groups – low, intermediate, and high – based on a combination of factors. These factors include the stage and grade of the tumor, its size, the number of tumors present, the presence of carcinoma in situ (CIS), and whether the cancer is a first-time diagnosis or a recurrence.1 Patients should ask, "What is my risk group (low, intermediate, or high) and what factors contribute to this classification?".1 Understanding your risk group is important because it helps guide decisions about treatment and the intensity of follow-up surveillance.1 Therefore, a relevant follow-up question is, "How does my risk group influence my treatment options and the frequency of my follow-up appointments?" This classification system allows for a more tailored approach to managing NMIBC, recognizing that not all non-muscle invasive cancers behave the same way.

E. Questions About the Pathology Report and Its Findings

The pathology report contains a detailed analysis of the tumor tissue removed during procedures like TURBT. Patients should feel empowered to ask, "Can you please explain my pathology report in detail, including the grade, stage, and any other significant findings?".4 This might involve understanding specific terms used in the report, such as "papillary urothelial neoplasm of low malignant potential (PUNLMP)" if that is the diagnosis.17 It is also important to inquire about the presence or absence of carcinoma in situ (CIS) 1, as CIS often indicates a higher risk of recurrence and progression. Asking, "Are there any specific features in my pathology report that I should be particularly aware of?" can help patients identify important aspects of their individual diagnosis. The pathology report serves as the foundation for understanding the nature of the cancer, and patients should feel comfortable asking their doctor to clarify any parts that are unclear.

III. Navigating Treatment Options: Questions to Facilitate Informed Decisions

Once you have a clear understanding of your diagnosis, the next crucial step is to discuss the available treatment options with your doctor. Asking detailed questions about each option will help you make informed decisions about your care.

A. Initial Management: Questions About Transurethral Resection of Bladder Tumor (TURBT)

Transurethral resection of bladder tumor (TURBT) is the standard initial treatment for NMIBC. This procedure serves a dual purpose: it allows the doctor to diagnose the cancer and determine its stage and grade, and it also removes the visible tumor from the bladder.9 Patients should ask, "What exactly does the TURBT procedure involve?".4 It is important to understand the risks and potential complications associated with TURBT, such as bleeding or perforation of the bladder.4 Patients often ask, "Will I have a catheter after the procedure, and for how long?".17 For high-grade tumors, or if the initial resection was incomplete, a repeat TURBT might be necessary. Therefore, it is prudent to clarify, "Is a repeat TURBT necessary in my case?".17 Understanding the role of TURBT and what to expect during and after the procedure is essential for managing anxiety and preparing for the next steps in treatment. The possibility of needing a second TURBT for more accurate staging or to ensure complete removal of the tumor is an important aspect for patients to be aware of from the outset.

B. Intravesical Therapies: In-Depth Questions About BCG and Chemotherapy

Following TURBT, intravesical therapy, which involves instilling medication directly into the bladder, is commonly used to reduce the risk of the cancer recurring.12 The two main types of intravesical therapy are BCG immunotherapy and intravesical chemotherapy.

1. BCG Immunotherapy: Bacillus Calmette-Guérin (BCG) is a type of immunotherapy frequently used for high-grade NMIBC.12 Patients should ask, "What is BCG immunotherapy and how does it work to treat bladder cancer?".4 It is important to understand the typical course of BCG treatment, which usually involves an initial induction phase followed by maintenance therapy in some cases.32 Inquire about the potential side effects of BCG, which can include flu-like symptoms and urinary irritation, and how these side effects can be managed.2 A specific concern some patients have is about vaccinations while on BCG, so asking, "Are there any concerns about vaccinations (flu, COVID) while on BCG?" 41 is relevant. It is also crucial to discuss the possibility of BCG not being effective, known as BCG refractoriness or relapse, and what alternative treatment options are available in such cases.37 Given occasional shortages of BCG 37, it might also be pertinent to ask about the availability and any potential impact on the treatment plan. Patients should be prepared for the treatment process and understand their options if BCG proves to be ineffective.

