Your first appointment at Fred Hutchinson Cancer Center is a time for you and your care team to meet. You will talk about your diagnosis, disease outlook and likely treatment. This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your care team will decide what needs to happen next.
We encourage you to bring a family member or friend to your first appointment (and any future visits).
What to Expect
When you come to Fred Hutch, we match you with the health care services and providers that are right for you. Your care here is always personalized. We tailor your first appointment — and all your visits with us — to your unique situation.
The plan for your first appointment will depend on if your cancer:
- Sits on or in the first lining of your bladder (non-muscle invasive, also called superficial or early-stage)
- Goes into the muscle wall of your bladder (muscle invasive)
- Has spread to distant parts of your body (metastatic)
We will also think about any treatment you have already had.
If you have a related cancer of the upper urinary tract, such as the ureter, renal pelvis or urethra, your first appointment will be similar to a visit for bladder cancer.
Non-Muscle Invasive Bladder Cancer With No Prior Treatment
If you have non-muscle invasive bladder cancer and you have not had treatment yet, our urologic oncologists are the experts who will plan and provide your care. Your first visit will be with this type of doctor. Most people in your situation have cystoscopy (a procedure to look inside the bladder and remove the tumor). This is often followed by chemotherapy that the surgeon puts directly into the bladder during the cystoscopy procedure. Your urologic oncologist will then decide if you need more treatments (BCG therapy or chemotherapy) directly in the bladder.
Non-Muscle Invasive Bladder Cancer With Prior BCG Therapy
If you have non-muscle invasive bladder cancer that did not respond to BCG therapy or came back after BCG therapy, you may need different types of treatment. These can include surgery, medicine-based options or radiation therapy. Our Bladder Cancer Multispecialty Clinic is designed for you. There, you will see several specialists in a single day. Together, they will recommend a complete, personalized treatment plan for you.
Muscle-Invasive, Nonmetastatic Bladder Cancer
If cancer has gone into the muscle wall of your bladder but has not spread to distant parts of your body, you may need two or more types of treatment. These can include surgery, medicine-based options or radiation therapy. Our Bladder Cancer Multispecialty Clinic is designed for you. There, you will see several specialists in a single day. Together, they will recommend a complete, personalized treatment plan for you.
Metastatic Bladder Cancer
If you have metastatic bladder cancer, our medical oncologists are the right match for your needs. They specialize in medicine-based treatments for bladder cancer and other cancers of the urinary tract. You will likely start by seeing one of them first. Most people in your situation need chemotherapy. They usually do not have surgery. They may have immunotherapy, targeted therapy or other treatment. Sometimes, they need radiation therapy to help with cancer-related symptoms.
First Appointments at the Bladder Cancer Multispecialty Clinic
Many people with bladder or other urinary tract cancer need more than one type of treatment. This means they need more than one type of physician. We bring a team of genitourinary specialists together for you in one place: the Bladder Cancer Multispecialty Clinic (BCMC). This clinic is at UW Medical Center – Montlake. It is our one-stop shop, where we guide you through complex treatment decisions. At the BCMC, we provide seamless, comprehensive, patient-centered care.
The BCMC is for people whose cancer has gone into the bladder muscle layer but has not spread to distant parts of the body. It is also for people who started treatment for non-muscle invasive bladder cancer and whose cancer did not respond to BCG therapy or came back after BCG therapy.
What is the BCMC?
The BCMC gives you a “home” where you can see a urologic oncologist, medical oncologist and radiation oncologist all on the same day. The clinic is held once a week in the Genitourinary Oncology Center in the Urology Clinic, which is located in the Surgery Pavilion at UW Medical Center – Montlake.
Our physicians are from UW Medicine, and they specialize in bladder cancer and other cancers of the urinary tract. They will work with you as a team to plan and provide the care you need.
Our BCMC is the first clinic in the region to provide this type of multidisciplinary care for people with bladder cancer. We treat all types of the disease, from urothelial cancer, the most common type, to rare types and variants.
As a new patient, you will get a complete evaluation of your unique case. You will leave your appointment with a personalized treatment plan and a clear set of next steps.
Your First Appointment at the BCMC
The first visit usually takes about four hours (8 a.m. to 12 p.m.). You will spend about three hours with your physicians. Here is what you can expect to happen.
Hour 1 – Exam
You will meet with a resident doctor or fellow, who will talk with you about your health history and do a detailed physical exam.
