Bladder Cancer Treatment

Bladder Cancer

Treatment options for bladder cancer are: 

    Surgery
    One of the following types of surgery may be done:
    • Transurethral resection, or TUR, with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra under general anesthesia or spinal anesthesia. A tool with a small wire loop on the end is then used to remove the cancer or to obtain a specimen for diagnosis. Your surgeon will attempt to remove the entire tumor if possible but some very large tumors cannot be removed by TUR.

      Patients whose cancers are not invasive into the muscle wall of the bladder are candidates for intravesical treatments. These are medications given to the patient as instillations inside the bladder to help prevent or delay the recurrence of the cancer. Examples of these medications include Mitomycin-C, BCG, Valrubicin, and Gemcitabine. Our urologic oncologists are experts in administering intravesical treatments for bladder cancers. 

    • Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body. Our urologic oncology surgeons are among the most experienced in performing cystectomies. 

    • Segmental or partial cystectomy: Surgery to remove part of the bladder. This is a rarely performed procedure used mostly for adenocarcinomas of the bladder or in patients with a single tumor that cannot be removed completely by TUR. 

    • Urinary diversion: Surgery to make a new way for the body to store and pass urine. There are several different types of urinary diversions, which include a neobladder (a new bladder made out of intestine), a continent catheterizable diversion (a pouch out of intestine with an opening on the skin through which you catheterize), and an ileal conduit, which is a piece of intestine that allows urine to drain into a bag that fits on the skin. You and your doctor will make the decision as to which is the best option for you.
An ileal conduit is a piece of small intestine (ileum) that is harvested from your own intestinal tract. It is usually about 12cm in length. The remaining bowel is reconnected at the time of surgery so that stool continues normally. Most patients have no side effects from the removal of 12cm of small intestine, although rarely some patients may have chronic diarrhea. This can be treated and should be brought to the attention of your doctor.

The small piece of intestine is connected to the ureters (the tubes from the kidneys through which urine drains). This connection is inside the abdomen. The other end of the intestine is brought up to the surface of the skin as a stoma.

A stoma is a small piece of intestine open in the middle allowing urine to flow out of the body into a bag, which fits around the stoma.

StomaStomaStoma

The type of urinary diversion will be up to you and your doctor to decide. The neobladder has the advantage of having no bags or appliances that fit to the body and represents the most “normal” reconstruction. However, it takes some retraining, during which time you will experience leakage of urine. In addition, you will be required to catheterize the new bladder for the first month after all catheters are removed. The ileal conduit has the advantage of being the simplest to take care of but does require the changing of bags attached to the skin for the rest of your life. However, both options will allow you to participate in essentially any activity you wish to, including swimming. Most people have serious concerns about possible side effects and life changes after this surgery. Remember, doctors and researchers are still learning about the treatment of bladder cancer. Talk with your surgeon any time you have concerns or questions. For patients with bladder cancer who require a cystectomy (bladder removal) and need to review post-operative care from surgery–please see the patient support section of our website.

Dr. Jeffrey Holzbeierlein, a national expert, Dr. Moben Mirza, Dr. Eugene Lee, and Dr. Hadley Wyre are all fellowship-trained urologic oncologists with expertise in the diagnosis and treatment of bladder cancer. These surgeons also perform many bladder cancer surgeries robotically. With the recent advancements in robotic technology, our urologists are now performing this complex operation with the aid of the daVinci® robot. This allows greater visualization and less blood loss. In addition, we hope this may lead to a quicker recovery and return to normal activities. Our urologists perform more bladder removal surgeries than any other urologist or institution in the Kansas City area and continue to examine ways to decrease the side effects associated with this procedure.

Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation treatments by themselves are not usually effective in getting rid of the cancer and thus are usually combined with chemotherapy (given through an IV). Most studies suggest this approach is inferior to surgical removal of the bladder, but does have the advantage of "sparing" the bladder. This treatment is appropriate in select patients and will be discussed by your provider. 

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. For invasive bladder cancer, the chemotherapy is given through the vein (intravenously) and is referred to as systemic chemotherapy. The most common type of chemotherapy for bladder cancer is Methotrexate, Vinblastine, Adriamycin, and Cisplatin or Gemcitabine and Cisplatin. Chemotherapy is sometimes given prior to bladder removal (neoadjuvant chemotherapy), this is typically done when the doctor feels that the cancer is not confined to the bladder. Sometimes chemotherapy is given after bladder removal (adjuvant chemotherapy) when the pathology determines cancer cells have grown into the fatty tissue around the bladder, into the prostate, or into the lymph nodes. Lastly, chemotherapy may be given if after surgery the cancer returns in another part of the body (salvage chemotherapy).

WATCH THE VIDEO