   
   

2. Intravesical Chemotherapy: Chemotherapy drugs, such as Mitomycin C and Gemcitabine, can also be administered directly into the bladder.12 Patients should ask, "What type of intravesical chemotherapy is recommended for me and why?".4 Inquire about the specific schedule for administering the chemotherapy and the overall duration of the treatment.37 Understanding the potential side effects of the chosen chemotherapy drug is important; common side effects can include increased urinary frequency, urgency, and a burning sensation during urination.12 It is also helpful to clarify whether intravesical chemotherapy will be used as the sole treatment or in combination with other therapies.12 Intravesical chemotherapy offers another approach to reducing the likelihood of recurrence, particularly for patients with low to intermediate-risk NMIBC.37

   
   

C. Understanding the Benefits, Risks, and Side Effects of Each Treatment Option

For every treatment option presented, patients should request a detailed explanation of the potential benefits and associated risks.4 Ask about the likelihood of the treatment being successful in your specific case.25 It is also important to inquire about both the short-term and long-term side effects that might occur 2 and to discuss strategies for managing these side effects effectively.23 A thorough understanding of the potential benefits and harms of each treatment is essential for informed consent and for aligning treatment choices with your personal values and preferences.

D. Questions About Surveillance Strategies and Their Rationale

Due to the high rate of recurrence associated with NMIBC, ongoing surveillance is a critical component of management.16 Patients should ask, "What is the recommended surveillance schedule for me after treatment?".4 Inquire about the specific types of tests that will be involved in this surveillance, such as cystoscopy, urine cytology, and potentially imaging studies.2 It is also important to understand the frequency and expected duration of the surveillance program 4 and the rationale behind the chosen intensity of surveillance based on your individual risk group.1 Understanding that follow-up is a crucial part of managing NMIBC and knowing the schedule and purpose of each test can improve adherence and help alleviate anxiety.

E. Exploring the Role of Radical Cystectomy in Specific NMIBC Cases

While radical cystectomy, the surgical removal of the bladder, is more commonly a treatment for muscle-invasive bladder cancer, it might be considered in certain high-risk NMIBC cases. This could be if the cancer does not respond to intravesical therapies or if it recurs aggressively.4 Patients should ask, "Is radical cystectomy a potential treatment option for me now or in the future, and what would be the reasons for considering it?".12 If cystectomy is a possibility, it is vital to inquire about the different urinary diversion options, such as a neobladder or an ileal conduit, and to understand the advantages and disadvantages of each.12 Discussing the potential impact of cystectomy on your quality of life, including aspects like sexual function and continence, is also crucial.12

F. Inquiring About the Timing and Duration of Treatment

Understanding the timeline of your treatment is important for planning and managing expectations. Patients should ask, "How soon do I need to start treatment?".24 Inquire about the expected duration of each phase of the treatment, such as the induction and maintenance phases of BCG therapy 25, and the frequency of individual treatments, such as weekly instillations.25

G. Questions Regarding the Impact of Treatment on Quality of Life

Treatment for NMIBC can have various impacts on a patient's daily life. It is important to ask, "How will treatment affect my normal activities, such as work and hobbies?".19 Inquire about potential effects on your urinary function, such as increased frequency, urgency, or incontinence 2, and discuss any potential impact on your sexual health and fertility.21 It is also beneficial to ask about the availability of support services that can help address these issues.4

H. The Relevance of Clinical Trials for NMIBC Patients

Clinical trials offer the opportunity to receive cutting-edge treatments that are not yet widely available and can contribute to advancing the understanding and treatment of bladder cancer.4 Patients should ask, "Are there any clinical trials that might be appropriate for my type and stage of bladder cancer?".4 If so, inquire about the potential benefits and risks of participating in such a trial 23 and how you can learn more about specific available trials.23

IV. Long-Term Follow-Up and Monitoring: Proactive Questions for Continued Care

Effective long-term management of NMIBC requires diligent follow-up and monitoring due to the risk of recurrence.

A. Importance of Regular Cystoscopies and Imaging Tests

Regular cystoscopies, where a small camera is inserted into the bladder, are the cornerstone of follow-up care for NMIBC as they allow for direct visualization of the bladder lining to detect any recurrence.4 In certain situations, imaging tests such as CT scans might also be used.2 Patients should ask, "How often will I need to have follow-up cystoscopies and other tests?".4 It is also important to understand what these tests are looking for, such as recurrence of the tumor, progression to a higher stage, or other potential issues.4

B. Questions About the Follow-Up Schedule and What to Expect

Patients should request a clear and detailed follow-up schedule from their healthcare team.25 Inquire about what each follow-up appointment will entail, including any physical examinations, urine tests, cystoscopies, or imaging studies.2 It is also essential to know who to contact if you experience any concerning symptoms between scheduled appointments.4

C. Understanding the Signs and Symptoms of Recurrence and Progression

Being aware of potential signs that the cancer might have returned or progressed is crucial for early detection and intervention. Patients should ask, "What are the signs and symptoms that the cancer might have come back or progressed?".2 Common symptoms can include blood in the urine, increased frequency or urgency of urination, and pain or burning during urination.2 It is also helpful to understand the difference between a local recurrence within the bladder and progression, where the cancer invades deeper into the bladder wall or spreads to other areas.17

D. Inquiring About Potential Late Effects of Treatment

Some side effects of NMIBC treatment might not appear until months or even years after the treatment has concluded. Patients should ask, "Are there any potential long-term or late side effects of the treatment I received?".25 These could include ongoing urinary problems, sexual dysfunction, or bowel issues.2 It is important to discuss strategies for managing any such late effects should they arise.23

E. Questions About Lifestyle Adjustments and Supportive Care Measures

Making certain lifestyle changes can play a supportive role in managing NMIBC and potentially reducing the risk of recurrence. Patients should ask, "Are there any lifestyle changes I should make, such as diet or exercise, to help manage my condition and reduce the risk of recurrence?".4 Quitting smoking is particularly important as it is a major risk factor for bladder cancer.4 Patients should also inquire about the availability of support groups and counseling services, which can provide valuable emotional and practical assistance.4

V. Active Participation and Support: Empowering Questions for Holistic Care

Beyond understanding the medical aspects of NMIBC, patients should also explore resources and support systems that can aid them throughout their journey.

A. Seeking Information About Bladder Cancer Support Groups and Resources

Connecting with others who have similar experiences can be incredibly beneficial. Patients should ask, "Do you know of any local or online support groups for bladder cancer patients?".4 Inquire about resources offered by reputable organizations such as the American Cancer Society, the National Cancer Institute, and the Bladder Cancer Advocacy Network.26 It can also be helpful to ask if there are specialist nurses who can provide additional information and support.24

B. The Value of Obtaining a Second Opinion and How to Pursue It

Seeking a second opinion from another specialist can provide additional insights and reassurance. Patients should ask, "Should I consider getting a second opinion? How do I do that, and can you recommend a doctor or cancer center specializing in bladder cancer?".4 Clarify if your current doctor can assist in facilitating a second opinion.4

C. Questions About Managing Treatment Costs and Insurance Coverage

The financial aspects of cancer treatment can be a significant concern. Patients should ask, "I am concerned about the costs of my diagnosis and treatment. Who at the clinic or hospital can help me understand these aspects and my insurance coverage?".23 Inquire about any available financial assistance programs or resources that might be helpful.23

D. Inquiring About the Role of Diet and Exercise in Managing NMIBC

Maintaining a healthy lifestyle can contribute to overall well-being during and after cancer treatment. Patients should ask, "Are there any specific dietary recommendations or restrictions I should follow?".4 Discuss the benefits of regular exercise and what types of activities are appropriate for your situation.12 It is also wise to clarify if there are any specific foods or supplements that you should avoid.21

VI. Understanding Prognosis and Recurrence: Questions for Realistic Expectations

Having realistic expectations about the course of NMIBC is important for long-term management and well-being.

A. Questions About the Likelihood of Recurrence Based on Individual Diagnosis

Recurrence is a significant concern for many NMIBC patients. It is important to ask, "What is the likelihood that my cancer will come back after treatment, given my specific stage and grade?".4 Inquire about your individual risk of recurrence based on your assigned risk group (low, intermediate, or high).1

B. Understanding Long-Term Survival Rates for NMIBC

While survival statistics are general and may not predict an individual's outcome 5, some patients find it helpful to ask, "What are the long-term survival rates for patients with my type and stage of NMIBC?".3 It is crucial for doctors to frame this information with the understanding that each patient's journey is unique and that these statistics represent averages across large groups of people.

C. Inquiring About Factors That May Influence Prognosis

Several factors related to your diagnosis and treatment can influence your long-term prognosis. Patients should ask, "Are there any specific factors related to my diagnosis or treatment that might affect my long-term prognosis?".1 These factors can include the initial stage and grade of the tumor, the presence of carcinoma in situ, the number and size of tumors, and how well the cancer responds to the initial treatment.1

VII. Conclusion: Fostering Collaborative Care Through Informed Questions

In conclusion, navigating a diagnosis of Non-Muscle Invasive Bladder Cancer requires patients to be proactive and engaged in their care. Asking informed questions is a powerful tool that empowers patients to understand their condition, explore their options, and build a strong partnership with their healthcare team.

Key questions for NMIBC patients span various critical areas, including understanding the specifics of their diagnosis (type, stage, grade, and risk group), thoroughly exploring all available treatment options (TURBT, intravesical therapies, and the potential role of radical cystectomy), comprehending the importance and details of long-term follow-up and monitoring, actively seeking support and resources, and developing realistic expectations regarding prognosis and the possibility of recurrence.

Open and consistent communication with healthcare providers is paramount throughout the entire journey. Patients are encouraged to prepare for appointments by writing down their questions beforehand 19 and to not hesitate to ask for clarification or more detailed explanations whenever needed. Bringing a family member or a friend to appointments can also be beneficial for support and for taking notes.21 Ultimately, by asking these essential questions, patients with NMIBC can become active participants in their care, leading to more informed decisions and a stronger sense of control over their health and well-being. A collaborative approach between knowledgeable patients and their dedicated healthcare team is the most effective way to manage this condition and strive for the best possible outcomes.

Works cited

1. Non muscle invasive bladder cancer staging - Cancer Research UK, accessed May 1, 2025, https://www.cancerresearchuk.org/about-cancer/bladder-cancer/types-stages-grades/non-muscle-invasive

2. Non-muscle Invasive Bladder Cancer: Symptoms, Diagnosis & Treatment, accessed May 1, 2025, http://www.urologyhealth.org/urology-a-z/n/non-muscle-invasive-bladder-cancer

3. Bladder Cancer Treatment: Treatment - Patient Information [NCI], accessed May 1, 2025, https://www.cham.org/health-library/article?id=ncicdr0000062705

4. Non-Muscle Invasive Bladder Cancer: A Patient Guide - Urology Care Foundation, accessed May 1, 2025, https://www.urologyhealth.org/documents/Product-Store/English/Non-Muscle-Invasive-Bladder-Cancer-A-Patient-Guide.pdf

5. Bladder Cancer Treatment - PDQ Cancer Information Summaries - NCBI, accessed May 1, 2025, https://www.ncbi.nlm.nih.gov/books/NBK66044/

6. Bladder Cancer Stages - NCI, accessed May 1, 2025, https://www.cancer.gov/types/bladder/stages

7. Bladder Cancer Stages - American Cancer Society, accessed May 1, 2025, https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/staging.html

8. Bladder Cancer - StatPearls - NCBI Bookshelf, accessed May 1, 2025, https://www.ncbi.nlm.nih.gov/books/NBK536923/

9. Treatment of Bladder Cancer, Based on the Stage and Other Factors, accessed May 1, 2025, https://www.cancer.org/cancer/types/bladder-cancer/treating/by-stage.html

10. 4. pathological staging, grading and classification systems - EAU Guidelines on Non-muscle-invasive Bladder Cancer - Uroweb, accessed May 1, 2025, https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer/chapter/pathological-staging-and-classification-systems

11. Bladder Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI], accessed May 1, 2025, https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.bladder-cancer-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062908

12. Bladder cancer - Diagnosis and treatment - Mayo Clinic, accessed May 1, 2025, https://www.mayoclinic.org/diseases-conditions/bladder-cancer/diagnosis-treatment/drc-20356109

13. Bladder cancer FAQs - Mayo Clinic, accessed May 1, 2025, https://www.mayoclinic.org/diseases-conditions/bladder-cancer/multimedia/vid-20537042

14. Bladder Cancer Treatment (PDQ®) - NCI, accessed May 1, 2025, https://www.cancer.gov/types/bladder/hp/bladder-treatment-pdq

15. Non-Muscle Invasive Bladder Cancer: A Patient Guide - Northeast Urologic Surgery, accessed May 1, 2025, https://northeasturologic.com/wp-content/uploads/2018/05/Bladder-Cancer-Patient-Guide.pdf

16. Surveillance and Treatment of Non-Muscle-Invasive Bladder Cancer in the USA - PMC, accessed May 1, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3357503/

17. Bladder Cancer Q&A | The Urology Group of Virginia, accessed May 1, 2025, https://www.urologygroupvirginia.com/urologic-cancer-center/bladder-cancer/bladder-cancer-core-concepts

18. NCCN Guidelines for Patients: Bladder Cancer, accessed May 1, 2025, https://www.nccn.org/patients/guidelines/content/PDF/bladder-patient.pdf

19. Information for Newly Diagnosed Bladder Cancer Patients | Bladder ..., accessed May 1, 2025, https://bladdercancercanada.org/en/patients/navigating-your-diagnosis/newly-diagnosed/

20. Questions to Ask Your Bladder Cancer Specialist | Moffitt, accessed May 1, 2025, https://www.moffitt.org/cancers/bladder-cancer/faqs/10-questions-to-ask-your-bladder-cancer-specialist/

21. After a Bladder Cancer Diagnosis: Questions to Ask Your Doctor - Fact Sheet, accessed May 1, 2025, https://www.cancercare.org/publications/319-after_a_bladder_cancer_diagnosis_questions_to_ask_your_doctor

22. Key questions to ask your doctor or nurse: New factsheet now available, accessed May 1, 2025, https://worldbladdercancer.org/news_events/key-questions-to-ask-your-doctor-or-nurse-new-factsheet-now-available/

23. Newly diagnosed cancer patients: Questions to ask your health care team, accessed May 1, 2025, https://www.mdanderson.org/cancerwise/newly-diagnosed-cancer-patients-questions-to-ask-your-health-car.h00-158830434.html

24. GBCI BLADDER CANCER QUESTION CHECKLIST Here are some useful questions to ask your care providers - Johns Hopkins Medicine, accessed May 1, 2025, https://www.hopkinsmedicine.org/-/media/greenberg-bladder-cancer-institute/documents/gbci-question-checklist-final.pdf

25. Questions For Your Doctor - Action Bladder Cancer UK, accessed May 1, 2025, https://actionbladdercanceruk.org/questions-for-your-doctor/

26. Questions to Ask About Bladder Cancer | American Cancer Society, accessed May 1, 2025, https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/talking-with-doctor.html

27. For Those Newly Diagnosed With Bladder Cancer - Cxbladder, accessed May 1, 2025, https://www.cxbladder.com/us/blog/newly-diagnosed-with-bladder-cancer/

28. Questions to ask your doctor about bladder cancer - My Vanderbilt Health, accessed May 1, 2025, https://my.vanderbilthealth.com/questions-to-ask-doctor-about-bladder-cancer/

29. Bladder Cancer: What Questions Should Patients Ask?, accessed May 1, 2025, https://www.patientpower.info/video/bladder-cancer/what-questions-should-patients-ask