Hour 2 – Team Meeting
Your team of physicians will meet to talk with each other about your cancer and the most effective and safe ways to treat it. During this time, you can visit the Patient Resource Center and other UW Medical Center amenities.
- Your resident or fellow will present the details they learned from talking with you and examining you.
- Your pathologist and radiologist will review and explain the results of any biopsies, other tests and imaging scans you have had.
- Your urologic oncologist, medical oncologist and radiation oncologist will use their high level of experience and knowledge about the best treatment approach for people in your situation.
Together, the team will design a treatment plan specifically for you.
Hours 3 and 4 – Recommendations
You will meet one-on-one with each physician from your team. You will stay in the same room, and the physicians will come to you. We will explain the treatment we recommend for you and why. We are here to answer your questions and talk through your options so you can make well-informed and shared decisions you feel good about.
What Happens Next?
Before you leave, you will meet the BCMC program coordinator. We will help schedule any appointments you need next. Your schedule will depend on your exact needs. We are here to handle the details and make the process as worry-free as possible for you.
How Does Team-Based Care Help?
Having a team of experts in one room at the same time is linked to:1
- More accurate diagnosis
- Shorter time from your diagnosis to when you start treatment
- A treatment plan that closely matches evidence-based national guidelines about the best ways to treat this disease
- Better communication between members of your care team
- More satisfied patients
- Access to innovative clinical trial options
At the BCMC, we often take another look at the test results and imaging that patients have had elsewhere. This allows us to update your diagnosis and disease stage in important ways that affect your treatment choices.
1. Leonidas N. Diamantopoulos et al, “Bladder Cancer Multispecialty Clinic (BCMC) Model Influences Disease Assessment and Impacts Treatment Recommendations,” Bladder Cancer 5 (2019): 289–298
First Appointments with Your Urologic Oncologist or Medical Oncologist
For many of our patients, the first step is to see a single physician who specializes in the main type of treatment they are likely to need.
If you have non-muscle invasive bladder cancer with no prior treatment, you will see a urologic oncologist at UW Medical Center – Montlake who can talk with you about surgery and other treatment options.
If you have metastatic disease, you will see a medical oncologist who knows the very latest about treating bladder and other urinary tract cancers with systemic therapies. Your medical oncology appointment may be either at UW Medical Center – Montlake or at the Fred Hutch South Lake Union Clinic. We will make sure you know where to go.
First appointments with these physicians usually last about one hour. Here is what you can expect to happen.
Confirming Your Diagnosis
To help us plan the right care for you, we start by checking your diagnosis. Our experienced pathologists carefully review your prior biopsy or surgery tissue. They specialize in genitourinary cancers.
This step helps your physician predict how your disease might behave and which treatment approach will likely work best. We often take another look at the test results and imaging that patients have had elsewhere. This allows us to update your diagnosis and disease stage in important ways that affect your treatment choices.
At your first appointment, your physician will have your results and will go over them with you.
Explaining Your Disease
Your physician will talk with you about your health history and do a physical exam.
They will explain what bladder cancer is and how it typically behaves over time. They will talk with you about how the disease is affecting your body, and they will describe what happens for most people in your situation.
The type, stage and grade of your cancer are important factors. Other factors, like your overall health and the exact size and location of your tumor(s), also matter. Your physician will explain these things in as much detail as you would like.
Discussing Your Treatment
Based on your test results so far, your physician will explain the treatment we recommend for you and why. If you need any other tests to tell us more about your disease, we will talk about your personalized treatment again after we have the results. We want to make sure that you understand all your possible options.
These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs, goals and preferences. We want to get to know you so we understand the best way to care for you.
Answering Your Questions
Starting with your first appointment (and after), we are here to answer your questions. We want to help you understand as much as you want to about your disease, your treatment and how care happens at Fred Hutch. We invite you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you. We also encourage you to talk with your care team about your hopes, wishes and concerns. Knowing more about you helps your team recommend the right treatment for you.
Before you leave, we will make sure you know what is going to happen next and how you can reach us if you have questions later. We will also schedule your next visit.
Resources for Patients and Caregivers
Here are tips about how to prepare for your first appointment at Fred Hutch and what to bring.
Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support during a first visit.
Caregiving at the First Appointment
Just like every patient’s situation is different, every caregiver may be asked to help with different tasks.
As a caregiver, you can give your loved one both emotional and practical support for their first appointment. Ask them if you can help with things like these:
- Helping them manage their stress, worry or other feelings.
- Planning how to get to and from the appointment, what time to leave home and where to park.
- Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered.
- Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes.