Also known as TURBT, this determines if someone has bladder cancer. This procedure is typically performed under a general anesthetic and involves using an electric loop that is passed into the bladder to remove bladder tumor tissue. In addition to removing as much tumor as possible within the bladder, it also allows proper characterization of the tumor grade and stage. Occasionally, chemotherapy is inserted into the bladder at the end of the TURBT procedure to reduce risk of recurrent tumor.
When bladder cancer is invading the muscle or is not successfully treated with Bacillus Calmette-Guerin (BCG), an immunotherapy for early-stage bladder cancer, the bladder may need to be removed. This operation is called a radical cystectomy. The surgeon removes the entire bladder and surrounding lymph nodes to keep the cancer from spreading to other organs and tissues. In men, the prostate is also removed. In women, the uterus, fallopian tubes, ovaries and part of the vagina may also be removed along with the bladder. During this surgery, surgeons must also reconstruct the urinary tract to allow urinary drainage.
The two most common methods of urinary diversion are creation of an ileal conduit and creation of orthotopic neobladder. Both reconstructions use portions of the patient’s intestines. With ileal conduit, a stoma is created on the abdomen to allow urine to continuously drain into an external appliance attached to the abdomen. Orthotopic neobladder involves creation of a pouch (neobladder) that is connected to the urethra, so urine passes out of the body through the urethra. A continent cutaneous reservoir, an internal pouch created to hold urine that is placed inside the abdomen, may be an option. This allows drainage of urine by passing a catheter through an opening created on the abdomen.
In some cases, chemotherapy may be an option before surgery to improve chances of cure (neoadjuvant chemotherapy). It is typically given intravenously in three-week cycles, usually for four cycles. It can also be given to patients in conjunction with radiation treatment to improve response to radiation treatment. In patients whose bladder cancer has spread beyond the pelvis, chemotherapy may be used to control the disease and improve symptoms and to prolong life.
Chemotherapy is usually given in cycles to allow healthy cells the time to recover. Treatment may be given daily, weekly, every few weeks or monthly, depending on your situation. Chemotherapy is typically given in an outpatient setting. This includes a hospital, clinic or health care provider's office. Patients are encouraged to take along something that is comforting to occupy their time during treatment. Since it is hard to predict how a patient will feel after treatment, it is important to have arrangements to have someone drive you to and from your appointment.
Radiation therapy may be an option for a select group of patients who have muscle-invasive bladder cancer or who have cancer that is unable to be removed surgically. Radiation is often combined with chemotherapy to improve the effectiveness of radiation. A machine directs the rays of energy to the area of cancer, with a goal to kill or shrink cancer cells.
For people with bladder cancer, radiation therapy is often used to ease their symptoms. Radiation is most often used along with other bladder cancer treatments, like surgery or chemotherapy.
Your doctor may advise radiation to:
- Relieve symptoms such as pain, bleeding, trouble swallowing, cough or problems caused by a spread of cancer.
- Shrink a tumor to make it easier to operate on before surgery.
- Kill any remaining small areas of cancer following a surgery.
- Treat a single area of cancer spread, such as a tumor in the brain or an adrenal gland. This may be done along with surgery to treat the tumor.