30. Stages of Bladder Cancer: TNM, Number Scale, and More - Healthline, accessed May 1, 2025, https://www.healthline.com/health/bladder-cancer/stages-of-bladder-cancer

31. Definition of noninvasive papillary carcinoma - NCI Dictionary of Cancer Terms, accessed May 1, 2025, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/noninvasive-papillary-carcinoma

32. Treatment of Bladder Cancer by Stage - NCI, accessed May 1, 2025, https://www.cancer.gov/types/bladder/treatment/by-stage

33. Manageing non-muscle-invasive bladder cancer - NCBI, accessed May 1, 2025, https://www.ncbi.nlm.nih.gov/books/NBK356310/

34. bladdercancercanada.org, accessed May 1, 2025, https://bladdercancercanada.org/en/patients/educational-resources/guidebooks/guidebook-translations/non-muscle-invasive-bladder-cancer-patient-guide/#:~:text=Usually%2C%20NMIBC%20is%20treated%20with,one%20time%20immediately%20after%20TURBT.

35. Bladder Cancer Treatment: Treatment - Patient Information [NCI] - Women's Health, accessed May 1, 2025, https://www.afwomensmed.com/health-library/hw-view.php?DOCHWID=ncicdr0000062705

36. Bladder Cancer Treatment (PDQ®)–Patient Version, accessed May 1, 2025, https://siteman.wustl.edu/ncipdq/bladder-cancer-treatment-pdq-patient-version/

37. Pharmacologic Therapies for Non-Muscle Invasive Bladder Cancer: Current and Future Treatments - PMC, accessed May 1, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9431226/

38. Definition of BCG Failure in Non-Muscle Invasive Bladder Cancer in Major Urological Guidelines - UroToday International Journal, accessed May 1, 2025, https://www.urotoday.com/current-issue/definition-of-bcg-failure-in-non-muscle-invasive-bladder-cancer-in-major-urologi/download.html

39. 4 Questions to Ask After a Bladder Cancer Diagnosis - Cure Today, accessed May 1, 2025, https://www.curetoday.com/view/4-questions-to-ask-after-a-bladder-cancer-diagnosis

40. Adherence to First-Line Intravesical Bacillus Calmette-Guérin Therapy in the Context of Guideline Recommendations for US Patients With High-Risk Non-muscle Invasive Bladder Cancer, accessed May 1, 2025, https://jheor.org/article/124208-adherence-to-first-line-intravesical-bacillus-calmette-guerin-therapy-in-the-context-of-guideline-recommendations-for-us-patients-with-high-risk-non-m

41. Questions and Answers about Non-Muscle Invasive Bladder Cancer - YouTube, accessed May 1, 2025, https://www.youtube.com/watch?v=INrPMYscL2s

42. Expert Interview 1: Frequently Asked Questions (FAQs) for Non-Muscle-Invasive Bladder Cancer (NMIBC) - ACE Oncology, accessed May 1, 2025, https://aceoncology.org/education/expert-interview-1-frequently-asked-questions-faqs-for-non-muscle-invasive-bladder-cancer-nmibc/

43. Novel Therapies for High-Risk Non-Muscle Invasive Bladder Cancer - PMC, accessed May 1, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9791638/

44. Living as a Bladder Cancer Survivor, accessed May 1, 2025, https://www.cancer.org/cancer/types/bladder-cancer/after-treatment/follow-up.html

45. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline - American Urological Association, accessed May 1, 2025, https://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-metastatic-muscle-invasive-guideline

46. Frequently Asked Questions About Bladder Cancer - Henry Ford Health, accessed May 1, 2025, https://www.henryford.com/services/bladder-cancer/diagnosis/faq

47. Bladder Cancer Information Guide, accessed May 1, 2025, https://www.rogelcancercenter.org/files/bladder-cancer-information-guide.pdf

48. Bladder Cancer Questions & Answers - Medscape Reference, accessed May 1, 2025, https://emedicine.medscape.com/article/438262-questions-and-answers

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